Motzer R J, Russo P, Nanus D M, Berg W J
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Curr Probl Cancer. 1997 Jul-Aug;21(4):185-232. doi: 10.1016/s0147-0272(97)80007-4.
Renal cell carcinoma (RCC) is characterized by (a) lack of early warning signs, which results in a high proportion of patients with metastases at the time of diagnosis; (b) protean clinical manifestations; and (c) resistance to radiotherapy and chemotherapy. The estimates of new diagnoses and deaths from kidney cancer in the United States during 1996 are 30,600 and 12,000, respectively. RCC occurs nearly twice as often in men as in women. The age at diagnosis is generally older than 40 years; the median age is in the midsixties. The incidence of RCC has been rising steadily. Between 1974 and 1990, there was a 38% increase in the number of patients who had a diagnosis of RCC. This increase was accompanied by a significant improvement in 5-year survival. Both trends are likely the result of improved diagnostic capability. Newer radiographic techniques, including ultrasonography, computed tomography, and magnetic resonance imaging, are detecting kidney tumors more frequently and at a lower disease stage, when tumors can be resected for cure. Surgical treatment is the only curative therapy for localized RCC. Radical nephrectomy remains the mainstay of surgical management, but techniques are being modified. These modifications include partial nephrectomy and resection of vena caval thrombi. In highly selected cases, surgical resection of locally recurrent RCC or of disease at a solitary metastatic site is associated with long-term survival. Metastatic RCC is highly resistant to the many systemic therapies that have been extensively investigated. A minority of patients achieve complete or partial response to interferon, interleukin-2, or both. Response can be dramatic but is rarely durable. Because most patients do not achieve response, these agents are not considered effective treatments for RCC, but the response in some patients indicates the need for continued research on their use. Identification of new agents with better antitumor activity against metastases remains a high priority in clinical investigation of therapy for this refractory disease.
肾细胞癌（RCC）具有以下特点：（a）缺乏早期预警信号，这导致很大一部分患者在诊断时已发生转移；（b）临床表现多样；（c）对放疗和化疗耐药。1996年美国肾癌新诊断病例数和死亡病例数估计分别为30,600例和12,000例。RCC在男性中的发病率几乎是女性的两倍。诊断年龄一般在40岁以上；中位年龄在65岁左右。RCC的发病率一直在稳步上升。1974年至1990年间，诊断为RCC的患者数量增加了38%。这一增长伴随着5年生存率的显著提高。这两种趋势可能都是诊断能力提高的结果。更新的影像学技术，包括超声、计算机断层扫描和磁共振成像，更频繁地检测到肾肿瘤，且肿瘤处于较低的疾病阶段，此时肿瘤可通过手术切除治愈。手术治疗是局限性RCC的唯一治愈性疗法。根治性肾切除术仍然是手术治疗的主要方法，但技术正在改进。这些改进包括部分肾切除术和腔静脉血栓切除术。在经过严格挑选的病例中，局部复发性RCC或孤立转移部位疾病的手术切除与长期生存相关。转移性RCC对许多已广泛研究的全身治疗具有高度耐药性。少数患者对干扰素、白细胞介素-2或两者有完全或部分反应。反应可能很显著，但很少持久。由于大多数患者没有反应，这些药物不被认为是RCC的有效治疗方法，但一些患者的反应表明需要继续研究它们的用途。鉴定对转移具有更好抗肿瘤活性的新药物仍然是这种难治性疾病治疗临床研究中的高度优先事项。
