Zhonghua Zhong Liu Za Zhi. 2024 Sep 23;46(9):844-854. doi: 10.3760/cma.j.cn112152-20240322-00117.
Renal cell carcinoma (RCC) accounts for approximately 2% to 3% of malignant tumors in adults, with a male-to-female ratio of approximately 1.5∶1 worldwide. It can occur in all age groups, with a peak incidence in the 60-70 age range, and the median age is approximately 64 years. The current causes of kidney cancer are still unclear, but smoking, obesity, hypertension, and some genetic factors are considered risk factors for kidney cancer development. Conducive to the gradual popularization of physical examination and screening, more and more patients with kidney cancer are being detected and treated in the early stages. However, nearly 30% of patients still have locally advanced or metastatic kidney cancer at the time of initial diagnosis. Traditional chemotherapy drugs are generally ineffective for advanced RCC, and currently, advanced RCC is mainly treated with anti-vascular and immunotherapy. At present, first-line treatment is mostly stratified based on clinical characteristics such as International mRCC Database Consortium (IMDC) prognosis risk, and there are multiple options available, including anti vascular therapy, anti-vascular combined immunotherapy, and dual immunotherapy. Subsequently, first-line treatment often selects drugs based on the composition, effectiveness, and safety of first-line treatment plans. In recent years, research has found that the molecular typing and metastasis characteristics of RCC also affect the prognosis of patients, leading to many controversies in the treatment of advanced RCC. This consensus is guided by the controversial clinical issues in the management of advanced RCC. After discussion and voting by multidisciplinary clinical experts, a consensus of 10 clinical issues has been reached. At the same time, experts recommend domestic clinical and research institutions to lead or participate in more large-scale clinical trials, providing more basis for clinical decision-making and the selection of the best beneficiaries.
肾细胞癌（RCC）约占成人恶性肿瘤的2%至3%，全球范围内男女比例约为1.5∶1。它可发生于所有年龄组，发病高峰在60至70岁年龄段，中位年龄约为64岁。目前肾癌的病因仍不明确，但吸烟、肥胖、高血压及一些遗传因素被认为是肾癌发生的危险因素。随着体检和筛查的逐渐普及，越来越多的肾癌患者在早期被发现并接受治疗。然而，仍有近30%的患者在初诊时就已出现局部晚期或转移性肾癌。传统化疗药物对晚期RCC一般无效，目前晚期RCC主要采用抗血管生成和免疫治疗。目前，一线治疗大多根据国际mRCC数据库联盟（IMDC）预后风险等临床特征进行分层，有多种选择，包括抗血管生成治疗、抗血管生成联合免疫治疗和双免疫治疗。随后，一线治疗常根据一线治疗方案的组成、有效性和安全性来选择药物。近年来，研究发现RCC的分子分型和转移特征也会影响患者的预后，这导致晚期RCC的治疗存在诸多争议。本共识以晚期RCC管理中的争议性临床问题为导向。经多学科临床专家讨论和投票，就十个临床问题达成了共识。同时，专家建议国内临床和研究机构牵头或参与更多大规模临床试验，为临床决策和最佳受益人群的选择提供更多依据。
