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Renal Cell Cancer: What Can We Learn from Pre-Operative Studies?

Frontiers in Oncology
Frontiers Media SA
Publication Date
DOI: 10.3389/fonc.2011.00051
  • Oncology
  • Opinion Article
  • Medicine


Renal cell cancer: what can we learn from pre-operative studies? December 2011 | Volume 1 | Article 51 | 1 OpiniOn Article published: 08 December 2011 doi: 10.3389/fonc.2011.00051 Renal cell carcinoma (RCC) affects approxi- mately 60,000 people in Europe and in the United States each year (Ferlay et al., 2007; Jemal et al., 2010), and is associated with high rates of morbidity and mortality. The incidence of RCC is rising, perhaps because of the widespread use of abdominal imaging, resulting in an increased detection of small renal masses, and surgical intervention for these (Hollingsworth et al., 2006; Falebita et al., 2009). Surgery remains an integral part of the management of RCC, and is the only curative treatment in patients with disease confined to the kidney and its regional vas- culature and lymph nodes. However, about 30% of patients are diagnosed with meta- static renal cell carcinoma (mRCC) at pres- entation (Motzer et al., 1996) and a similar proportion will later develop metastases (Leibovich et al., 2003). Until 2007, a combi- nation of cytoreductive nephrectomy (CN) and immunotherapy, usually interferon-α, was considered to be the standard of care for those patients presenting with mRCC deemed fit enough, although cytokine therapy was associated with modest ben- efits and much toxicity (Coppin et al., 2005). The basis for nephrectomy in the context of metastatic disease was provided by two similar prospective trials which randomized patients to CN plus interferon or inter- feron alone. Combined analysis of the two trials demonstrated a median survival of 13.6 months for surgery plus interferon, and 7.8 months for interferon alone (HR = 0.69, 95% CI = 0.55–0.87, p = 0.002; Flanigan et al., 2004). The simplest rationale for why CN might improve survival in mRCC is a reduction in overall tumor burden, thus delaying time to a lethal burden of disease; other theories include a decrease in the amount of tumor shedding and

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