晚期肾癌新视点29页.pptVIP

晚期肾癌目前没有明确定义 哪些肾癌可以界定为晚期肾癌？ 晚期肾癌的生存现状如何？ 晚期肾癌的治疗观点？ 疾病无进展生存时间（PFS） 疾病无复发生存时间（RFS） 总生存期（OS） 疾病特异性生存期（CSS） Locally advanced RCC, including patients with: 1, Venous thrombi 静脉瘤栓形成 2, Extracapsular 肿瘤穿透至包膜外 3, Adjacent organ involvement 肿瘤侵犯临近器官 4, Lymph node disease 区域淋巴结转移 5, Locally recurrent RCC after definitive surgical therapy 肾癌切除术后的局部复发 The Mayo Clinic risk factors for prediction of regional nodal metastases in renal cell carcinoma 1, Grade 3 or 4 病理分级3--4级 2, sarcomatoid component 肿瘤具肉瘤样成分 3, tumor size ≥ 10 cm 肿瘤直径大于10厘米 4, tumor stage pT3 or pT4 病理分期T３或T４期 5, coagulative tumor necrosis 肿瘤内有凝固性坏死 A LND should be done in patients with two or more of these 5 pathological criteria ( intraoperative decision) Isolated local recurrence without evidence of distant metastases is a rare event, with a reported incidence of 1-2% following RN with curative intent. 孤立的肾癌术后局部复发而不同时伴有其他远处转移的情况非常少见，仅占所有行RN患者的1-2% Local recurrences including recurrent disease within； 肾癌术后的局部复发包括以下三种情况： Adrenal gland 肾上腺的复发 Retroperitoneal LNs 腹膜后淋巴结的复发 the soft tissues in the area of the prior renal tumor 原肿瘤部位的复发 In the absence of metastatic disease, aggressive surgical resection, appears to provide the best outcomes for locally recurrent RCC 1, positive surgical margin after resection of local recurrence 2, size of recurrent tumor ≥ 5cm 3, presence of sarcomatoid features in recurrence specimen 4, abnormal serum alkaline phosphatase at the time of recurrence 5, abnormal serum lactate dehydrogenase at the time of recurrence Patient