In this paper, systematic reviews, randomized controlled trials and other relevant studies on surgical and adjuvant therapy following operative therapy in renal cancer were identified by searching the Guidelines International Network, ACP Journal Club, the Cochrane Library （Issue 3, 2005 ） , MEDLINE, EMBASE and CBMdisc （ from 1996 to Sept. 2005）. In operative therapy, we found no study comparing operative therapy with no treatment or adjuvant therapy alone; A meta-analysis of cytoreductive nephrectomy in patients with metastatic renal cancer showed adjuvant therapy following nephrectomy was more effective than adjuvant therapy alone; a review comparing radical nephrectomy with nephron-sparing surgery in small-volume renal tumors found similar effectiveness between the two procedures. In the adjuvant therapy following nephrectomy, ten RCTs found adjuvant cytokine therapy （Interferon and Interleukin-2 ） and 5-FU not effective in the adjuvant setting, and could increase adverse reaction; Four RCTs found adjuvant vaccine therapy effective in the adjuvant setting with only a few side effects.
目的 探讨von-Hippel-Lindau（VHL）综合征并发肾癌的临床诊断和治疗水平。 方法 回顾分析2008年9月-2008年10月分别收治的2例VHL综合征并发双肾多发肿瘤患者的临床诊治过程并结合文献进行讨论。 结果 2例患者均为女性。例1为36岁，因腰痛不适3个月入院。既往8年有左眼视网膜血管母细胞瘤手术史。入院后双肾CT检查发现双肾肿瘤伴囊肿，考虑诊断为VHL综合征并发双侧肾癌。患者因故拒绝手术治疗，随访至今，患者病情无明显变化。例2为41岁，因B型超声发现右肾占位4年，反复肉眼血尿2年入院。4年前行小脑蚓部血管母细胞瘤切除术。入院后CT检查显示右肾巨大实性肿瘤伴多发囊肿，左肾多发性小的囊实性占位；胰腺多发小囊肿。诊断为VHL综合征并发右侧肾癌，行右肾根治性切除。手术后病理检查为右肾透明细胞癌，手术后随访至今病情稳定。 结论 VHL综合征并发肾癌临床少见，若患者表现为双侧、多发性、囊实性肾肿瘤，应考虑VHL综合征并发肾癌。及时正确诊断并根据患者病情制定个体化治疗方案，尽量避免肾切除，保留肾单位，手术结合影像学观察是主要治疗策略。
ObjectiveTo study the expression variation of immune-related molecules in perpheral blood monouclear cells (PBMC) from renal cancer patient upon Toll-like receptor 7 (TLR7) agonist Gardiquimod stimulation. MethodsThe study was carried out in June 2013 on one patient with renal cancer. PBMC isolated from the patient were stimulated by Gardiquimod and real-time polymerase chain reaction was conducted to measure the expression variation of many immune-related molecules. ResultsAmong all molecules influenced by TLR7 agonist, adhesion molecules were down-regulated by Gardiquimod, while the majority members of cytokines, chemokines and interleukins were dramatically induced in the presence of Gardiquimod. ConclusionTLR7 pathway plays an important role in regulating the immune responses and can be used as potential target in renal cancer.
Metastatic renal cell carcinoma accounts for 20%-30% of newly diagnosed renal cell carcinoma and its prognosis is poor. It is not sensitive to radiotherapy or chemotherapy, and traditional cytokine therapy has limited efficacy in patient with metastatic renal cell carcinoma. In recent years, with the emergence of targeted drugs and immune checkpoint inhibitors, the survival of patients with metastatic renal cancer has been greatly improved. This article reviews treatment and research progress of metastatic renal cell carcinoma. It mainly introduces the medical treatment, including cytokine therapy, targeted therapy and emerging immunotherapy, and further analyzes the value of cytoreductive nephrectomy in the context of targeted therapy. The purpose of this article is to provide evidence for reasonable choices of treatment regimens in order to better guide clinical treatment.
ObjectiveTo systematically review the correlation between type 2 diabetes mellitus (T2DM) and the risk of kidney cancer. MethodsPubMed, EMbase, Web of Science, CBM, VIP and CNKI databases were electronically searched to collect cohort studies on the association between T2DM and kidney cancer from inception to August 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis then performed by using Stata 15.0 software. ResultsA total of 17 cohort studies involving 2 003 165 T2DM patients were included. The results of meta-analysis showed that patients with T2DM had a higher kidney cancer risk than controls (RR=1.51, 95%CI 1.39 to 1.64, P<0.001). Subgroup analysis showed that the incidence of kidney cancer in T2DM patients was higher in different gender, region, population, follow-up time, diabetes assessment method and other subgroups. ConclusionsCurrent evidence shows that T2DM is a risk factor for kidney cancer.
ObjectiveTo analyze the disease burden of prostate, bladder and kidney cancers attributable to smoking in China from 1990 to 2019. MethodsBased on the global burden of disease study 2019, the current situation of the disease burden of prostate, bladder and kidney cancers attributable to smoking was analyzed by using the population attributable fraction (PAF), deaths and disability-adjusted life years (DALYs). Furthermore, the annual percent change (APC) and the average annual percent change (AAPC) were calculated by joinpoint regression analysis to describe the long-term trends of the smoking-attributable burden of these three cancers from 1990 to 2019. ResultsThere were an estimated 18 800 cases of deaths and 393 106 person-years of DALYs for bladder cancer caused by smoking in 2019. The age-standardized mortality and DALY rate decreased by 0.41% and 0.39% per year from 1990 to 2019, respectively. For prostate cancer, smoking was estimated to have caused 5 016 cases of deaths and 98 276 person-years of DALYs in 2019. The age-standardized mortality and DALY rate decreased by 0.28% and 0.25% per year from 1990 to 2019, respectively. For kidney cancer, the deaths and DALYs attributable to smoking were 4 935 cases and 120 620 person-years, respectively. The standardized mortality and DALY rates increased by 3.03% and 2.98% per year from 1990 to 2019. Additionally, males suffered from a higher disease burden of these three cancers attributable to smoking than females. The elderly population had a higher smoking-attributable disease burden than the younger population. ConclusionThe situation of the disease burden of bladder, prostate and kidney cancers attributable to smoking is still serious in China, which has substantial disparities in different groups. Specifically, males and the elderly are the high-risk groups for the smoking-attributable burden. Among the three cancers, bladder cancer has the highest burden and kidney cancer has the largest burden increase during 1990-2019.
Renal cancer is a common malignant tumor and the deadliest cancer of the urinary and reproductive system. Given the increasing incidence rate of kidney cancer, timely intervention of its controllable risk factors is crucial. Antimicrobial agent is widely used worldwide, and in recent years, some studies have found that long-term use of antimicrobial agent is associated with an increased risk of kidney cancer. The mechanism may involve multiple factors such as nephrotoxicity of antimicrobial agent and intestinal flora imbalance. This article reviews the relationship between long-term use of antimicrobial agent and risk of kidney cancer, and explores possible mechanisms, to understand the impact of long-term use of antimicrobial agent on the risk of kidney cancer, and to provide more references for early prevention of kidney cancer and rational use of antimicrobial agent.