Further work in this area led to a refinement in these variables and a scoring system where patients can be placed in to good, intermediate or poor risk categories.
This graph demonstrates the clinical usefulness of this scoring system and their relevance to prognosis.
Patients were ineligible if they had brain metastases, uncontrolled hypertension, or clinically significant cardiovascular events or disease during the preceding 12 months. All patients gave written informed consent. Randomization was stratified according to baseline levels of lactate dehydrogenase (>1.5 vs. ≤1.5 times the upper limit of the normal range), ECOG performance status (0 vs. 1), and previous nephrectomy (yes vs. no). Patients were randomly assigned in a 1:1 ratio to receive either sunitinib or interferon alfa. Random permuted blocks of four were used to attain balance within strata.
CÂNCER RENAL 2009 Lucas Nogueira Sociedade Brasileira de Urologia Tisbu 100% Coordenador do Grupo de Uroncologia – HC / UFMG
Comorbidades associadas geram mais exames de imagem ??
Parkin CM, Whelan SL, Ferlay J, et alIn: Cancer incidence in five continents, Vol VIII. Lyon (France): International Agency for Research on Cancer; 2002. Ries LAG, Harkins D, Krapcho M, et al. SEER cancer statistics review, 1975–2004. Available at: http:// seer.cancer.gov/csr/1975_2004/. Accessed February 1, 2008.
Aumentos da prevalência de HAS nos EUA, principalmente em negros:
Grossman E, Messerli FH, Boyko V, et al. Is there an association between hypertension and cancer mortality? Am J Med 2002;112(6):479–86. Grove JS, Nomura A, Severson RK, et al. The association of blood pressure with cancer incidence in a prospective study. Am J Epidemiol 1991;134(9): 942–7.
Tsui KH, Shvarts O, Barbaric Z, et al. Is adrenalectomy a necessary component of radical nephrectomy? UCLA experience with 511 radical nephrectomies. J Urol 2000;163:437-441. Pantuck AJ, Zisman A, Dorey F, et al. Renal cell carcinoma with retroperitoneal lymph nodes: role of lymph node dissection. J Urol 2003;169:2076-2083
Clayman RV, Kavoussi LR, Soper NJ, et al. Laparoscopic nephrectomy: initial case report. J Urol 1991;146:278-282 Eskicorapci SY, Teber D, Schulze M, et al. Laparoscopic radical nephrectomy: the new gold standard surgical treatment for localized renal cell carcinoma. ScientificWorldJournal 2007;7:825-836.
Using the SEER registry: 14,647 patients with primary tumor size ≤ 7 cm treated surgically.
Overall, 1,401 (9.6%) were treated with partial nephrectomy.
Trends till 2001 of increased use of partial nephrectomy
Below Graph: A = ≤ 2 cm; B = 2 to 4 cm; C = 4 to 7 cm
Even though they witnessed increasing use of partial nephrectomy over the past two decades, nationwide, the use of nephron sparing surgery “remains relatively infrequent, even for the smallest renal masses .”
Miller et al.: Journal of Urology 175:853-858, 2006
41 yo with massive kidney cancer metastatic to the liver and lung, treated with sunitinib 7/06. The metastases and the primary tumor decreased dramatically and were removed 14 months later. Dramatic response in metastatic kidney cancer Sunitinib (Sutent)
KDR Temsirolimus (CCI-779), Everolimus (RAD001) Bevacizumab Sunitinib, Sorafenib HIF VEGF The Future of mRCC Targeted Therapy: Vertical Combinations – Targeting of VEGF at Multiple Levels Kaelin WG Jr. Clin Cancer Res 2004;10:6290s–6295s