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中华腔镜泌尿外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (02) : 100 -104. doi: 10.3877/cma.j.issn.1674-3253.2023.02.001

所属专题: 指南共识

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2022版欧洲泌尿外科学会肾细胞癌诊疗指南更新要点解读
周硕明1, 甘卫东1,()   
  1. 1. 210008 南京大学医学院附属鼓楼医院泌尿外科
  • 收稿日期:2023-01-06 出版日期:2023-04-01
  • 通信作者: 甘卫东
  • 基金资助:
    2022江苏省卫生健康委员会医学科研重点项目(ZD2022013)

Interpretation of the updated key points of the European Society of Urology's guidelines for the diagnosis and treatment of renal cell carcinoma (2022)

Shuoming Zhou1, Weidong Gan1()   

  • Received:2023-01-06 Published:2023-04-01
  • Corresponding author: Weidong Gan
引用本文:

周硕明, 甘卫东. 2022版欧洲泌尿外科学会肾细胞癌诊疗指南更新要点解读[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(02): 100-104.

Shuoming Zhou, Weidong Gan. Interpretation of the updated key points of the European Society of Urology's guidelines for the diagnosis and treatment of renal cell carcinoma (2022)[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(02): 100-104.

肾细胞癌(renal cell carcinoma,RCC)的发病率约占所有癌症的3%,西方国家的肾癌发病率高于发展中国家[1]。尽管如此,在过去的30年里,我国肾癌的发病率和死亡率总体呈上升趋势,其造成的疾病负担仍然是一个严重的公共卫生问题[2]。2022版欧洲泌尿外科学会(European Association of Urology,EAU)RCC诊疗指南在2021年基础上进行了多方面的更新,尤其是对转移性肾细胞癌的综合治疗进行了补充。本文旨在对2022版EAU指南更新内容要点进行解读,为国内的泌尿外科同仁提供参考。

表1 其他少见肾细胞癌的特点及治疗建议(弱推荐)
病理类型 临床特点 恶性潜能 治疗方式
肾细胞癌的肉瘤样分化亚型 RCC高级别转化的标志,具有高侵袭性 高度 外科手术;ICI和TKI联合治疗;舒尼替尼、吉西他滨加多柔比星联合治疗
低度恶性潜能多房囊性肾肿瘤   良性 神经保留手术
贝利尼集合管癌 罕见,通常在疾病晚期确诊(诊断时44%的患者有淋巴结转移,33%患者有远处转移) 高度,高侵袭性,中位生存期为30个月 外科手术;免疫治疗应答性差
肾髓质癌 非常罕见,主要见于年轻黑人男性 高度,高侵袭性,中位生存期为5个月 外科手术;化疗;对放疗敏感
Xp 11.2异位型肾癌 罕见,主要见于小于40岁的年轻患者,在女性中更常见 高度 外科手术;VEGF靶向治疗
t(6;11)异位型肾癌   低度/中度 外科手术;神经保留手术;VEGF靶向治疗
黏液小管状和梭形细胞癌 肿瘤的发生和亨利氏袢有关 中度 外科手术;神经保留手术
透明细胞乳头状肾细胞癌   低度 外科手术;神经保留手术
遗传性平滑肌瘤病和肾细胞癌相关性肾细胞癌 罕见,是一类伴有延胡索酸水合酶基因胚系突变的肾细胞癌 高度 外科手术;建议对患者亲属进行影像学筛查
管状囊性肾癌 主要见于男性 低度 外科手术;神经保留手术
琥珀酸脱氢酶缺陷型肾细胞癌 罕见 未确定 外科手术;神经保留手术
未分类的肾细胞癌 不具备现有肾细胞癌亚型特征 未确定 未确定
表2 不同复发风险肾细胞癌患者在接受治疗后的复查随访计划(EAU专家意见)
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