Analysis About Therapy Of Renal Cell Carcinoma

In the US about 32,000 new cases (~12,000 deaths) of kidney cancer yearly. RCC is the 10th leading cause of cancer death in the US and Western Europe. About 40% of RCC patients die due to distant metastases. about 25% –40% of RCC patients treated for localized disease will develop metastatic disease. Median survival time for patients with mRCC is 6 to 10 months. Objective To evaluate the clinical results of different operative procedures and renal tumor embolization before operation,immuno-therapy for renal cell carcinomas.Methods The clinical data of 179 patients with renal cell carcinoma diagnosed and operated in our department in the time from 1997.1 to 2002.12 were reviewed, including 133 cases received radical nephrectomy, 39 cases received nephrectomy and extended lymphadenectomy, 7 cases received nephron sparing surgery; 78 cases received renal artery embolization of tumor, after 3~5d radical nephrectomy was carried out for them; 31cases received immunotherapy in or after operation. Then the clinical data was analyzed completely.Results 133 cases underwent regional radical nephrectomy and 39 cases underwent extended radical nephrectomy were compared. The former has more virtue than the later in many cases, such as the time of operation,the time of postoperation adimission, the rate of blood transfusion, and so on, the two groups have significant difference(P<0.05). But the 5-year survival rate of them have no significant difference (P<0.05). There were 29 small renal cell carcinomas, 22 cases underwent radical nephrectomy and 7 cases received nephron sparing surgery. The time of operation,the time of postoperation adimission, the 5-year survival rate of two groups have no significant difference(P<0.05), but patients after nephron sparing surgery often had some complications, such as hemorrhage, fistula of urine. 78 cases were received renal artery embolization of tumor, the average diagmeter of tumors is 10.5cm. 3~5days later radical nephrectomy were carried out for them. In the operations, we found that the sizes of carcinomas were decreased, the edema aroud tumors became obvious, and bleeding was reduced, which were convenient for operations and prolonged survivals. Conclusions Radical nephrectomy is the typical procedure of operation for treatent of renal cell carcinomas. But the 5-year survival rate of regional radical nephrectomy and extended radical nephrectomy have no significant difference (P<0.05). In addition, regional radical nephrectomy is more simple than the extended radical nephrectomy, and the time of the former is shorter than the later; For the small renal tumors, radical nephrectomy can not improve the 5-year survival more obviously than the nephron sparing surgery, but nephron sparing surgery often lead to some complications, such as hemorrhage,fistula of urine; Selective renal artery embolization is a safe, effective approach with less complications for the treatment of the larger renal carcinomas, and renal artery embolization as a valuable treatment should be widely applied; Immunotherapy is another important theraputic approach in addition to surgery, especially tumor vaccine (ASI, DC, HSPPS )have excellent clinical results for the treatment of later stage tumors or metastatic renal cell carcinoma.