EAU指南解读之肾细胞癌RCC治疗

Definition
Renal Cell Carcinoma, RCC Renal cell carcinoma is a kidney cancer that originates in the lining of the proximal convoluted tubule. RCC is the most common type of kidney cancer in adults.
[1]McLaughlin JK, Lipworth L: Epidemiologic aspects of renal cell cancer. Semin Oncol 2000; 27:115. [2] Moore LE, et al: Lifestyle factors, exposures, genetic susceptibility, and renal cell cancer risk: a review. Cancer Invest 2005; 23:240.
2.Imaging investigations
Guidelines on Renal Cell Carcinoma. European Association of Urology 2015
Diagnosis
肾癌的临床诊断主要依靠影像学检查；实验室检查作为对患者术前一般状况、肝肾功能以及预后判定的评价指标；确诊 则需依靠病理学检查。 1．推荐必须包括的实验室检查项目： 尿素氮、肌酐、肝功能、全血细胞计数、血红蛋白、血钙、血糖、红细胞沉降率、碱性磷酸酶和乳酸脱氢酶(推荐分级C) 2．推荐必须包括的影像学检查项目： 腹部B超或彩色多普勒超声；胸部X线片(正、侧位)、腹部CT平扫和增强扫描(碘过敏试验阴性、无相关禁忌证者)； 腹部CT平扫和增强扫描及胸部X线片是术前临床分期的主要依据(推荐来自百度文库级A） 3．推荐参考选择的影像学检查项目：
• KUB：可为开放性手术选择手术切口提供帮助 • 核素肾图或IVU：可用于未行CT增强扫描，无法评价对侧肾功能者 • 核素骨显像：碱性磷酸酶高、有相应骨症状或临床分期≥Ⅲ期的患者(证据水平I b) • 胸部CT扫描：胸部x线片有可疑结节、临床分期≥Ⅲ期的患者(证据水平I b) • 头部MRI、CT扫描：有头痛或相应神经系统症状患者(证据水平T b) • 腹部MRI扫描：肾功能不全、超声波检查或CT检查提示下腔静脉瘤栓患者(证据水平I b)。
Guidelinesonrenalcel lcarcinoma
EAU-Guidelines-Renal-Cell-Cancer-2015-v2
• 1、Introduction • 2、Treatment of localised RCC • 3、Treatment of locally advanced RCC • 4、Treatment of advanced/metastatic RCC • 5、Systemic therapy for advanced/metastatic RCC
Risk factors[1] [2]
The most significant risk factor
tobacco (Cigarette smokers have double the incidence of renal cell carcinoma) pipe and cigar smokers are also more susceptible.
Additional risk factors
• obesity (particularly in women) • hypertension; • unopposed estrogen therapy; • exposure to asbestos, petroleum products, and heavy metals.
Diagnosis
1.Symptoms
Physical examination:Physical examination has a limited role in RCC diagnosis • Palpable abdominal mass; • Palpable cervical lymphadenopathy; • Non-reducing varicocele and bilateral lower extremity oedema, which suggests venous involvement.
America[2]
Renal cell carcinomas represent about 3% of all newly diagnosed visceral cancers in the United States and account for 85% of renal cancers in adults.
Approximately 30,000 new cases /year and 12,000 deaths from the disease.
[1]马建辉,李呜,张思维等.中国部分市县肾癌及泌尿系其他恶性肿瘤发病趋势比较研究[J]. 中华泌尿外科杂志,2009,30(8):511-514.DOI:10.3760/cma.j.issn.1000-6702.2009.08.002. [2]Jemal A, et al: Cancer statistics, 2008. CA Cancer J Clin 2008; 58:71.
Epidemiology
我国目前研究[1]
马建辉等收集了中国大陆1988～2002年15年间数据较齐全的11个 研究单位的资料，1988～1992、1993～1997、1998—2002年3个时 间段我国肾和泌尿系统其他恶性肿瘤的发病率分别为4.26／10万、 5.40／10万、6.63／10万人口，发病率呈现逐年上升趋势。我国 上海、南京、广州分别排在第245(4.8／10万)、273(3.2／10万)、 282(2.3／10万)。