Division of Oncology, Department of Medicine, University of North Carolina at Chapel Hill.
Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill.
JAMA. 2024 Sep 24;332(12):1001-1010. doi: 10.1001/jama.2024.12848.
Renal cell carcinoma (RCC) is a common malignancy, with an estimated 434 840 incident cases worldwide in 2022. In the US, it is the sixth most common cancer among males and ninth among females.
Clear cell RCC is the most common histologic subtype (75%-80% of cases) and is characterized by inactivation of the von Hippel Lindau (VHL) tumor suppressor gene. Many patients (37%-61%) are diagnosed with RCC incidentally on an abdominal imaging study such as ultrasound or computed tomographic scan, and 70% of patients have stage I RCC at diagnosis. Although its incidence has increased approximately 1% per year from 2015 through 2019, the mortality rate of RCC has declined about 2% per year in the US from 2016 through 2020. Patients with a solid renal mass or complex cystic renal mass should be referred to urology. Treatment options for RCC confined to the kidney include surgical resection with partial or radical nephrectomy, ablative techniques (eg, cryoablation, radiofrequency ablation, radiation), or active surveillance for some patients (especially those with renal masses <2 cm). For patients with renal masses less than 4 cm in size (48% of patients), partial nephrectomy can result in a 5-year cancer-specific survival of more than 94%. For advanced or metastatic RCC, combinations of immune checkpoint inhibitors or the combination of immune checkpoint inhibitors with tyrosine kinase inhibitors are associated with tumor response of 42% to 71%, with a median overall survival of 46 to 56 months.
RCC is a common malignancy that is often diagnosed incidentally on an abdominal imaging study. Seventy percent of patients are diagnosed with stage I RCC and 11% of patients with stage IV. First-line treatments for early-stage RCC are partial or radical nephrectomy, which can result in 5-year cancer-specific survival of more than 94%, ablative techniques, or active surveillance. New treatment options for patients with metastatic RCC include immune checkpoint inhibitors and tyrosine kinase inhibitors.
肾细胞癌（RCC）是一种常见的恶性肿瘤，估计 2022 年全球有 434,840 例新发病例。在美国，它是男性中第六大常见癌症，女性中第九大常见癌症。
透明细胞 RCC 是最常见的组织学亚型（75%-80%的病例），其特征是 von Hippel Lindau（VHL）肿瘤抑制基因失活。许多患者（37%-61%）在腹部成像研究（如超声或计算机断层扫描）中偶然被诊断为 RCC，70%的患者在诊断时为 I 期 RCC。尽管其发病率自 2015 年至 2019 年每年增加约 1%，但自 2016 年至 2020 年，美国 RCC 的死亡率每年下降约 2%。有实体性肾肿块或复杂囊性肾肿块的患者应转至泌尿科就诊。局限于肾脏的 RCC 的治疗选择包括外科切除（部分或根治性肾切除术）、消融技术（如冷冻消融、射频消融、放射治疗）或某些患者的主动监测（尤其是那些肾肿块<2cm 的患者）。对于肾肿块小于 4cm 的患者（48%的患者），部分肾切除术可导致 5 年癌症特异性生存率超过 94%。对于晚期或转移性 RCC，免疫检查点抑制剂的联合或免疫检查点抑制剂与酪氨酸激酶抑制剂的联合与 42%至 71%的肿瘤反应相关，中位总生存期为 46 至 56 个月。
RCC 是一种常见的恶性肿瘤，通常在腹部成像研究中偶然诊断出来。70%的患者被诊断为 I 期 RCC，11%的患者为 IV 期。早期 RCC 的一线治疗方法是部分或根治性肾切除术，可导致 5 年癌症特异性生存率超过 94%，消融技术或主动监测。转移性 RCC 患者的新治疗选择包括免疫检查点抑制剂和酪氨酸激酶抑制剂。
