Gold P J, Fefer A, Thompson J A
Division of Medical Oncology, University of Washington Medical Center, Seattle 98195, USA.
Semin Urol Oncol. 1996 Nov;14(4):216-22.
Paraneoplastic manifestations are present in up to 20% of patients with renal cell carcinoma (RCC). There is convincing evidence that RCC tumor cells elaborate proteins that serve as mediators of endocrine (eg, ectopic production of parathyroid hormone-related protein or erythropoietin) as well as nonendocrine paraneoplastic syndromes. A paraneoplastic syndrome may be the initial clinical presentation of RCC in a significant number of patients, and recognition of these syndromes may facilitate early diagnosis. Most paraneoplastic syndromes associated with RCC remit after resection of the primary RCC or treatment of metastatic sites. The natural history of metastatic RCC is extremely variable. A significant proportion of patients may survive several years with slowly progressing metastatic disease. In these patients, the accurate diagnosis and management of paraneoplastic syndromes may be important in palliative management. Except for hypercalcemia, conventional medical therapies are seldom helpful. Other paraneoplastic manifestations of RCC include cachexia, fever, hepatic dysfunction, anemia, and amyloidosis, although our understanding of the underlying pathophysiology remains incomplete.
副肿瘤表现见于多达20%的肾细胞癌（RCC）患者。有确凿证据表明，RCC肿瘤细胞分泌的蛋白质可作为内分泌（如甲状旁腺激素相关蛋白或促红细胞生成素的异位产生）以及非内分泌副肿瘤综合征的介质。在相当多的患者中，副肿瘤综合征可能是RCC的初始临床表现，认识这些综合征可能有助于早期诊断。大多数与RCC相关的副肿瘤综合征在原发性RCC切除或转移部位治疗后缓解。转移性RCC的自然病程变化极大。相当一部分患者可能患有进展缓慢的转移性疾病并存活数年。在这些患者中，副肿瘤综合征的准确诊断和管理在姑息治疗中可能很重要。除高钙血症外，传统药物治疗很少有帮助。RCC的其他副肿瘤表现包括恶病质、发热、肝功能障碍、贫血和淀粉样变性，尽管我们对其潜在病理生理学的理解仍不完整。
