Rigaud Jérôme, Hétet Jean-François, Braud Guillaume, Battisti Simon, Le Normand Loïc, Glemain Pascal, Karam Georges, Bouchot Olivier
Service d'Urologie, Hôtel Dieu, Nantes, France.
Prog Urol. 2006 Jun;16(3):297-302.
The objective of this study was to evaluate survival and risk of recurrence in patients undergoing nephrectomy with resection of inferior vena cava tumour thrombus in our department.
From June 1991 to March 2003, 40 patients underwent radical nephrectomy with resection of inferior vena cava tumour thrombus. The upper limit of the tumour thrombus was below the hepatic veins in 21 cases (52.5%) and above the hepatic veins in 19 cases (47.5%), with thrombus in the right atrium in 6 cases (15%). Cardiopulmonary bypass (CPB) was used in 12 patients (30%)
With a mean follow-up of 28.5 +/- 36.8 months (range: 0-150), 22 patients (55%) have died. The 2- and 5-year overall survival rates were 45.2% and 38. 7%, respectively. Local and/or metastatic recurrence was observed in 28 patients (70%) after a mean interval of 18 +/- 22.9 months (range: 1-104). Patients with tumour thrombus derived from the left kidney had a higher local recurrence rate than patients with thrombus derived from the right kidney (p = 0.0194). The 2- and 5-year recurrence-free survival rates were 28.3% and 8.9%, respectively. Only stage pN had a statistically significant prognostic value on overall survival, but not on recurrence-free survival. At the end of the study, only 1 patient (2.5%) can be considered to be cured with no disease progression with a sufficient follow-up (52 months) after nephrectomy.
Nephrectomy with resection of tumour thrombus from the inferior vena cava provides a gain in terms of medium-term survival, but the majority of patients are not cured by this major surgery. Only lymph node status has a prognostic value.
本研究的目的是评估在我院接受肾切除术并切除下腔静脉肿瘤血栓的患者的生存率和复发风险。
1991年6月至2003年3月，40例患者接受了根治性肾切除术并切除下腔静脉肿瘤血栓。肿瘤血栓上限位于肝静脉以下的有21例（52.5%），位于肝静脉以上的有19例（47.5%），其中6例（15%）血栓位于右心房。12例患者（30%）使用了体外循环（CPB）。
平均随访28.5±36.8个月（范围：0 - 150个月），22例患者（55%）死亡。2年和5年总生存率分别为45.2%和38.7%。28例患者（70%）在平均18±22.9个月（范围：1 - 104个月）的间隔后出现局部和/或远处复发。来自左肾的肿瘤血栓患者的局部复发率高于来自右肾的血栓患者（p = 0.0194）。2年和5年无复发生存率分别为28.3%和8.9%。仅pN分期对总生存有统计学显著的预后价值，但对无复发生存无此价值。在研究结束时，只有1例患者（2.5%）在肾切除术后经过足够的随访（52个月）可被认为治愈且无疾病进展。
肾切除术并切除下腔静脉肿瘤血栓在中期生存方面有一定益处，但大多数患者不能通过这种大型手术治愈。只有淋巴结状态具有预后价值。
