Predicting recurrence in patients with localised renal cell carcinoma after nephrectomy
Menée en Chine à partir d'échantillons tumoraux inclus en paraffine après prélèvement sur 227 patients atteints d'un carcinome rénal à cellules claires de stade localisé puis validée à partir de données portant sur 206 patients complémentaires et à partir de données du projet "The Cancer Genome Atlas", cette étude évalue la performance d'une signature génétique, basée sur la présence de 6 polymorphismes à simple nucléotide, pour prédire le risque de récidive
Although most patients who undergo nephrectomy for clear cell renal cell carcinoma for cT1–T3 N0 disease achieve a complete response, up to 30% will recur. 1
Targeted agents and immune checkpoint inhibitors exist that are clinically beneficial for the treatment of metastatic disease and thus there is a motivation to ascertain whether these also provide a benefit in the adjuvant setting. 2
However, successful use of adjuvant therapy depends on several premises. The first is that the benefits of treating those who need therapy (ie, patients with micrometastatic disease) outweigh the risks of treating those whose disease was organ confined and in whom nephrectomy alone had already been successful. The second consideration is that a survival benefit with adjuvant therapy is only possible if early therapy results in improved survival compared with delayed treatment when the patient already manifests metastatic disease. Although these two steps are crucial for adjuvant therapies to be accepted, identification of patients who should have adjuvant therapy is also an important component to spare unnecessary toxicity in patients who are already likely to be cured by surgery alone.
The Lancet Oncology , commentaire, 2018