Kirkali Ziya, Van Poppel Hein
Dokuz Eylul University School of Medicine, Department of Urology, Izmir, Turkey.
Eur Urol. 2007 Sep;52(3):658-62. doi: 10.1016/j.eururo.2007.05.009. Epub 2007 May 24.
Patients with kidney cancer with venous system involvement are at high risk of cancer recurrence even after the tumor thrombus is successfully removed. This review analyzes the impact on prognosis of the level of involvement of the inferior vena cava (IVC) in renal cell carcinoma (RCC).
A literature search was done and relevant papers were reviewed. Relatively recent papers as well as large series or papers from expert centers are included in the reference list.
Venous invasion in RCC is a major challenge for urologists and patients with venous involvement have a worse prognosis. Although successful removal of a tumor thrombus in the renal vein and IVC may result in improved long-term survival in more than half of the affected patients, a higher level of thrombus appears to be a bad prognosticator for cancer recurrence. A complete IVC thrombectomy, even in the metastatic setting, provides a better quality of life and may prolong survival.
Because surgery still remains the most effective therapeutic option in patients wtih RCC, every attempt should be made to completely remove the IVC thrombus. New targeted agents could be promising as adjuvant therapy in this subset of patients.
即使肿瘤血栓成功切除，伴有静脉系统受累的肾癌患者仍有较高的癌症复发风险。本综述分析了肾细胞癌（RCC）中肾静脉受累水平对预后的影响。
进行文献检索并回顾相关论文。参考文献列表中纳入了相对近期的论文以及大型系列研究或来自专家中心的论文。
RCC中的静脉侵犯是泌尿外科医生面临的主要挑战，静脉受累的患者预后较差。尽管成功切除肾静脉和下腔静脉（IVC）中的肿瘤血栓可能会使超过一半的受影响患者长期生存得到改善，但血栓水平较高似乎是癌症复发的不良预后指标。即使在转移情况下，完整切除IVC血栓也能提高生活质量并可能延长生存期。
由于手术仍然是RCC患者最有效的治疗选择，应尽一切努力完全切除IVC血栓。新的靶向药物有望作为这部分患者的辅助治疗。
