Biological and Clinical Insight into the Prevention and Management of Metastatic Renal Cell Carcinoma with a Sarcomatoid Component.

IF 5.6 2区医学 Q1 UROLOGY & NEPHROLOGY

European urology focus Pub Date : 2025-06-13 DOI:10.1016/j.euf.2025.05.011

Nicholas J Salgia, Yu Fujiwara, Bo Xu, Saby George, Jason B Muhitch, Eric C Kauffman

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Abstract

Renal cell carcinoma with sarcomatoid dedifferentiation (sRCC) has high metastatic potential and poor prognosis. While metastatic sRCC is relatively resistant to conventional anticancer drugs, recent advances demonstrate that it is highly sensitive to immune checkpoint inhibitors (ICIs), with response rates as high as 60% to ICI-based combination therapies. Congruent with these discoveries, sRCC has been characterized by an increase in inflammatory programs potentially driving ICI sensitivity. In clinically localized sRCC, this unique immune sensitivity supports consideration for adjuvant ICI therapy to prevent post-nephrectomy metastasis, the risk of which increases with higher sarcomatoid percentage in the primary tumor. Together, these advances represent an exciting paradigm shift in the understanding and management of sRCC. PATIENT SUMMARY: While a type of kidney cancer called sRCC (renal cell carcinoma with sarcomatoid dedifferentiation) is very aggressive and resistant to typical anticancer therapies, recent evidence shows that it is highly sensitive to immunotherapy. Studies have confirmed that immune-related changes in sRCC tumors may explain this response.

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具有肉瘤样成分的转移性肾细胞癌的预防和管理的生物学和临床见解。

肾细胞癌伴肉瘤样去分化（sRCC）具有高转移潜力和不良预后。虽然转移性sRCC对常规抗癌药物相对耐药，但最近的进展表明，它对免疫检查点抑制剂（ici）高度敏感，对基于ici的联合治疗的应答率高达60%。与这些发现一致，sRCC的特点是炎症程序的增加可能会导致ICI敏感性。在临床上定位的sRCC中，这种独特的免疫敏感性支持考虑辅助ICI治疗以防止肾切除术后转移，其风险随着原发肿瘤中肉瘤样百分比的增加而增加。总之，这些进展代表了对sRCC的理解和管理的一个令人兴奋的范式转变。患者总结：虽然一种名为sRCC（肾细胞癌伴肉瘤样去分化）的肾癌具有很强的侵袭性，对典型的抗癌治疗具有耐药性，但最近的证据表明，它对免疫治疗高度敏感。研究证实，sRCC肿瘤的免疫相关变化可能解释了这种反应。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European urology focus Medicine-Urology

CiteScore

10.40

自引率

3.70%

发文量

274

审稿时长

23 days

期刊介绍： European Urology Focus is a new sister journal to European Urology and an official publication of the European Association of Urology (EAU). EU Focus will publish original articles, opinion piece editorials and topical reviews on a wide range of urological issues such as oncology, functional urology, reconstructive urology, laparoscopy, robotic surgery, endourology, female urology, andrology, paediatric urology and sexual medicine. The editorial team welcome basic and translational research articles in the field of urological diseases. Authors may be solicited by the Editor directly. All submitted manuscripts will be peer-reviewed by a panel of experts before being considered for publication.