Bensalah Karim, Guillé François, Vincendeau Sébastien, Rioux-Leclercq Nathalie, Manunta Andréa, Lobel Bernard, Patard Jean-Jacques
Service d'Urologie, Hôpital Pontchaillou, Rennes, France.
Prog Urol. 2004 Apr;14(2):160-6; discussion 165.
The objective of this study was to determine the clinical and histological factors influencing survival of patients with renal cancer and caval thrombus.
The clinical and pathological data of 46 patients operated for renal cancer with caval thrombus were reviewed. The following prognostic factors were studied: tumour stage and grade, tumour diameter, invasion of the perirenal fat or adrenal gland, presence of lymph node involvement or distant metastases, level of the thrombus, invasion of the wall of the vena cava, partial or complete nature of the resection. Survival was determined by the Kaplan-Meier method and multivariate analysis was performed with the Cox test.
The study population comprised 30 males and 16 females with a mean age of 64.4 years. The mean tumour diameter was 10.6 cm. Twelve thrombi were perirenal (26.1%), 15 were infrahepatic (32.6%), 12 were retrohepatic (26.1%), and 7 were supradiaphragmatic (15.2%). Forty four tumours were stage T3 and 2 were stage T4. Fifteen tumours were N1-2 or M1 (32.6%). The median disease-specific survival was 22 months and the 5-year survival rate was 25%. On univariate analysis, complete resection, lymph node invasion and metastases and adrenal gland invasion had an impact on survival. On multivariate analysis, only the presence of metastases had an independent prognostic value.
This study confirms the prognostic value of certain factors (lymph node invasion and metastases, complete tumour resection) and raises the question of the prognostic significance of adrenal gland invasion. On the basis of these data, the authors recommend that surgery should only be performed in patients with a good general status, without metastases and in whom complete resection of the tumour mass appears to be possible.
本研究的目的是确定影响肾癌合并腔静脉血栓患者生存的临床和组织学因素。
回顾性分析46例接受肾癌合并腔静脉血栓手术患者的临床和病理资料。研究了以下预后因素：肿瘤分期和分级、肿瘤直径、肾周脂肪或肾上腺侵犯、淋巴结受累或远处转移情况、血栓水平、腔静脉壁侵犯、切除的部分或完全性质。采用Kaplan-Meier法确定生存率，并使用Cox检验进行多因素分析。
研究人群包括30名男性和16名女性，平均年龄64.4岁。平均肿瘤直径为10.6 cm。12例血栓位于肾周（26.1%），15例位于肝下（32.6%），12例位于肝后（26.1%），7例位于膈上（15.2%）。44例肿瘤为T3期，2例为T4期。15例肿瘤为N1-2或M1期（32.6%）。疾病特异性生存中位数为22个月，5年生存率为25%。单因素分析显示，完整切除、淋巴结侵犯和转移以及肾上腺侵犯对生存有影响。多因素分析显示，只有转移的存在具有独立的预后价值。
本研究证实了某些因素（淋巴结侵犯和转移、肿瘤完整切除）的预后价值，并提出了肾上腺侵犯的预后意义问题。基于这些数据，作者建议仅对一般状况良好、无转移且似乎有可能完整切除肿瘤肿块的患者进行手术。
