Recent developments in kidney cancer
DOI:
https://doi.org/10.5489/cuaj.642Abstract
Renal cell carcinoma (RCC) diagnosis and management have
undergone significant shifts in the recent past. The increasing rate
of diagnosis of small renal masses, often in patients at high risk of
morbidity with operative treatment, has led to studies, trials and
discoveries in renal mass biopsy, active surveillance and minimally
invasive thermal ablation. At the other end of the disease spectrum,
targeted systemic therapies for metastatic RCC have supplanted
cytokine-based treatment, with significant benefits to progression
and survival. Recent reviews and trials have also cemented the role
of partial nephrectomy as standard surgical management for most
low-stage masses, and the roles of regional lymphadenectomy and
adrenalectomy concomitant with nephrectomy have been clarified.
This review aims to highlight recent evidence that has emerged in
the management of this complicated oncologic issue.
Le diagnostic d’hypernéphrome et la prise en charge de cette
maladie ont fait l’objet d’importants changements au cours des
dernières années. Le taux accru de cas de petites masses rénales,
souvent chez des patients présentant un risque élevé de morbidité
avec le traitement chirurgical, a amené la conduite d’études
et d’essais qui ont entraîné des découvertes touchant la biopsie
des masses rénales, la surveillance active et l’ablation thermique
minimalement invasive. À l’autre bout du spectre pathologique, les
traitements généraux ciblés de l’hypernéphrome métastatique ont
supplanté le traitement à base de cytokines, ce qui a amené des
avantages significatifs sur le plan de la progression et de la survie.
Des articles de synthèse et des essais récents ont aussi confirmé
le rôle de la néphrectomie partielle en tant que prise en charge
chirurgicale standard pour la plupart des masses de faible stade,
et les rôles de la lymphadénectomie régionale et de la surrénalectomie
en concomitance avec une néphrectomie ont été clarifiés.
Le présent article vise à faire ressortir les données récentes dans la
prise en charge de ce problème oncologique complexe
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