肾细胞癌异质性与个性化医疗现状

Heterogeneity of renal cell carcinoma and personalized medicine

目的总结国内外对肾细胞癌异质性及个性化医疗的研究现状。方法检索PubMed及CHKD期刊全文数据库检索系统,以"renal cell carcinoma(RCC)、targeted therapy、personalized medicine和heterogeneity"等为英文关键词,以"肾细胞癌、靶向治疗、个性化医疗和异质性"等为中文关键词,检索1990-01-01-2014-10-31的相关文献,共检索到英文文献3 683篇,中文文献506篇。纳入标准:1)肾细胞癌相关的研究性文章;2)肾细胞癌靶向治疗的研究性、综述类文章;3)肾细胞癌异质性相关的研究性文章。剔除标准:1)中文除外非核心期刊文章,英文除外非SCI收录的文章;2)排除陈旧及重复的实验性研究;3)除外与临床联系不密切的研究。精选21篇英文和4篇中文文献纳入分析。结果多靶点多组学测序研究结果揭示,肾癌存在异质性。针对特定靶点及通路的靶向药物是当前晚期肾癌患者治疗的主流药物,而肾癌异质性可能是阻碍该治疗发展的主要因素之一。个性化治疗可通过多组学多靶点测序技术获取肿瘤的遗传信息,并联合靶向药物给予针对性治疗。结论个性化医疗可能成为晚期肾细胞癌患者治疗的趋势。

OBJECTIVE To summarize the advancements in heterogeneity of renal cell carcinoma （RCC） and personalized medicine at home and abroad. METHODS The periodic full-text databases of both PubMed and CHKD disc from 1990-1-1 to 2014-10-31 in the corresponding materials were searched. The major index words were composed of ＂renal cell carcinoma＂targe- ted therapy＂personalized cancer medicine＂ and ＂heterogeneity＂. A total 3683 articles were obtained from PubMed and 506 from CHKD. The adoptive standards were as the following： 1） Research articles related to renal cell carcinoma~ 2） Research articles or reviews which contained the targeted therapy of renal cell carcinoma 3） Research articles which elaborate the heterogeneity of re- nal cell carcinoma. The eliminated standards： 1） Except for non-core journal articles in Chinese and the non-SCI articles in English; 2） Eliminate the old and repeated experiments 3） Eliminate the articles that are not closed to clinical. Handpick 21 SCI papers and 4 Chinese literatures were finally analyzed. RESULTS With the application of multi-targets and multilayered molecular profiling, tumor heterogeneity within the renal cell carcinoma was revealed by the analysis. Targeted therapies for the specific targets and pathways become the main trend medicines for the treatment of advanced renal cell carcinoma patients, while heterogeneity may be one of the major hindrances for the targeted therapy. Personalized medicine obtains genetic information by means of multi-targets and multilayered molecular profiling technology, and combined with targeted therapy to offer specific therapy. CONCLUSION Personalized medicine may become the treatment tendency for advanced renal cell carcinoma patients.