Renal Hücreli Karsinom
Özet
Dünya genelinde, renal hücreli karsinom insidansı bölgeden bölgeye büyük farklılıklar göstermektedir. Amerika Birleşik Devletleri'nde her yıl yaklaşık 82.000 yeni renal hücreli kanser vakası ve neredeyse 15.000 renal hücreli kanser kaynaklı ölüm gözlenmektedir. İnsidansı artmasına rağmen renal hücreli kanserden ölüm oranı azalmaktadır.Bu nispeten batın görüntülemesinde rastlantısal yakalanan erken evre renal hücreli kanserlere ve sistemik tedavilerdeki gelişmelere bağlanmaktadır. Tedavide cerrahi, radyoterapi ve kemoterapi gibi multimodal yaklaşımlar uygulanırken, tedavi sonrası sürveyans hastaların uzun dönem sağkalımını artırmak ve yaşam kalitesini korumak açısından büyük önem taşır. Sürveyans, tümör nüksünün erken tespiti, tedaviye bağlı yan etkilerin yönetimi ve genel sağlık durumunun değerlendirilmesi için kritik bir süreçtir. Takip protokolleri tümörün histopatolojik özelliklerine, nüks riskine ve hastanın genel durumuna göre kişiselleştirilir. Bu bölümde renal hücreli kanserlerin epidemiyolojisi, etiyolojisi,patolojisi,klinik bulguları,tanı ve evrelemesi, tedavisi ve izlem kriterleri gözden geçirilecektir. Bu bölümün amacı, renal hücreli kanserlerin tanı ve yönetimindeki ilgili gelişmeleri tartışmak ve özellikle takip ile ilgili literatürü gözden geçirmektir.
The incidence of renal cell carcinoma (RCC) varies significantly across different regions of the world. In the United States, approximately 82,000 new cases of renal cell cancer and nearly 15,000 renal cell cancer-related deaths are observed annually. Despite the rising incidence, the mortality rate from renal cell cancer is decreasing. This trend is attributed to the early-stage renal cell cancers that are incidentally detected through abdominal imaging and advancements in systemic treatments. Treatment approaches include multimodal strategies such as surgery, radiotherapy, and chemotherapy, while post-treatment surveillance plays a crucial role in improving long-term survival and maintaining quality of life. Surveillance is essential for the early detection of tumor recurrence, managing treatment-related side effects, and assessing the patient's overall health. Follow-up protocols are personalized based on the tumor's histopathological characteristics, recurrence risk, and the patient's general condition. This section will review the epidemiology, etiology, pathology, clinical findings, diagnosis and staging, treatment, and follow-up criteria for renal cell cancers. The purpose of this section is to discuss the relevant developments in the diagnosis and management of renal cell cancers, with particular emphasis on reviewing the literature related to follow-up.
Referanslar
Bukavina L, Bensalah K, Bray F, Carlo M, Challacombe B, Karam JA, et al. Epidemiology of renal cell carcinoma: 2022 update. European urology. 2022;82(5):529-42.
Escudier B, Porta C, Schmidinger M, Algaba F, Patard J, Khoo V, et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology. 2014;25:iii49-iii56.
Huang J, Leung DK-W, Chan EO-T, Lok V, Leung S, Wong I, et al. A global trend analysis of kidney cancer incidence and mortality and their associations with smoking, alcohol consumption, and metabolic syndrome. European urology focus. 2022;8(1):200-9.
Carlo MI, Mukherjee S, Mandelker D, Vijai J, Kemel Y, Zhang L, et al. Prevalence of germline mutations in cancer susceptibility genes in patients with advanced renal cell carcinoma. JAMA oncology. 2018;4(9):1228-35.
Hsieh JJ, Purdue MP, Signoretti S, Swanton C, Albiges L, Schmidinger M, et al. Renal cell carcinoma. Nature reviews Disease primers. 2017;3(1):1-19.
Ljungberg B, Albiges L, Abu-Ghanem Y, Bedke J, Capitanio U, Dabestani S, et al. European Association of Urology guidelines on renal cell carcinoma: the 2022 update. European urology. 2022;82(4):399-410.
Garnick MB. Primary neoplasms of the kidney. Therapy in Nephrology & Hypertension: Elsevier; 2008. p. 455-60.
Skinner DG, Colvin RB, Vermillion CD, Pfister RC, Leadbetter WF. Diagnosis and management of renal cell carcinoma A clinical and pathologic study of 309 cases. Cancer. 1971;28(5):1165-77.
Mazziotti S, Cicero G, D’Angelo T, Marino MA, Visalli C, Salamone I, et al. Imaging and management of incidental renal lesions. Biomed Research International. 2017;2017(1):1854027.
Gudbjartsson T, Thoroddsen A, Petursdottir V, Hardarson S, Magnusson J, Einarsson GV. Effect of incidental detection for survival of patients with renal cell carcinoma: results of population- based study of 701 patients. Urology. 2005;66(6):1186-91.
Kabala J, Gillatt D, Persad R, Penry J, Gingell J, Chadwick D. Magnetic resonance imaging in the staging of renal cell carcinoma. The British journal of radiology. 1991;64(764):683-9.
Shuch B, Pantuck AJ, Bernhard J-C, Morris MA, Master V, Scott A, et al. LBA03-01 89Zr- DFO-GIRENTUXIMAB FOR PET/CT IMAGING OF INDETERMINATE RENAL MASSES– RESULTS FROM PHASE 3 ZIRCON STUDY. Journal of Urology. 2023;209(Supplement 4):e1192.
Marshall ME, Pearson T, Simpson W, Butler K, McRoberts W. Low incidence of asymptomatic brainmetastases in patients with renal cell carcinoma. Urology. 1990;36(4):300-2.
Koga S, Tsuda S, Nishikido M, Ogawa Y, Hayashi K, Hayashi T, et al. The diagnostic value of bone scan in patients with renal cell carcinoma. The Journal of urology. 2001;166(6):2126-8.
Vogel C, Ziegelmüller B, Ljungberg B, Bensalah K, Bex A, Canfield S, et al. Imaging in suspected renal-cell carcinoma: systematic review. Clinical genitourinary cancer. 2019;17(2):e345- e55.
Ko JJ, Xie W, Kroeger N, Lee J-l, Rini BI, Knox JJ, et al. The International Metastatic Renal Cell Carcinoma Database Consortium model as a prognostic tool in patients with metastatic renal cell carcinoma previously treated with first-line targeted therapy: a population-based study. The lancet oncology. 2015;16(3):293-300.
Leveridge MJ, Finelli A, Kachura JR, Evans A, Chung H, Shiff DA, et al. Outcomes of small renal mass needle core biopsy, nondiagnostic percutaneous biopsy, and the role of repeat biopsy. European urology. 2011;60(3):578-84.
Maturen KE, Nghiem HV, Caoili EM, Higgins EG, Wolf Jr JS, Wood Jr DP. Renal mass core biopsy: accuracy and impact on clinical management. American Journal of Roentgenology. 2007;188(2):563-70.
Shannon BA, Cohen RJ, de Bruto H, Davies RJ. The value of preoperative needle core biopsy for diagnosing benign lesions among small, incidentally detected renal masses. The Journal of urology. 2008;180(4):1257-61.
Richard PO, Jewett MA, Bhatt JR, Kachura JR, Evans AJ, Zlotta AR, et al. Renal tumor biopsy for small renal masses: a single-center 13-year experience. European urology. 2015;68(6):1007-13.
Edition S, Edge S, Byrd D. AJCC cancer staging manual. AJCC cancer staging manual. 2017.
Motzer RJ, Bacik J, Mazumdar M. Prognostic factors for survival of patients with stage IV renal cell carcinoma: Memorial Sloan-Kettering Cancer Center experience. Clinical Cancer Research. 2004;10(18):6302S-3S.
Motzer RJ, Bukowski RM, Figlin RA, Hutson TE, Michaelson MD, Kim ST, et al. Prognostic nomogram for sunitinib in patients with metastatic renal cell carcinoma. Cancer: Interdisciplinary International Journal of the American Cancer Society. 2008;113(7):1552-8.
Heng DY, Chi KN, Murray N, Jin T, Garcia JA, Bukowski RM, et al. A population‐based study evaluating the impact of sunitinib on overall survival in the treatment of patients with metastatic renal cell cancer. Cancer: Interdisciplinary International Journal of the American Cancer Society. 2009;115(4):776-83.
Heng DY, Xie W, Regan MM, Warren MA, Golshayan AR, Sahi C, et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor–targeted agents: results from a large, multicenter study. Journal of clinical oncology. 2009;27(34):5794-9.
Heng DY, Xie W, Regan MM, Harshman LC, Bjarnason GA, Vaishampayan UN, et al. External validation and comparison with other models of the International Metastatic Renal-Cell Carcinoma Database Consortium prognostic model: a population-based study. The lancet oncology. 2013;14(2):141-8.
Kroeger N, Xie W, Lee JL, Bjarnason GA, Knox JJ, MacKenzie MJ, et al. Metastatic non– clear cell renal cell carcinoma treated with targeted therapy agents: characterization of survival outcome and application of the International mRCC Database Consortium criteria. Cancer. 2013;119(16):2999-3006.
Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. European urology. 2011;59(4):543-52.
Miller DC, Schonlau M, Litwin MS, Lai J, Saigal CS. Renal and cardiovascular morbidity after partial or radical nephrectomy. Cancer: Interdisciplinary International Journal of the American Cancer Society. 2008;112(3):511-20.
富智斌, 陈如潭, 顾迪, 董凯, 江爱民, 晏睿, et al. 机器人辅助与传统腹腔镜肾部分切除术 治疗早期肾癌合并肥胖患者的疗效对比. 第二军医大 学报. 2020;41(7):704-8.
Masson-Lecomte A, Yates DR, Hupertan V, Haertig A, Chartier-Kastler E, Bitker M-O, et al., editors. A prospective comparison of the pathologic and surgical outcomes obtained after elective treatment of renal cell carcinoma by open or robot-assisted partial nephrectomy. Urologic Oncology: Seminars and Original Investigations; 2013: Elsevier.
Bhindi B, Wallis CJ, Boorjian SA, Thompson RH, Farrell A, Kim SP, et al. The role of lymph node dissection in the management of renal cell carcinoma: a systematic review and meta‐analysis. BJU international. 2018;121(5):684-98.
Capitanio U, Abdollah F, Matloob R, Suardi N, Castiglione F, Di Trapani E, et al. When to perform lymph node dissection in patients with renal cell carcinoma: a novel approach to the preoperative assessment of risk of lymph node invasion at surgery and of lymph node progression during follow‐up. BJU international. 2013;112(2):E59-E66.
Luo X, Li J-X, Liu Y-T, Zou G, Yao W-X, Qing G-Q, et al. Influence of lymph node dissection in patients undergoing radical nephrectomy for non-metastatic renal cell carcinoma: a systematic review and meta-analysis. European Review for Medical & Pharmacological Sciences. 2019;23(14).
Tsui K-H, Shvarts O, Smith RB, Figlin RA, Dekernion JB, Belldegrun A. Prognostic indicators for renal cell carcinoma: a multivariate analysis of 643 patients using the revised 1997 TNM staging criteria. The Journal of urology. 2000;163(4):1090-5.
Breen DJ, King AJ, Patel N, Lockyer R, Hayes M. Image-guided cryoablation for sporadic renal cell carcinoma: three-and 5-year outcomes in 220 patients with biopsy-proven renal cell carcinoma. Radiology. 2018;289(2):554-61.
Kim SD, Yoon SG, Sung GT. Radiofrequency ablation of renal tumors: four-year follow-up results in 47 patients. Korean Journal of Radiology. 2012;13(5):625-33.
Correa RJ, Louie AV, Zaorsky NG, Lehrer EJ, Ellis R, Ponsky L, et al. The emerging role of stereotactic ablative radiotherapy for primary renal cell carcinoma: a systematic review and meta- analysis. European urology focus. 2019;5(6):958-69.
Zhou W, Herwald SE, McCarthy C, Uppot RN, Arellano RS. Radiofrequency ablation, cryoablation, and microwave ablation for T1a renal cell carcinoma: a comparative evaluation of therapeutic and renal function outcomes. Journal of Vascular and Interventional Radiology. 2019;30(7):1035-42.
Choueiri TK, Tomczak P, Park SH, Venugopal B, Ferguson T, Symeonides SN, et al. Overall survival results from the phase 3 KEYNOTE-564 study of adjuvant pembrolizumab versus placebo for the treatment of clear cell renal cell carcinoma (ccRCC). American Society of Clinical Oncology; 2024.
Choueiri TK, Powles T, Burotto M, Escudier B, Bourlon MT, Zurawski B, et al. Nivolumab plus cabozantinib versus sunitinib for advanced renal-cell carcinoma. New England Journal of Medicine. 2021;384(9):829-41.
Motzer RJ, Tannir NM, McDermott DF, Arén Frontera O, Melichar B, Choueiri TK, et al. Nivolumab plus ipilimumab versus sunitinib in advanced renal-cell carcinoma. New England Journal of Medicine. 2018;378(14):1277-90.
Motzer R, Alekseev B, Rha S-Y, Porta C, Eto M, Powles T, et al. Lenvatinib plus pembrolizumab or everolimus for advanced renal cell carcinoma. New England Journal of Medicine. 2021;384(14):1289-300.
Powles T, Plimack ER, Soulières D, Waddell T, Stus V, Gafanov R, et al. Pembrolizumab plus axitinib versus sunitinib monotherapy as first-line treatment of advanced renal cell carcinoma (KEYNOTE-426): extended follow-up from a randomised, open-label, phase 3 trial. The Lancet Oncology. 2020;21(12):1563-73.
Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Oudard S, et al. Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. Journal of clinical oncology. 2009;27(22):3584-90.
Bracarda S, Iacovelli R, Boni L, Rizzo M, Derosa L, Rossi M, et al. Sunitinib administered on 2/1 schedule in patients with metastatic renal cell carcinoma: the RAINBOW analysis. Annals of Oncology. 2015;26(10):2107-13.
Motzer RJ, Hutson TE, Olsen MR, Hudes GR, Burke JM, Edenfield WJ, et al. Randomized phase II trial of sunitinib on an intermittent versus continuous dosing schedule as first-line therapy for advanced renal cell carcinoma. Journal of clinical oncology. 2012;30(12):1371-7.
Choueiri TK, Hessel C, Halabi S, Sanford B, Michaelson MD, Hahn O, et al. Cabozantinib versus sunitinib as initial therapy for metastatic renal cell carcinoma of intermediate or poor risk (Alliance A031203 CABOSUN randomised trial): Progression-free survival by independent review and overall survival update. European journal of cancer. 2018;94:115-25.
Pal SK, Albiges L, Tomczak P, Suárez C, Voss MH, de Velasco G, et al. Atezolizumab plus cabozantinib versus cabozantinib monotherapy for patients with renal cell carcinoma after progression with previous immune checkpoint inhibitor treatment (CONTACT-03): a multicentre, randomised, open-label, phase 3 trial. The Lancet. 2023;402(10397):185-95.
Motzer RJ, Escudier B, McDermott DF, George S, Hammers HJ, Srinivas S, et al. Nivolumab versus everolimus in advanced renal-cell carcinoma. New England Journal of Medicine. 2015;373(19):1803-13.
Albiges L, Rini B, Peltola K, Oria GDV, Burotto M, Rodriguez CS, et al. LBA88 Belzutifan versus everolimus in participants (pts) with previously treated advanced clear cell renal cell carcinoma (ccRCC): Randomized open-label phase III LITESPARK-005 study. Annals of Oncology. 2023;34:S1329-S30.
Montie JE. Follow-up after partial or total nephrectomy for renal cell carcinoma. The Urologic Clinics of North America. 1994;21(4):589-92.
Donat SM, Diaz M, Bishoff JT, Coleman JA, Dahm P, Derweesh IH, et al. Follow-up for clinically localized renal neoplasms: AUA guideline. The Journal of urology. 2013;190(2):407-16.
Network N. Clinical practice guidelines in oncology http://www. nccn. org/professionals/physician_gls/f_guidelines. asp. Accessed March. 2015;24.
Klatte T, Seligson DB, LaRochelle J, Shuch B, Said JW, Riggs SB, et al. Molecular signatures of localized clear cell renal cell carcinoma to predict disease-free survival after nephrectomy. Cancer Epidemiology Biomarkers & Prevention. 2009;18(3):894-900.
Parker AS, Leibovich BC, Lohse CM, Sheinin Y, Kuntz SM, Eckel‐Passow JE, et al. Development and evaluation of BioScore: a biomarker panel to enhance prognostic algorithms for clear cell renal cell carcinoma. Cancer. 2009;115(10):2092-103.
Di Napoli A, Signoretti S. Tissue biomarkers in renal cell carcinoma: issues and solutions. Cancer. 2009;115(S10):2290-7.
Klatte T, Rao PN, De Martino M, LaRochelle J, Shuch B, Zomorodian N, et al. Cytogenetic profile predicts prognosis of patients with clear cell renal cell carcinoma. Journal of clinical oncology. 2009;27(5):746-53.
Hakimi AA, Chen Y-B, Wren J, Gonen M, Abdel-Wahab O, Heguy A, et al. Clinical and pathologic impact of select chromatin-modulating tumor suppressors in clear cell renal cell carcinoma. European urology. 2013;63(5):848-54.
Zisman A, Pantuck AJ, Wieder J, Chao DH, Dorey F, Said JW, et al. Risk group assessment and clinical outcome algorithm to predict the natural history of patients with surgically resected renal cell carcinoma. Journal of clinical oncology. 2002;20(23):4559-66.
Leibovich BC, Lohse CM, Cheville JC, Zaid HB, Boorjian SA, Frank I, et al. Predicting oncologic outcomes in renal cell carcinoma after surgery. European urology. 2018;73(5):772-80.
Correa AF, Jegede O, Haas NB, Flaherty KT, Pins MR, Messing EM, et al. Predicting renal cancer recurrence: defining limitations of existing prognostic models with prospective trial-based validation. Journal of Clinical Oncology. 2019;37(23):2062-71.
Peña-Llopis S, Vega-Rubín-de-Celis S, Liao A, Leng N, Pavía-Jiménez A, Wang S, et al. BAP1 loss defines a new class of renal cell carcinoma. Nature genetics. 2012;44(7):751-9.
Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang A, et al. Renal mass and localized renal cancer: AUA guideline. The Journal of urology. 2017;198(3):520-9.
Kunkle DA, Egleston BL, Uzzo RG. Excise, ablate or observe: the small renal mass dilemma—a meta-analysis and review. The Journal of urology. 2008;179(4):1227-34.
Klatte T, Grubmüller B, Waldert M, Weibl P, Remzi M. Laparoscopic cryoablation versus partial nephrectomy for the treatment of small renal masses: systematic review and cumulative analysis of observational studies. European urology. 2011;60(3):435-43.
Weight CJ, Kaouk JH, Hegarty NJ, Remer EM, O’Malley CM, Lane BR, et al. Correlation of radiographic imaging and histopathology following cryoablation and radio frequency ablation for renal tumors. The Journal of urology. 2008;179(4):1277-83.
