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d%> d= _ d=> Because kidney cancer has a certain degree of secrecy and many people do not pay attention to cancer screening, patients with advanced stage and or stage IV account for a large proportion of kidney cancer patients. This article is about kidney cancer. The advanced and/or stage IV treatment evaluation model and surgical treatment are introduced to readers.
Surgical treatment for advanced and/or stage IV
Stage IV patients can also benefit from surgical treatment. For example, the suspicious lymph nodes above may be hyperplasia unrelated to the tumor, so regional lymph node enlargement does not affect surgery. treat. In addition, patients with primary tumors combined with a single isolated metastasis and possible surgical resection of metastases can undergo surgical treatment. These situations include:
Primary r combined with a single isolated metastasis.
The distance is shorter after nephrectomy.
Isolated recurrences occur in patients who have not had disease recurrence for a long time. Resectable solitary metastases include lung, bone, and brain. The primary tumor and metastases can be surgically removed at the same time or in stages. Most patients who undergo resection of solitary metastases may experience recurrence of the primary tumor or metastases; however, it has been reported that these patients can achieve longer recurrence-free survival.
Prognostic assessment model for advanced and/or stage IV
A prognostic scoring system has been developed based on a combination of independent prognostic factors related to survival for patients with metastatic renal cancer.
1. Kidney cancer scoring system
The most widely used prognostic scoring system at present is the score ( ). This model was obtained based on the clinical data of patients enrolled in clinical trials and receiving interferon treatment (total patients). The multivariate analysis included five factors:
High D (more than . times the normal value), high blood pressure Calcium (corrected calcium/d or./), anemia, time from diagnosis to systemic treatment less than years and score points.
Patients without the above-mentioned risk factors have a good prognosis and are considered to be low-risk; patients with one of the above-mentioned risk factors have a high risk and have a poor prognosis.
The ratings were also confirmed by an independent research team at Cleveland Clinic. The research team analyzed patients enrolled in immunotherapy clinical trials to validate the scoring system. The prognostic score was established in the era of renal cancer immunotherapy and the study population was limited to patients eligible for immunotherapy.
2. His prognostic model
In recent years, a prognostic scoring system suitable for anti-target therapy has been developed, namely the International Metastatic Renal Cancer Database Consortium (International Metastatic Renal Cancer Database Consortium) model or known as his prognostic model. This model was obtained through a retrospective analysis of a patient population who had received sunitinib, sorafenib, bevacizumab combined with interferon treatment.
The study also included patients who had previously received immunotherapy (that is, targeted therapy was their second-line treatment) and used six clinical characteristics to classify them into low-risk (good prognosis), intermediate-risk, and high-risk (poor prognosis). ). Four of the five poor prognostic factors were previously identified as poor prognostic factors by the scoring system including hemoglobin below the lower limit of normal, serum corrected calcium above the upper limit of normal, score below, and less than 10 years from initial diagnosis to treatment Year. Two other independently validated adverse prognostic factors were an absolute neutrophil count above the upper reference limit and a platelet count above the upper reference limit.
This study shows that patients with no six adverse prognostic factors are classified as low-risk group (patients accounted for .%). The median overall survival has not reached its annual survival rate of % (% %-%) - prognosis Patients with adverse prognostic factors were classified into the intermediate-risk group (patients accounted for .%). The median overall survival was 3 months and the annual survival rate was % (% was %-%), while patients with one adverse prognostic factor were classified into the high-risk group (patients accounted for .%). Accounting for .%) the median overall survival is .months and the annual survival rate is % (% is %-%). An independent data analysis recently validated this prognostic model.
Initial treatment for stage 1 patients and patients who cannot be surgically resected
1. Cytoreductive nephrectomy is recommended before systemic treatment for patients whose primary lesions may be surgically resectable but combined with multiple metastases. Multiple randomized trials have shown a survival benefit when given steroids after cytoreductive nephrectomy.
2. The Southwest Oncology Group ( ) and the European Organization for Research and Treatment of Oncology conducted a randomized trial of combined interferon therapy for patients with or without nephrectomy and showed that the median survival of the surgery combined with interferon group was better than that of interferon alone. group(.month.month).
3. Case selection is very important for whether one can benefit from cytoreductive surgery. Patients most likely to benefit are those with favorable prognostic factors and behavioral status who only have lung metastases. Similar data are not available for patients who are candidates for high-dose therapy. Data published by the Kidney Cancer Database and other research groups suggest that patients treated with other forms of immunotherapy may also benefit from palliative cytoreduction.
4. As for whether tumor reduction surgery will also benefit from subsequent targeted therapy, randomized clinical studies are currently being conducted, but data show that palliative tumor reduction surgery is still important for patients receiving resistance to treatment.
5. Patients with hematuria and other tumor-related symptoms should undergo palliative debulking surgery if conditions permit. .d/ .