Internal Medicine, UNC Health Southeastern, Lumberton, North Carolina, USA
Internal Medicine, Campbell University Jerry M Wallace School of Osteopathic Medicine, Buies Creek, North Carolina, USA.
BMJ Case Rep. 2022 Mar 16;15(3):e248156. doi: 10.1136/bcr-2021-248156.
Renal cell carcinoma (RCC) is the most aggressive urological malignancy, with a high recurrence rate. Despite the rapid evolution of the treatment of RCC from non-specific cytotoxic therapies to specific novel combination therapies, the general prognosis for advanced RCC remains poor because patients' responses to these therapies vary. Herein, we present the case of a male in early forties who was diagnosed with a right lower pole renal mass with a level IV tumour thrombus, which was later confirmed as stage IIIc clear cell RCC. About 19 months after radical nephrectomy (curative surgery), the patient was diagnosed with a biopsy-proven metastatic disease, which was not responsive to first-line treatment owing to insufficient data on the best treatment regimen. Herein, we also present a literature review on the pathological impact of genomic alterations in tumour suppressors and highlight emerging paradigm shifts in the treatment of RCC.
肾细胞癌（RCC）是最具侵袭性的泌尿系统恶性肿瘤，复发率较高。尽管 RCC 的治疗已经从非特异性细胞毒性治疗快速发展为特异性新型联合治疗，但晚期 RCC 的总体预后仍然较差，因为患者对这些治疗的反应存在差异。在此，我们报告了一例四十出头的男性患者，他被诊断为右肾下极有一个 IV 级肿瘤栓子的肿块，后来被证实为 IIIc 期透明细胞 RCC。根治性肾切除术后约 19 个月，患者被诊断为经活检证实的转移性疾病，由于最佳治疗方案的数据不足，一线治疗无效。在此，我们还对肿瘤抑制基因中基因组改变的病理影响进行了文献复习，并强调了 RCC 治疗中出现的新兴范式转变。
