Publication: Modelo predictivo de recidiva tumoral en los pacientes con cáncer renal no metastásico tratado con nefrectomía
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2017-08-21
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Universidad Complutense de Madrid
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Abstract
El carcinoma de células renales (CCR) es la 13º neoplasia en frecuencia a nivel mundial. En los casos con enfermedad localizada y localmente avanzado (estadios I/II y T3,T4,N0M0 según la clasificación TNM del año 2009, respectivamente), la cirugía constituye el único tratamiento existente con intención curativa. El tratamiento quirúrgico incluye todas sus variantes: la nefrectomía radical, la nefrectomía parcial y la tumorectomía; así como las diferentes vías de abordaje (abierta, laparoscópica y robótica). A pesar del tratamiento quirúrgico adecuado, entre un 20-40% de los pacientes con enfermedad localizada al diagnóstico experimentarán una recurrencia a lo largo del seguimiento. Existen una serie de factores pronósticos de recurrencia establecidos, que agrupan variables anatómicas, histológicas, clínicas y moleculares. El conocimiento de estos factores predictivos ha permitido crear modelos predictivos tanto en el CCR metastásico como en el CCR localizado. En el caso del CCR localizado, los modelos predictivos desarrollados nos permiten predecir la supervivencia global, la supervivencia cancer-específica y la recurrencia tumoral, tanto pre como postnefrectomía. Sin embargo, su uso en la práctica clínica diaria es escaso. Con la aparición de las nuevas terapias diana (sunitinib, pazopanib, axitinib, sorafenib, temsirolimus, everolimus y bevacizumab), el horizonte pronóstico y las posibilidades de tratamiento para los pacientes que experimentan una recurrencia ha cambiado radicalmente. Existen 5 ensayos clínicos en marcha para establecer la ventaja terapéutica aportada por estos fármacos en régimen de adyuvancia tras la nefrectomía en los pacientes con alto riesgo de recurrencia...
Renal cell carcinoma (RCC) is the 13th most frequent neoplasy worldwide. In the cases with localized and locally advanced disease (stages I/II and T3, T4, N0M0 according to the TNM classification 2009, respectively), surgery is the only curative available treatment. Surgical treatment includes a wide spectrum: radical nephrectomy, partial nephrectomy and tumorectomy; as well as the different surgical approaches (open, laparoscopic and robotic). Despite the proper surgical treatment, from 20 to 40% of the patients with local disease when diagnosed will develop recurrence throughout the follow-up. There is a series of well stablished recurrence predictive factors, that include anatomic, histological, clinical and molecular parameters. The knowledge of these predictive factors has enabled the development of predictive models for both, localized and methastatic RCC. The predictive models for localized RCC allow us to predict the global survival, cancer-specific survival and tumor recurrence, both pre and post-nephrectomy. However, its daily use in clinical practice is poor. The appeareance of new targeted therapies (such as sunitinib, pazopanib, axitinib, sorafenib, temsirolimus, everolimus, bevacizumab), the prognosis and treatment possibilities for the patients who experience recurrence have dramatically changed. There are 5 ongoing clinical trials to set the therapeutic advantage provided by these drugs in adjuvant regimen after nephrectomy in high recurrence risk patients...
Renal cell carcinoma (RCC) is the 13th most frequent neoplasy worldwide. In the cases with localized and locally advanced disease (stages I/II and T3, T4, N0M0 according to the TNM classification 2009, respectively), surgery is the only curative available treatment. Surgical treatment includes a wide spectrum: radical nephrectomy, partial nephrectomy and tumorectomy; as well as the different surgical approaches (open, laparoscopic and robotic). Despite the proper surgical treatment, from 20 to 40% of the patients with local disease when diagnosed will develop recurrence throughout the follow-up. There is a series of well stablished recurrence predictive factors, that include anatomic, histological, clinical and molecular parameters. The knowledge of these predictive factors has enabled the development of predictive models for both, localized and methastatic RCC. The predictive models for localized RCC allow us to predict the global survival, cancer-specific survival and tumor recurrence, both pre and post-nephrectomy. However, its daily use in clinical practice is poor. The appeareance of new targeted therapies (such as sunitinib, pazopanib, axitinib, sorafenib, temsirolimus, everolimus, bevacizumab), the prognosis and treatment possibilities for the patients who experience recurrence have dramatically changed. There are 5 ongoing clinical trials to set the therapeutic advantage provided by these drugs in adjuvant regimen after nephrectomy in high recurrence risk patients...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 08-04-2016