Editor's Note: Kidney cancer is one of the three most common urological tumors in China, with an increasing incidence rate in recent years. As surgical techniques and new treatment strategies for kidney cancer have advanced, patient survival rates have also improved. At the 2024 Annual Meeting of the Urological Surgeon Branch of the Chinese Medical Doctor Association (CUDA) in Xi'an, Urology Frontier invited Dr. Zhisong He from Peking University First Hospital to share insights on the development of kidney cancer surgery in China, second-line treatments for advanced kidney cancer, and progress in the national kidney cancer quality control project.Urology Frontier: How do you perceive the rapid advancements in kidney cancer surgical techniques in China in recent years (such as laparoscopy, robotics, vena cava tumor thrombus, and complex nephron-sparing surgeries)?
Dr. Zhisong He: This is indeed a hot topic among surgeons. Over the past 20-30 years, with the improvement in economic levels, the accessibility of surgical equipment in China has greatly improved. Urologists actively participating in international exchanges and collaborations have also led to significant enhancements in the concepts and methods of kidney cancer surgery. On one hand, large medical centers such as top-tier hospitals can now effectively perform nephron-sparing surgeries. On the other hand, several major centers in China (such as the PLA General Hospital, Peking University First Hospital, and Peking University Third Hospital) have accumulated extensive experience in diagnosing and treating locally advanced kidney cancer, particularly cases involving vena cava tumor thrombus. In terms of patient volume, these centers are now among the leading in the world. Academician Zhang Xu’s team at the PLA General Hospital has published numerous clinical studies in top international urology journals. These studies have not only elevated China’s standards for treating kidney cancer with vena cava tumor thrombus but also provided valuable diagnostic and treatment experience to international colleagues.
Furthermore, with the advancement of medical device development in China, domestic surgical robots are continuously emerging. Currently, four brands have undergone multiple clinical studies, with some already being used in clinical practice. These domestic robots are convenient and safe to use, catering to the specific needs of Chinese patients. In terms of performance, they are fully comparable to the internationally renowned Da Vinci surgical robot system. Additionally, Chinese surgical robots have introduced various innovations, such as dual-surgeon dual-console robots. It can be said that China’s surgical robot concepts, technologies, and methods are at the forefront of international standards.
Urology Frontier: The CONCEPT clinical study analyzed second-line treatment options for metastatic kidney cancer. Could you briefly introduce the study’s findings and clinical significance?
Dr. Zhisong He: Currently, various international guidelines recommend first-line targeted therapy combined with immunotherapy for patients with advanced kidney cancer. However, in China, PD-1 inhibitors have long lacked the necessary indications and insurance coverage, leading to the more frequent use of targeted monotherapy in first-line treatments in clinical practice. After the failure of targeted therapy, guidelines recommend clinically accessible drugs such as everolimus, axitinib, sunitinib, and sorafenib, but these treatments often have limited efficacy and do not fully meet patient needs. The CONCEPT clinical study further explored second-line treatment strategies for this subset of patients. The study found that everolimus combined with vorolanib provided a 10-month progression-free survival (PFS) benefit compared to everolimus monotherapy in patients with advanced kidney cancer, representing one of the longer PFS benefits currently seen in second-line treatments for advanced kidney cancer. This multi-center, three-arm, randomized controlled study provides a new second-line treatment option for kidney cancer patients in China with high-level evidence.
Urology Frontier: The goal of the tumor quality control project is to promote the standardization, homogenization, and normalization of tumor diagnosis and treatment nationwide, ultimately improving patient survival and quality of life. Could you provide an update on the progress of the kidney cancer quality control project in China?
Dr. Zhisong He: Quality control for specific diseases is also a requirement for the high-quality development of national tertiary public hospitals. The “National Tertiary Public Hospital Performance Assessment Operational Manual (2024 Edition)” issued by the National Health Commission includes specific requirements for kidney cancer, such as TNM staging at initial diagnosis, pathological diagnosis before non-surgical treatment, postoperative TNM staging, and perioperative mortality. Although TNM staging is relatively easy to implement, it is not yet widely practiced, so there is a need to strengthen staging to enable more scientific and individualized treatment, balancing tumor control and quality of life for patients. This is crucial for improving kidney cancer treatment levels in China.
In 2022, 20 quality control standards were established, and in 2023, 11 standards were finally approved by the National Health Commission, with only four included in the 2024 national examination indicators. This suggests that quality control work needs to progress gradually. I believe that the diagnosis and treatment concepts and methods for kidney cancer in China’s first-tier cities are on par with those of any other country. However, there is still significant room for improvement in the treatment levels of grassroots hospitals. We hope that the kidney cancer quality control project will help improve the diagnosis and treatment levels of kidney cancer nationwide, ultimately benefiting more patients.
Dr. Zhisong He
Chief Physician, Professor, Doctoral Supervisor Department of Urology, Peking University First Hospital Deputy Director, Urology Research Institute, Peking University Council Member, Chinese Society of Clinical Oncology (CSCO) Chairman, Urothelial Cancer Committee, CSCO Vice Chairman, Prostate Cancer Committee, CSCO Vice Chairman, Kidney Cancer Committee, CSCO Vice Chairman, Male Reproductive System Tumors Committee, Chinese Anti-Cancer Association Member, Oncology Group, Urology Branch, Chinese Medical Association Vice President, Urology Surgeon Branch, Chinese Medical Doctor Association (CUDA) Vice Chairman, Integrated Urology Committee, Integrated Medicine Branch, Chinese Medical Doctor Association Member, Enhanced Recovery After Surgery Committee, China International Exchange and Promotive Association for Medical and Health Care Member, Urology Branch, Beijing Medical Association Executive Director, Urology Specialist Branch, Beijing Medical Doctor Association
