1ByJamesYeh234200631520072006CUA200707070607CUA0607CUA62007CUACUACUA20075207200620063208clinicalguidelinesconsensusbasedguidelineevidence-basedmedicineEBMevidencebasedguidelineWorldHealthOrganizationWHO[1,2][3]2080clinicalpracticeguidelines1994[4]199792005[3],(evidencebasedguidelinedevelopment)1[5]102310[6-8],121134○1○2○3○451.WorldHealthOrganization.GuidelinesforWHOguidelines.EIP/GPE/EQC/2003.WorldHealthOrganization.Geneva,Switzerland,20032.BurgersJS,GrolR,KlazingaNS,etal.Towardsevidencebasedclinicalpractice:aninternationalsurveyof18clinicalguidelineprograms.InterJQuaHealthCare,15:31-45,20033...2006,.:,20064.McConnellJD,BarryMJ,BruskewitzRC,etal.Benignprostatichyperplasia:diagnosisandtreatment.In:ClinicalPracticeGuideline.RockvilleMD:AgencyforHealthCarePolicyandResearch,19945..Guideline.:,20006.SackettDL,RosenbergWMC,MuirGrayJA,etal.Evidencebasedmedicine:whatitisandwhatitisn’t.BMJ,1996:12:1-27.AtkinsD,EcclesM,FlottorpS,etal.TheGRADEWorkingGroup.Systemsforgradingthequalityofevidence12andthestrengthofrecommendationsI:criticalappraisalofexistingapproaches.BMCHealthServicesRes.2004:4:38-448.AtkinsD,BrissPA,EcclesM,etal.TheGRADEWorkingGroup.SystemsforgradingthequalityofevidenceandthestrengthofrecommendationsII:pilotstudyofanewsystem.BMCHealthServicesRes,2005:5:25-36131415[]incidentalrenalcellcarcinomasBCTparaneoplasticsyndromeslocalizedrenalcellcarcinoma2002AJCCTNMT1-T2N0M0locallyadvancedrenalcellcarcinoma2002AJCCmetastaticrenalcellcarcinoma2002AJCCT4N0M0nephron-sparingsurgeryNSSminimallyinvasivetreatmentNSS16[1][2][3][4]-1-1AaMetabBababCD80%~90%2%~3%[1]1988~19972143[5,6]50~704%[178]10%~20%[8]177cm2%~4%[8]1981MostofiWHO1997[9]60%~85%7%~14%4%~10%1%~2%2[10,11]2004WHO19974BelliniXp112004WHO1982Fuhrman[13]1997WHOFuhrman[9]2002AJCCTNMclinicalstagegroupingcTNM-2-3[14]2002AJCCN818N0N1≥2NN2-22002AJCCTNMTTXT0T1≤7cmT1a≤4cmT1b4cm≤7cm18T27cmT3T3aT3b()T3cT4NNxN0N1N2MMXM0M1-32002AJCCT1N0M0T2N0M0T1N1M0T2N1M0T3N1M0T3aN0M0T3aN1M0T3bN0M0T3bN1M0T3cN0M0T3cN1M019T4N0M0T4N1M0TN2M0TNM1“”15%[1,11]1013.8%~48.9%[1516]33%50%[8]10%~40%[17]30%BXCTCTXIVUCTCTX≥CTMRIMRICTCTMRIpositronemissiontomographyPETPET-CT201~3cTNMcTNMpathologicalstagegroupingpTNMpTNMcTNMpTNM[18-20],8cmCT[21-23][24][25]2%[26]1%~2%[27-29](nephronsparingsurgeryNSS)NSS[30-33]NSS0.5~1.0cm[34-36][36-38][39,40]NSS0~10%≤4cm0~3%[41]NSS1%~2%[41]NSS[18]NSS[18]NSS21NSST1a≤4cmNSS[42][4344]≥T3radio-frequencyablationRFAhigh-intensityfocusedultrasoundHIFUcryoablation~4cm[4546]~pT1a590%pT1b~pT21~220%~30%[4748]gemcitabine[2]TNM[49]T3bN0M022CTMRI9%MayoClinic[50]0≤2cm2cm3IFN-αIL-22004[51]T35IFN-α()IL-2[52-54]-4[55][56]2%~11%LAKTILIFN-γIFN-αIL-215%IFN-αIFN-α9MIUimH3/123MIU13MIU26MIU39MIU113×109/L9MIU6MIU3MIUIL-2IL-26.0~7.2×105IU/kg()·8h15min1515~1991IL-24%23IL-22.5×105IU/kgH5d/W×1IL-21.25×105IU/kgH5d/W×6818MIU/dH5d/W×8IL-2IFN-α()IL-2[3](vascularendothelialgrowthfactor,VEGF)10%~40%80%[57-58]VEGFIFN-α()IL-2[3]RECIST[59][60-62]-4-470mm/h2≤70mm/h024280U/L2≤280U/L06000/µL1≥6000/µL0100g/L1≥100g/L0101001~34VHLBHD(Birt-Hogg-Dube)/VHLVHLVHLVHL3cm≥3cmNSS4~6[1,2]NSS4~6CT,[2]25XXCTNSST3~T4CT612T1~T23~63T3~T43236VHL6CT1MRI26271.....:,2004.889-9172.MichischG,CarballidoJ,HellstenS,etal.Guidelinesonrenalcellcancer.EurUrol,2001,40:252-2553.://~1992.:,2001.265-2916..1993~1997.2.:,2002.271-2977.LinehanWM,WaltherMM,ZbarB.Thegeneticbasisofcancerofthekidney.JUrol,2003,170:2163-21728.WalshPC,RetikAB,VaughED,etal.Campbell’sUrology.8thed.Philadelphia,PA:WBSaundersCompany,2002.2672-27199.StörkelS,EbleJN,AdlakhaK,etal.Classificationofrenalcellcarcinoma.Cancer,1997,80:987-98910.DelahuntB,EbleJN.Papillaryrenalcellcarcinoma:aclinicopathologicandimmunohistochemicalstudyof105tumors.ModPathol,1997,10:537-54411.DelahuntB,EbleJN,McCredieMR,etal.Morphologictypingofpapillaryrenalcellcarcinoma:comparisonofgrowthkineticsandpatientsurvivalin66cases.HumPathol,2001,32:590–59512.EbeleJN,SauterG,EpsteinJI,etal.PathologyandGeneticsofTumoursoftheUrinarySystemandMaleGenitalOrgans.Lyon:IARC,2004,9013.FuhrmanSA,LaskyLC,LimasC.Prognosticsignificanceofmorphologicparamaetersinrenalcellcarcinoma.AmJSurgPathol,1982,6:655-66314.AJCCCancerStagingManual.Sixthed.NewYork:SpringerVerlag,200215.,,.(44).,2000,2:54-5716.,,.289312.,2003,6:454-4552817.PalapattuGS,KristoB,RajferJ.Paraneoplasticsyndromesinurologicmalignancy:themanyfacesofrenalcellcarcinoma.RevUrol,2002,4:163-17018.GodleyPA,StinchcombeTE.Renalcellcarcinoma.CurrOpinOncol,1999,11:213-21719..525.,2000,3:135-13720..369.,2001,23:496-49921.PaulR,MordhorstJ,BuschR,LeyhH,HartungR.Adrenalsparingsurgeryduringradicalnephrectomyinpatientswithrenalcellcancer:anewalgorithm.JUrol,2001,166:59–6222..326.,2002,23:392-39423..?,1998,19:161-16324.SwansonDA,BorgesPM.complicationsoftransabdominalradicalnephrectomyforrenalcellcarcinoma.JUrol,1983,129:704-70725.WunderlichH,SchlichterA,ReicheltO,etal.Renalindicationsforadrenalectomyinrenalcellcarcinoma.EurUrol,1999,35:272-27626.SugaoH,MatsudaM,NakanoE,etal.Compa