Integrating Surgery with Targeted Therapies for Renal Cell Carcinoma: Maximizing Benefits, Minimizing Risk

摘要

In a paper written in 1995, Sackett and Rosenberg, among the early proponents of evidence-based medicine, defined it as a process where "clinically important information about diagnosis, prognosis, therapy, cost, utility and other clinical and health care issues are considered and converted to answerable questions," and they commented that "the results of this appraisal are applied to our clinical practice" [1]. Many urologists follow this credo, but what should we do when the best evidence available is poor?Urologic oncology currently has such a scenario in relation to renal cell carcinoma (RCC) and the use of the new class of targeted drugs. As outlined in the article in this issue by Bex et al, the new approaches to treatment stemming from the development of new agents and data on improved efficacy in advanced RCC have generated considerable uncertainty about how to manage such cases, without providing an evidence base to guide clinicians on how to deal with the consequences of the altered clinical environment [2].