Abstract：
Cytoreductive nephrectomy (CN) has been the standard of care in patients with metastatic clear-cell renal cancer who present with the tumour in place. The CARMENA trial compared systemic therapy alone with CN followed by systemic therapy. This article outlines the new guidelines based on these data. PATIENT SUMMARY: The CARMENA trial demonstrates that immediate cytoreductive nephrectomy should no longer be considered the standard of care in patients diagnosed with intermediate and poor risk metastatic renal cell carcinoma when medical treatment is required. However, the psychological burden poor risk patients experience hearing that removal of their primary tumour will not be beneficial, should be carefully considered.
摘要：
细胞减灭性肾切除术（CN）已成为转移性透明细胞肾癌患者的标准治疗方法。CARMENA试验比较了单独的全身治疗与随后的全身治疗。本文概述了基于这些数据的新指南。患者总结：CARMENA试验表明，在需要药物治疗时，立即进行细胞减灭性肾切除术不应再被视为诊断为中度和低风险转移性肾细胞癌的患者的标准治疗。然而,心理负担低风险患者会听到切除原发肿瘤将无益，应该仔细考虑。
