<link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/css/video-js.min.css?v=1"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/base.css?v=5"><link rel="stylesheet" href="https://studioyszimg.yxj.org.cn/article/css/index.css?v=35"><link rel="stylesheet" href="https://ysz-web.yxj.org.cn/live/dist/static/base/index.css?ysz_v=2.0"><script src="https://studioyszimg.yxj.org.cn/js/dsbridge.js?v=13" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/dsBridge/main.js?v=26" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/base/fun.js?ysz_v=3" type="text/javascript"></script><script src="https://ysz-web.yxj.org.cn/live/dist/static/js/nativeToWeb.js?v=1" type="text/javascript"></script><div id="ysz-header" style="margin:0;overflow:hidden;"><h1 style="font-size:24px;line-height:1.8;color:#333333;word-wrap:break-word;">2022EAU指南肾细胞癌(1):内容变化部分</h1><h2 style="font-size:16px;color:#999999;word-wrap:break-word;"><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">2022-04-26</em><em style="font-style:normal;margin-right:10px;color:#7f7f7f;display:inline-block;">原创:医学镜界</em></h2></div><h3><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">1.5. 发布历史和更改摘要</span></h3><h4><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">1.5.1. 出版历史</span></h4><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">EAU RCC指南于2000年首次发布。这份2022年RCC指南文件是对2021年出版物的重大更新。</span></p><h4><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">1.5.2. 更改摘要</span></h4><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">《2022年RCC指南》的所有章节均已根据2021年版《指南》进行了更新。在整个文档中添加了引用。</span></p><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">以下各节中包含了新数据,导致证据摘要和建议发生变化:</span></p><h4><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">5.4 RCC诊断评估的证据和建议摘要</span></h4><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; visibility: visible;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; visibility: visible;" class="firstRow"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; visibility: visible; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">建议</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; visibility: visible; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强度等级</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; visibility: visible;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; visibility: visible; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在考虑全身治疗或细胞减灭性肾切除术时,为转移患者提供脑部 CT/MRI。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; visibility: visible; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">弱</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; visibility: visible;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; visibility: visible; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">不要对囊性肾肿块进行肾肿瘤活检,除非在影像学检查中可见明显的固体成分。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; visibility: visible; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强</span></p></td></tr></tbody></table><h4><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">5.5 RCC遗传评估的证据和建议摘要</span></h4><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; visibility: visible;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; visibility: visible;" class="firstRow"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; visibility: visible; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">证据摘要</span></p></td><td width="8%" style="margin: 0px; padding: var(--spacing-md); outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; font-size: var(--font-size-md); line-height: var(--lineHeight-md); color: inherit; font-family: var(--font-family-secondary); font-weight: var(--font-weight-secondary-bold); letter-spacing: -1px; visibility: visible; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">L</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; visibility: visible;"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; visibility: visible; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">遗传性肾癌被认为占所有肾癌病例的5-8%,尽管这个数字可能被低估了。</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; visibility: visible; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">3</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; visibility: visible;"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; visibility: visible; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在肾癌的情况下,如果患者的年龄为46岁或更年轻,和/或伴有双侧或多灶性肿瘤和/或具有RCC的一级或二级亲属和/或具有已知致病变异和/或具有特定组织学特征的近亲(见文本),则风险或遗传性癌症显着更高。</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; visibility: visible; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">3</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important; visibility: visible;"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; visibility: visible; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">遗传性RCC检测对决策和随访具有独特的意义。</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; visibility: visible; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">3</span></p></td></tr></tbody></table><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">建议</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强度等级</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对 46 岁&lt;、双侧或多灶性肿瘤和/或 RCC 一级或二级亲属和/或具有已知致病变异和/或特定组织学特征的近亲进行遗传评估,提示存在遗传性 RCC。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">如果疑似遗传性肾癌,将患者转诊至癌症遗传学家或综合临床护理中心。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强</span></p></td></tr></tbody></table><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">7.1.2.2.4 局部RCC治疗的证据和建议摘要</span></p><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">建议</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强度等级</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">不要为器官受限疾病患者提供扩展淋巴结清扫术。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">弱</span></p></td></tr></tbody></table><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">7.1.3.4 根治性和部分性肾切除术的证据和建议摘要</span></p><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">证据摘要</span></p></td><td width="8%" style="margin: 0px; padding: var(--spacing-md); outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; font-size: var(--font-size-md); line-height: var(--lineHeight-md); color: inherit; font-family: var(--font-family-secondary); font-weight: var(--font-weight-secondary-bold); letter-spacing: -1px; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">L</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">经腹膜和腹膜后腹腔镜 PN 在术后手术和躯体并发症、手术切缘阳性和肾功能方面没有差异。</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">2a</span></p></td></tr></tbody></table><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">建议</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强度等级</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">加强手术切缘阳性患者的随访,尤其是上期 pT3a 患者。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">弱</span></p></td></tr></tbody></table><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">7.2.4.3 静脉肿瘤血栓RCC治疗的证据和建议摘要</span></p><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">建议</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强度等级</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在肾切除术期间,切除临床上肿大的淋巴结以进行分期,预后和随访意义。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">弱</span></p></td></tr></tbody></table><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">7.2.5.1 新辅助和辅助治疗的证据和建议摘要</span></p><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="473" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">证据摘要</span></p></td><td width="61" style="margin: 0px; padding: var(--spacing-md); outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; font-size: var(--font-size-md); line-height: var(--lineHeight-md); color: inherit; font-family: var(--font-family-secondary); font-weight: var(--font-weight-secondary-bold); letter-spacing: -1px; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">L</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="NaN" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">辅助 TKI 治疗不能改善肾切除术后的 OS。</span></p></td><td width="61" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">1b</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="NaN" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在高危 RCC 患者肾切除术后辅助使用派姆单抗可提高无进展生存期。</span></p></td><td width="61" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">1b</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="NaN" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在一项随机对照试验中,在选定的中/高危或高危患者或无疾病证据的 M1 患者中,辅助 pembrolizumab 可提高无病生存率。</span></p></td><td width="61" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">1b</span></p></td></tr></tbody></table><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">建议</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强度等级</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">对于手术后具有治愈意图且存在试验中定义的复发风险的透明细胞 (cc) RCC 患者,提供 pembrolizumab 辅助治疗。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">弱</span></p></td></tr></tbody></table><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">*pT2 G4 或 pT3 任何 G;pT4 任何 G;pN+ 任何 G。</span></p><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">7.3.2.6 转移性RCC转移灶局部治疗的证据和建议摘要</span></p><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">证据摘要</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">乐</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">一项单臂前瞻性和回顾性研究支持,在由于进展而需要全身治疗之前,寡异构酶可观察到长达 16 个月。</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">2a</span></p></td></tr></tbody></table><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">建议</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强度等级</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在转移灶切除术前对疾病状态进行确认性轴向扫描,以排除需要全身治疗的快速进行性转移性疾病。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">弱</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在开始对无法切除的寡变异酶进行全身治疗之前,请与您的患者讨论观察期,直到确认进展。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">弱</span></p></td></tr></tbody></table><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">7.4.2.4 透明细胞转移性RCC靶向治疗的证据和建议摘要</span></p><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">建议</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强度等级</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">为具有肉瘤样特征的晚期 cc-mRCC 提供免疫检查点抑制剂联合治疗。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">弱</span></p></td></tr></tbody></table><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">7.4.4.1.2 透明细胞转移性RCC免疫治疗的证据和建议摘要</span></p><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">证据摘要</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">乐</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td colspan="2" width="100%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">测序全身治疗</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">Nivolumab加ipilimumab与15%的3-5级毒性和1.5%的治疗相关死亡相关。基于酪氨酸激酶抑制剂的IO联合疗法与3-5级毒性相关,在治疗相关死亡中,61-72%至1%。。</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">1b</span></p></td></tr></tbody></table><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">建议</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强度等级</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td colspan="2" width="100%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">未接受治疗的患者</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在一两线治疗后,为免疫检查点抑制剂 -初见血管内皮生长因子受体 (VEGFR)-难治性透明细胞转移性肾细胞癌 (cc-mRCC) 提供 nivolumab 或 cabozantinib。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强</span></p></td></tr></tbody></table><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">7.4.4.1.3.1 具有肉瘤样特征的RCC靶向治疗的证据和建议摘要</span></p><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">证据摘要</span></p></td><td width="8%" style="margin: 0px; padding: var(--spacing-md); outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; font-size: var(--font-size-md); line-height: var(--lineHeight-md); color: inherit; font-family: var(--font-family-secondary); font-weight: var(--font-weight-secondary-bold); letter-spacing: -1px; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">L</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在具有肉瘤样特征的cc-RCC的试验亚组分析中,免疫检查点抑制剂联合治疗在PFS和OS方面优于舒尼替尼。</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">2a</span></p></td></tr></tbody></table><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">建议</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强度等级</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">为具有肉瘤样特征的晚期 cc-mRCC 提供免疫检查点抑制剂联合治疗。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">弱</span></p></td></tr></tbody></table><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">7.4.4.2.1 非透明细胞转移性RCC靶向治疗的证据和建议摘要</span></p><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">证据摘要</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">乐</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">mTOR抑制剂和VEGF靶向治疗在非cc-mRCC中的活性均有限。舒尼替尼优于依维莫司的肿瘤学结局没有显著趋势。</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">2a</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在非cc-mRCC中,在II期试验和患者亚组的系统评价中,舒尼替尼比依维莫司改善了PFS。</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">2a</span></p></td></tr></tbody></table><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">建议</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强度等级</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; padding: var(--spacing-md); outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; font-size: var(--font-size-sm); line-height: var(--lineHeight-lg); overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">向乳头状 RCC 以外的其他非 ccRCC 亚型患者提供舒尼替尼。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">弱</span></p></td></tr></tbody></table><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">7 . 4 . 4 . 3 . 1 状转移性 RCC 靶向治疗的证据和建议摘要</span></p><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">证据摘要</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">乐</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">Cabozantinib在晚期pRCC患者中改善了PFS优于舒尼替尼,无需额外的分子检测。</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">2a</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">与舒尼替尼相比,萨沃利替尼在 MET 驱动的晚期 pRCC 患者中改善了 PFS。</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">2a</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">Pembrolizumab在pRCC亚组的单组研究中导致长期中位OS。</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">2a</span></p></td></tr></tbody></table><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">建议</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强度等级</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; padding: var(--spacing-md); outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; font-size: var(--font-size-sm); line-height: var(--lineHeight-lg); overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">向晚期乳头状 RCC ( pRCC )患者提供卡博替尼,无需进行分子检测。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">弱</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">向 MET 驱动的晚期 pRCC 患者提供沃利替尼。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">弱</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">向晚期 pRCC 患者提供 pembrolizumab,无需进行分子检测。</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">弱</span></p></td></tr></tbody></table><h5><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">7.5.1 局部疾病治疗后局部复发性RCC的证据和建议摘要</span></h5><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">证据摘要</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">乐</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在没有全身进展的情况下,应考虑手术或经皮治疗局部复发,特别是在没有不良预后参数和良好体力状态的情况下。</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">3</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="92%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">未确定保留肾单位或肾切除术后局部复发性 RCC 的最佳局部治疗方式。</span></p></td><td width="8%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">3</span></p></td></tr></tbody></table><table width="572"><tbody style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;" class="firstRow"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">建议</span></p></td><td width="18%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">强度等级</span></p></td></tr><tr style="margin: 0px; padding: 0px; outline: 0px; max-width: 100%; box-sizing: border-box; overflow-wrap: break-word !important;"><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><p><span class="ysz-ueditor-content" style="font-size: 16px; line-height: 28px; color: rgb(0, 0, 0);">在技术上可行的情况下,在平衡不良预后特征、合并症和预期寿命后,对局部复发性疾病进行局部治疗。</span></p></td><td width="82%" style="margin: 0px; outline: 0px; word-break: break-all; max-width: 100%; box-sizing: border-box; min-width: 100px; vertical-align: top; overflow-wrap: break-word !important;"><br/></td></tr></tbody></table><p><br/></p>

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