PDF(Pubmed)
Abstract：
Renal cancer is the seventh most common cancer in men and the tenth in women. The aim of this article is to review the diagnosis, treatment, and follow-up of renal carcinoma accompanied by recommendations with new evidence and treatment algorithms. A new pathologic classification of RCC by the World Health Organization (WHO) was published in 2022 and this classification would be considered a \"bridge\" to a future molecular classification. For patients with localized disease, surgery is the treatment of choice with nephron-sparing surgery recommended when feasible. Adjuvant treatment with pembrolizumab is an option for intermediate-or high-risk cases, as well as patients after complete resection of metastatic disease. More data are needed in the future, including positive overall survival data. Clinical prognostic classification, preferably IMDC, should be used for treatment decision making in mRCC. Cytoreductive nephrectomy should not be deemed mandatory in individuals with intermediate-poor IMDC/MSKCC risk who require systemic therapy. Metastasectomy can be contemplated in selected subjects with a limited number of metastases or long metachronous disease-free interval. For the population of patients with metastatic ccRCC as a whole, the combination of pembrolizumab-axitinib, nivolumab-cabozantinib, or pembrolizumab-lenvatinib can be considered as the first option based on the benefit obtained in OS versus sunitinib. In cases that have an intermediate IMDC and poor prognosis, the combination of ipilimumab and nivolumab has demonstrated superior OS compared to sunitinib. As for individuals with advanced RCC previously treated with one or two antiangiogenic tyrosine-kinase inhibitors, nivolumab and cabozantinib are the options of choice. When there is progression following initial immunotherapy-based treatment, we recommend treatment with an antiangiogenic tyrosine-kinase inhibitor. While no clear sequence can be advocated, medical oncologists and patients should be aware of the recent advances and new strategies that improve survival and quality of life in the setting of metastatic RC.
摘要：
肾癌是男性第七大最常见的癌症，女性第十。本文的目的是回顾诊断，治疗,和肾癌的随访伴随着新的证据和治疗算法的建议。世界卫生组织（WHO）于2022年发布了一项新的RCC病理分类，该分类将被认为是未来分子分类的“桥梁”。对于患有局部疾病的患者，在可行的情况下，建议采用保留肾单位的手术治疗。pembrolizumab辅助治疗是中危或高危病例的一种选择，以及转移性疾病完全切除后的患者。未来需要更多的数据，包括积极的总体生存数据。临床预后分类，最好是IMDC，应用于mRCC的治疗决策。对于IMDC/MSKCC风险中等且需要全身治疗的患者，不应将细胞减灭术视为强制性的。可以在具有有限数量的转移或长的无异时疾病间隔的选定受试者中考虑转移切除术。对于转移性ccRCC患者的整体人群，pembrolizumab-axitinib的组合，纳武单抗-卡博替尼，根据OS与舒尼替尼相比获得的益处，可以将pembrolizumab-lenvatinib视为首选方案。在有中度IMDC和不良预后的病例中，与舒尼替尼相比,ipilimumab和nivolumab的联合用药具有更高的OS.对于先前接受过一种或两种抗血管生成酪氨酸激酶抑制剂治疗的晚期肾癌患者，nivolumab和cabozantinib是首选.当初始免疫疗法治疗后出现进展时，我们建议用抗血管生成酪氨酸激酶抑制剂治疗.虽然不能提倡明确的顺序，医学肿瘤学家和患者应该意识到在转移性RC的情况下提高生存率和生活质量的最新进展和新策略。
