Clinical pathway of kidney cancer

Kidney cancer, primarily renal cell carcinoma, comprises about ۹۰% of renal malignancies and is rising globally. Diagnosis has recently improved through advancements in imaging techniques and biomarker development, enabling earlier detection and better staging. Despite breakthroughs in immunotherapies and targeted treatments, the prognosis for advanced-stage kidney cancer remains poor, with less than a ۱۵% five-year survival rate. Current literature highlights the urgent need for personalized treatment approaches and clinical pathways to enhance patient outcomes and reduce treatment variability, ensuring comprehensive care across all stages of the disease. This study employed a systematic review method. From ۲۰۱۶ to ۲۰۲۴, evidence was searched in international databases such as PubMed, WOS, Scopus, and Google Scholar, using keywords including Kidney Cancer, Surveillance, treatment option, and Clinical Pathway. The search process and data analysis were based on the PRISMA checklist. In total, ۳۶ original articles were analyzed that met inclusion criteria of being freely accessible, written in English, and employing a prospective observational methodology. Recent studies concerning the clinical pathway for kidney cancer emphasize the importance of a multidisciplinary approach to improving patient outcomes at every stage of the disease. Advances in diagnostic techniques, such as multiphasic CT and MRI imaging, along with the implementation of molecular biomarkers, have significantly improved early detection capabilities and the accuracy of staging processes. Personalized treatment plans that are guided by molecular profiling and risk stratification have become central to modern clinical pathways, leading to tailored therapeutic strategies. For localized kidney cancer, nephron-sparing surgery is regarded as the standard of care, while robotic-assisted procedures show promise in decreasing recovery times and minimizing complications. The clinical pathway emphasizes transitioning from standard therapies when the disease is advanced or has metastasized toward immunotherapy and targeted treatments, such as immune checkpoint inhibitors like nivolumab and pembrolizumab, and tyrosine kinase inhibitors like sunitinib and pazopanib. These therapies have demonstrated improved progression-free survival rates compared to previous standards of care. Additionally, clinical pathways now include routine monitoring through imaging and biomarkers, emphasizing the need to adjust therapy based on disease progression. Follow-ups are increasingly personalized, considering the patient's overall condition, treatment responses, and recurrence risks. Supportive care focusing on quality of life and symptom management has also been underscored, promoting a holistic approach to kidney cancer management. Overall, the clinical process in kidney cancer treatment involves: prevention and early diagnosis, initial evaluations incorporating imaging and biomarkers, definitive diagnosis, treatment plan formulation, initiation of treatment, symptom management, and adjustments in case of metastasis or recurrence. In cases of treatment failure, end-of-life care is also provided. The results indicate that attention and action are needed in the stages of prevention and early diagnosis of this cancer. Performing these measures over the long term can decrease the costs imposed on the health system.

کلیدواژه ها:

Kidney Cancer ، Surveillance ، Treatment options ، Clinical Pathway ، Diagnosis