Gelb A B
Department of Pathology, University of California, San Francisco 94143-0102, USA.
Cancer. 1997 Sep 1;80(5):981-6.
Renal cell carcinomas include several distinct entities with a range of biologic and clinical behavior from relatively indolent to extremely aggressive. Although conventional prognostic factors such as stage and grade are quite useful, other clinical, laboratory, and pathologic findings are now believed to have additional predictive value.
A review of the literature on the evaluation of prognostic factors in general and on the current status of prognostic factors in renal cell carcinoma in particular was undertaken. A working classification of prognostic factors, as recommended by the College of American Pathologists, was used. For clarity, the prognostic indicators were grouped according to whether each was a patient-related or tumor-related factor.
Patient-related prognostic factors include symptomatic presentation, significant weight loss, poor performance status, anemia, hypercalcemia, elevated alkaline phosphatase and, perhaps, elevated serum ferritin. The most widely used tumor-related prognostic factors include stage, grade, and histologic type. Recently proposed biomarkers still under investigation include DNA content, as well as markers of cellular proliferation, apoptosis, and angiogenesis, among others.
Current prognostic factors for renal cell carcinoma yield considerable information for assisting with patient management and predicting clinical outcome. Traditional prognostic factors remain the most valuable, even though a variety of other patient-related and tumor-related factors may significantly contribute to prognostic information. A number of recently described biomarkers show great promise but the current data are insufficient to recommend their use.
肾细胞癌包括几种不同的类型，其生物学和临床行为范围从相对惰性到极具侵袭性。尽管诸如分期和分级等传统预后因素非常有用，但现在认为其他临床、实验室和病理发现具有额外的预测价值。
对一般预后因素评估的文献，特别是肾细胞癌预后因素的现状进行了综述。采用了美国病理学家学会推荐的预后因素工作分类法。为清晰起见，根据每个预后指标是患者相关因素还是肿瘤相关因素进行分组。
患者相关的预后因素包括症状表现、显著体重减轻、身体状况差、贫血、高钙血症、碱性磷酸酶升高，或许还有血清铁蛋白升高。使用最广泛的肿瘤相关预后因素包括分期、分级和组织学类型。目前仍在研究的最近提出的生物标志物包括DNA含量，以及细胞增殖、凋亡和血管生成等标志物。
目前肾细胞癌的预后因素可为协助患者管理和预测临床结果提供大量信息。传统预后因素仍然最有价值，尽管各种其他患者相关和肿瘤相关因素可能对预后信息有显著贡献。一些最近描述的生物标志物显示出很大的前景，但目前的数据不足以推荐使用它们。
