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Recommandations en onco-urologie 2016-2018 du CCAFU : Cancer du rein

Référence : Prog Urol, 2017, Supplément 1, 27, S27

Résumé

Les précédentes recommandations du Comité de cancérologie de l’Association française d’urologie (CCAFU) datent de 2013. Nous avons voulu cette nouvelle version résolument simple, claire et pragmatique. Les nouveautés significatives de la littérature sur le cancer du rein y ont été intégrées. Voici les principaux changements par rapport à 2013 :

•

Nous avons ajouté une courte section d’épidémiologie : la prévalence du tabagisme reste très élevée en France et il nous est apparu fondamental que l’urologue sensibilise les patients avec un cancer du rein à l’importance d’arrêter de fumer

•

Certaines classifications ont changé : la classification de l’Organisation mondiale de la santé (OMS) a été revue en 2016 et le grade de Fuhrman a été remplacé par le grade nucléolaire de l’Internationel Society of Urological Pathology (ISUP).

•

Les facteurs pronostiques restent essentiellement cliniques et histologiques ; les systèmes pronostiques sont surtout utiles chez les patients métastatiques ; la classification de l’International Metastatic Renal Cancer Database Concertium (IMDC) (ou de Heng) est maintenant celle qui prévaut sur celle du Memorial Sloan Kettering Cancer Center (MSKCC).

•

Concernant le traitement du cancer du rein localisé : les bénéfices de la néphrectomie partielle (NP) sont clairement établis ; la voie d’accès robotique s’est beaucoup développée est a montré une morbidité moins importante que la voie ouverte ; elle peut maintenant être recommandée au même titre que la voie ouverte (qui était auparavant la voie de référence).

•

Le traitement du cancer du rein localement avancé repose toujours sur la chirurgie ; les premiers essais de traitements adjuvants sont négatifs ; en attendant les résultats d’autres études en cours, les thérapies ciblées ne doivent être prescrites que dans le cadre d’essais cliniques.

•

Le traitement du cancer du rein métastatique (CRM) s’est enrichi de deux molécules (lenivolumab et la cabozantinib) qui sont devenues, suite à des essais de phase III ayant montré un bénéfice en terme de survie, les molécules de référence en deuxième ligne .

•

Enfin, les modalités de suivi après chirurgie du cancer du rein sont toujours imprécises ; en attendant les résultats d’études multicentriques de grande envergure, il faut adapter le suivi au risque d’agressivité tumorale ; les tumeurs de faible risque récidivent rarement et il est donc possible d’utiliser moins fréquemment les imageries irradiantes.

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Recommandations en onco-urologie 2016-2018 du CCAFU : Cancer du rein

CCAFU french national guidelines 2016-2018 on renal cancer

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	Références


	Épidémiologie

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	Diagnostic et évaluation du cancer du rein

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	Classifications et facteurs pronostiques du cancer du rein

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	Traitement du cancer du rein localisé

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[9]	Gill I.S., Kavoussi L.R., Lane B.R., Blute M.L., Babineau D., Colombo J.R., et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors J Urol 2007 ; 178 : 41-46 [cross-ref]

[10]	Lane B.R., Gill I.S. 7-year oncological outcomes after laparoscopic and open partial nephrectomy J Urol 2010 ; 183 : 473-479 [cross-ref]

[11]	Gong E.M., Orvieto M.A., Zorn K.C., Lucioni A., Steinberg G.D., Shalhav A.L. Comparison of laparoscopic and open partial nephrectomy in clinical T1a renal tumors J Endourol Endourol Soc 2008 ; 22 : 953-957

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	Tumeurs localisées de plus de 4cm (T1b et T2)

[1]	Simmons M.N., Weight C.J., Gill I.S. Laparoscopic radical versus partial nephrectomy for tumors >4cm: intermediate-term oncologic and functional outcomes Urology 2009 ; 73 : 1077-1082 [inter-ref]

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[3]	Patard J.J., Pantuck A.J., Crepel M., Lam J.S., Bellec L., Albouy B., et al. Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication Eur Urol 2007 ; 52 : 148-154 [cross-ref]

[4]	Kutikov A., Uzzo R.G. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth J Urol 2009 ; 182 : 844-853 [cross-ref]

[5]	Kopp R.P., Liss M.A., Mehrazin R., Wang S., Lee H.J., Jabaji R., et al. Analysis of Renal Functional Outcomes After Radical or Partial Nephrectomy for Renal Masses >7cm Using the RENAL Score Urology 2015 ; 86 : 312-319 [inter-ref]

[6]	Kopp R.P., Mehrazin R., Palazzi K.L., Liss M.A., Jabaji R., Mirheydar H.S., et al. Survival outcomes after radical and partial nephrectomy for clinical T2 renal tumours categorised by R.E.N.A.L. nephrometry score Bju Int 2014 ; 114 : 708-718 [cross-ref]

[7]	Lane B.R., Tiong H.-Y., Campbell S.C., Fergany A.F., Weight C.J., Larson B.T., et al. Management of the adrenal gland during partial nephrectomy J Urol 2009 ; 181 : 2430-2436discussion 2436–7.

[8]	Bekema H.J., MacLennan S., Imamura M., Lam T.B.L., Stewart F., Scott N., et al. Systematic review of adrenalectomy and lymph node dissection in locally advanced renal cell carcinoma Eur Urol 2013 ; 64 : 799-810 [cross-ref]

[9]	Blom J.H.M., van Poppel H., Maréchal J.M., Jacqmin D., Schroder F.H., de Prijck L., et al. Radical nephrectomy with and without lymph-node dissection: final results of European Organization for Research and Treatment of Cancer (EORTC) randomized phase 3 trial 30881 Eur Urol 2009 ; 55 : 28-34 [cross-ref]

[10]	Dimashkieh H.H., Lohse C.M., Blute M.L., Kwon E.D., Leibovich B.C., Cheville J.C. Extranodal extension in regional lymph nodes is associated with outcome in patients with renal cell carcinoma J Urol 2006 ; 176 : 1978-1982discussion 1982–1983. [cross-ref]

[11]	Terrone C., Cracco C., Porpiglia F., Bollito E., Scoffone C., Poggio M., et al. Reassessing the current TNM lymph node staging for renal cell carcinoma Eur Urol 2006 ; 49 : 324-331 [cross-ref]

[12]	Kim S., Thompson R.H., Weight C., Cheville J., Lohse C., Boorjian S., et al. The Relationship of Lymph Node Dissection with Recurrence and Survival for Patients Treated with Nephrectomy for High-Risk Renal Cell Carcinoma J Urol 2012 ; 187 : e233-e234

[13]	Hutterer G.C., Patard J.J., Perrotte P., Ionescu C., de La Taille A., Salomon L., et al. Patients with renal cell carcinoma nodal metastases can be accurately identified: external validation of a new nomogram Int J Cancer 2007 ; 121 : 2556-2561 [cross-ref]

[14]	Gratzke C., Seitz M., Bayrle F., Schlenker B., Bastian P.J., Haseke N., et al. Quality of life and perioperative outcomes after retroperitoneoscopic radical nephrectomy (RN), open RN and nephron-sparing surgery in patients with renal cell carcinoma Bju Int 2009 ; 104 : 470-475 [cross-ref]

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[16]	Hemal A.K., Kumar A., Kumar R., Wadhwa P., Seth A., Gupta N.P. Laparoscopic versus open radical nephrectomy for large renal tumors: a long-term prospective comparison J Urol 2007 ; 177 : 862-866 [cross-ref]

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[19]	Kwon T., Song C., Hong J.H., Kim C.S., Ahn H. Reassessment of renal cell carcinoma lymph node staging: analysis of patterns of progression Urology 2011 ; 77 : 373-378 [inter-ref]

[20]	Laird A., Choy K.C.C., Delaney H., Cutress M.L., OʼConnor K.M., Tolley D.A., et al. Matched pair analysis of laparoscopic versus open radical nephrectomy for the treatment of T3 renal cell carcinoma World J Urol 2015 ; 33 : 25-32 [cross-ref]

[21]	Sprenkle P.C., Power N., Ghoneim T., Touijer K.A., Dalbagni G., Russo P., et al. Comparison of open and minimally invasive partial nephrectomy for renal tumors 4-7 centimeters Eur Urol 2012 ; 61 : 593-599 [cross-ref]

[22]	Ebbing J., Wiebach T., Kempkensteffen C., Miller K., Bachmann A., Gunzel K., et al. Evaluation of perioperative complications in open and laparoscopic surgery for renal cell cancer with tumor thrombus involvement using the Clavien-Dindo classification Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 2015 ; 41 : 941-952 [cross-ref]

[23]	Peng B., Zheng J.H., Li H. Effect of retroperitoneal laparoscopic radical nephrectomy of renal carcinoma (nephroma) on perioperative cell immunity J Endourol Endourol Soc 2008 ; 22 : 2161-2164 [cross-ref]

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	Traitement dʼun cancer du rein localement avancé

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[2]	Stewart G.D., Ang W.J., Laird A., Tolley D.A., Riddick A.C.P., McNeill S.A. The operative safety and oncological outcomes of laparoscopic nephrectomy for T3 renal cell cancer BJU Int 2012 ; 110 : 884-890 [cross-ref]

[3]	Verhoest G., Couapel J.P., Oger E., Rioux-Leclercq N., Pignot G., Patard J.-J., et al. Safety and Feasibility of Laparoscopic Nephrectomy for Big Tumors (>10cm): A Retrospective Multi-centric Study Clin Genitourin Cancer 2016 ; 14 : e335-e340

[4]	Capitanio U., Becker F., Blute M.L., Mulders P., Patard J.J., Russo P., et al. Lymph node dissection in renal cell carcinoma Eur Urol 2011 ; 60 : 1212-1220 [cross-ref]

[5]	Capitanio U., Suardi N., Matloob R., Abdollah F., Castiglione F., Briganti A., et al. Staging lymphadenectomy in renal cell carcinoma must be extended: a sensitivity curve analysis BJU Int 2013 ; 111 : 412-418 [cross-ref]

[6]	Sun M., Trinh Q.D., Bianchi M., Hansen J., Abdollah F., Tian Z., et al. Extent of lymphadenectomy does not improve the survival of patients with renal cell carcinoma and nodal metastases: biases associated with the handling of missing data BJU Int 2014 ; 113 : 36-42

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	Traitement du CRM

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[26]	Kroeger N., Xie W., Lee J.-L., Bjarnason G.A., Knox J.J., Mackenzie M.J., et al. Metastatic non-clear cell renal cell carcinoma treated with targeted therapy agents: Characterization of survival outcome and application of the International mRCC Database Consortium criteria Cancer 2013 ; 119 : 2999-3006 [cross-ref]

[27]	Motzer R.J., Hutson T.E., Tomczak P., Michaelson M.D., Bukowski R.M., Rixe O., et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma N Engl J Med 2007 ; 356 : 115-124 [cross-ref]

[28]	Escudier B., Eisen T., Stadler W.M., Szczylik C., Oudard S., Siebels M., et al. Sorafenib in advanced clear-cell renal-cell carcinoma N Engl J Med 2007 ; 356 : 125-134 [cross-ref]

[29]	Escudier B., Pluzanska A., Koralewski P., Ravaud A., Bracarda S., Szczylik C., et al. Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma: a randomised, double-blind phase III trial Lancet 2007 ; 370 : 2103-2111 [cross-ref]

[30]	Hudes G., Carducci M., Tomczak P., Dutcher J., Figlin R., Kapoor A., et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma N Engl J Med 2007 ; 356 : 2271-2281 [cross-ref]

[31]	Hutson T.E., Escudier B., Esteban E., Bjarnason G.A., Lim H.Y., Pittman K.B., et al. Randomized phase III trial of temsirolimus versus sorafenib as second-line therapy after sunitinib in patients with metastatic renal cell carcinoma J Clin Oncol 2014 ; 32 : 760-767 [cross-ref]

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[39]	Choueiri T.K., Escudier B., Powles T., Mainwaring P.N., Rini B.I., Donskov F., et al. Cabozantinib versus Everolimus in Advanced Renal-Cell Carcinoma N Engl J Med 2015 ; 373 : 1814-1823 [cross-ref]

[40]	Choueiri T.K., Escudier B., Powles T., Tannir N.M., Mainwaring P.N., Rini B.I., et al. Cabozantinib versus everolimus in advanced renal cell carcinoma (METEOR): final results from a randomised, open-label, phase 3 trial Lancet Oncol 2016 ; 17 : 917-927 [inter-ref]

[41]	Motzer RJ, Porta C, Vogelzang NJ, Sternberg CN, Szczylik C, Zolnierek J, et al. Dovitinib versus sorafenib for third-line targeted treatment of patients with metastatic renal cell carcinoma: an open-label, randomised phase 3 trial. Lancet Oncol 201;15:286-96.

[42]	Motzer R.J., Barrios C.H., Kim T.M., Falcon S., Cosgriff T., Harker W.G., et al. Phase II randomized trial comparing sequential first-line everolimus and second-line sunitinib versus first-line sunitinib and second-line everolimus in patients with metastatic renal cell carcinoma J Clin Oncol 2014 ; 32 : 2765-2772 [cross-ref]

[43]	Tannir N.M., Jonasch E., Albiges L., Altinmakas E., Ng C.S., Matin S.F., et al. Everolimus Versus Sunitinib Prospective Evaluation in Metastatic Non-Clear Cell Renal Cell Carcinoma (ESPN): A Randomized Multicenter Phase 2 Trial Eur Urol 2016 ; 69 : 866-874 [cross-ref]

[44]	Armstrong A.J., Halabi S., Eisen T., Broderick S., Stadler W.M., Jones R.J., et al. Everolimus versus sunitinib for patients with metastatic non-clear cell renal cell carcinoma (ASPEN): a multi-centre, open-label, randomised phase 2 trial Lancet Oncol 2016 ; 17 : 378-388 [inter-ref]


	Situations particulières

[1]	Linehan W.M., Srinivasan R., Schmidt L.S. The genetic basis of kideney cancer: a metabolic disease Nat Rev Urol 2010 ; 7 : 277-285 [cross-ref]

[2]	Lonser R.R., Glenn G.M., Walther M., Chew E.Y., Libutti S.K., Linehan W., et al. Von Hippel-Lindau disease Lancet 2003 ; 361 : 2059-2067 [cross-ref]

[3]	Maher E.R., Neumann H.P.H., Richard S. Von Hippel-Lindau disease: a clinical and scientific review Eur J Hum Genet 2011 ; 19 : 617-623 [cross-ref]

[4]	Schmidt L.S., Nickerson M.L., Angeloni D., Glenn G.M., Walther M.M., Albert P.S., et al. Early onset hereditary papillary renal carcinoma: germline missense mutations in the tyrosine kinase domain of the Met proto-oncogene J Urol 2004 ; 172 : 1256-1261 [cross-ref]

[5]	Grubb R.L., Franks M.E., Toro J., Middelton L., Choyke L., Fowler S., et al. Hereditary leiomyomatosis and renal cell cancer: a syndrome associated with an aggressive form of inherited renal cancer J Urol 2007 ; 177 : 2074-2079 [cross-ref]

[6]	Menko F.H., van Steensel M.A., Giraud S., Friis-Hansen L., Richard S., Ungari S., et al. Birt-Hogg-Dubé syndrome: diagnosis and management Lancet Oncol 2009 ; 10 : 1199-1206 [inter-ref]

[7]	Joly D., Mejean A., Correas J.M., Timsit M.O., Deveaux S., Landais P., et al. Progress in nephron-sparing therapy of renal cell carcinoma in von Hippel-Lindau disease J Urol 2011 ; 185 : 2056-2060 [cross-ref]

[8]	Herring J.C., Enquist E.G., Chernoff A., Linehan W.M., Choyke P.L., Walthler M.M. Parenchymal sparing surgery in patients with hereditary renal cell carcinoma: 10-year experience J Urol 2001 ; 165 : 777-781 [cross-ref]

[9]	Kim J.K., Kim S.H., Jang Y.J., Ahn H., Kim C.S., Park H., et al. Renal angiomyolipoma with minimal fat: differentiation from other neoplasms at double-echo chemical shift FLASH MR imaging Radiology 2006 ; 239 : 174-180 [cross-ref]

[10]	Kim J.I., Cho J.Y., Moon K.C., Lee H.J., Kim S.H. Segmental enhancement inversion at biphasic multidetector CT: characteristic finding of small renal oncytoma Radiology 2009 ; 252 : 441-448 [cross-ref]

[11]	Guzzo T.J., Pierorazio P.M., Schaeffer E.M., Fishman E.K., Allaf M.E. The accuracy of multidetector computerized tomography for evaluating tumor thrombus in patientswith renal cell carcinoma J Urol 2009 ; 181 : 486-490

[12]	Gerst S., Hann L.E., Li D., Gonen M., Tickoo S., Sohn M.J. Evaluation of renal masses with contrast-enhanced ultrasound: initial experience AJR Am J Roentgenol 2011 ; 197 : 897-906 [cross-ref]

[13]	Bosniak M.A. The Bosniak renal cyst classification: 25 years later Radiology 2012 ; 262 : 781-785 [cross-ref]

[14]	Warren K.S. The Bosniak classification of renal cystic masses BJU Int 2005 ; 95 : 939 [cross-ref]


	Suivi

[1]	Bernhard J.C., Pantuck A.J., Wallerand H., Crepel M., Ferrière J.M., Bellec L., et al. Predictive Factors for Ipsilateral Recurrence After Nephron-sparing Surgery in Renal Cell Carcinoma Eur Urol 2010 ; 57 : 1080-1086 [cross-ref]

[2]	Tollefson M.K., Takahashi N., Leibovich B.C. Contemporary imaging modalities for the surveillance of patients with renal cell carcinoma Curr Urol Rep 2007 ; 8 : 38-43 [cross-ref]

[3]	Antonelli A., Cozzoli A., Zani D., Zanotelli T., Nicolai M., Cunico S.C., et al. The follow-up management of non-metastatic renal cell carcinoma: definition of a surveillance protocol BJU Int 2007 ; 99 : 296-300 [cross-ref]

[4]	Eggener S.E., Yossepowitch O., Pettus J.A., Snyder M.E., Motzer R.J., Russo P. Renal cell carcinoma recurrence after nephrectomy for localized disease: predicting survival from time of recurrence J Clin Oncol 2006 ; 24 : 3101-3106 [cross-ref]

[5]	Ljungberg B., Alamdari F.I., Rasmuson T., Roos G. Follow-up guidelines for nonmetastatic renal cell carcinoma based on the occurrence of metastases after radical nephrectomy BJU Int 1999 ; 84 : 405-411

[6]	Herold C.J., Bankier A.A., Fleischmann D. Lung metastases Eur Radiol 1996 ; 6 : 596-606

[7]	Han K.R., Bleumer I., Pantuck A.J., Kim H.L., Dorey F.J., Janzen N.K., et al. Validation of an integrated staging system toward improved prognostication of patients with localized renal cell carcinoma in an international population J Urol 2003 ; 170 : 2221-2224 [cross-ref]

[8]	Cindolo L., Chiodini P., Gallo C., Ficarra V., Schips L., Tostain J., et al. Validation by calibration of the UCLA integrated staging system prognostic model for nonmetastatic renal cell carcinoma after nephrectomy Cancer 2008 ; 113 : 65-71 [cross-ref]

[9]	Casalino D.D., Remer E.M., Bishoff J.T., Coursey C.A., Dighe M., Harvin H.J., et al. ACR appropriateness criteria post-treatment follow-up of renal cell carcinoma J Am Coll Radiol 2014 ; 11 : 443-449 [cross-ref]