肾癌患者的手术及术后辅助治疗

我们带着肾癌患者是否应进行手术治疗以及应选择何种术式、术后是否应进行辅助治疗及辅助治疗方案等问题,检索了从1996年1月～2005年9月的The Guidelines International Network、ACP Journal Club、Cochrane图书馆(2005年第3期)、MEDLINE、EMBASE和中国生物医学文献数据库.结果未找到比较单纯手术与不治疗或单用辅助治疗比较的研究;找到1篇研究转移性肾癌在辅助治疗的基础上是否应手术治疗的Meta分析,肯定了肾切除在转移性肾癌中的疗效;1篇比较不同术式的综述发现保留肾单位的肾切除与肾全切术同样有效,且并发症更少;14篇研究术后辅助治疗的RCT发现,细胞因子(干扰素和白细胞介素)和5-氟尿嘧啶在肾癌术后辅助治疗中无效且有增多不良反应的趋势,而疫苗治疗显示出较好的疗效.

Operative Therapy and Postoperative Adjuvant Therapy in Patients with Renal Caner

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.