Terakawa Tomoaki, Miyake Hideaki, Takenaka Atsushi, Hara Isao, Fujisawa Masato
Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
Int J Urol. 2007 Sep;14(9):781-4. doi: 10.1111/j.1442-2042.2007.01749.x.
The objective of this study was to evaluate the clinical outcome after surgical management of renal cell carcinoma (RCC) extending to the inferior vena cava (IVC).
This study included a total of 55 patients (41 men and 14 women; mean age, 59.3 years) with RCC (39 right- and 16 left-sided tumors) involving the IVC, who underwent radical nephrectomy and tumor thrombectomy between 1983 and 2005 at a single institution in Japan. The level of thrombus was classified as follows: level I, infrahepatic; level II, intrahepatic; level III, suprahepatic; and level IV, extending to the atrium. Clinicopathological data from these patients were retrospectively reviewed to identify factors associated with survival.
There were 11 and 18 patients who were diagnosed as having lymph node and distant metastases, respectively. Twenty-two patients had tumor thrombus in level I, 20 in level II, 10 in level III, and 3 in level IV. Pathological examinations demonstrated that 34 and 21 patients had clear cell carcinoma and non-clear cell carcinoma, respectively, 42, 9 and 4 were pT3b, pT3c and pT4, respectively, and 6, 35 and 14 were Grades 1, 2 and 3, respectively. Cancer-specific 1-, 3- and 5-year survival rates of these 55 patients were 74.5%, 51.4% and 30.3%, respectively. Among several factors examined, clinical stage (P = 0.047), lymph node metastasis (P = 0.016), histological subtype (P = 0.034) and tumor grade (P < 0.001) were significantly associated with cancer-specific survival by univariate analysis. Furthermore, multivariate analysis demonstrated clinical stage (P = 0.037) and tumor grade (P < 0.001) as independent predictors of cancer-specific survival irrespective of other significant factors identified by univariate analysis.
In patients with RCC involving the IVC, biological aggressiveness characterized by tumor grade rather than tumor extension would have more potential prognostic importance; therefore, more intensive multimodal therapy should be considered in patients with high grade RCC with tumor thrombus extending into the IVC.
本研究的目的是评估手术治疗累及下腔静脉（IVC）的肾细胞癌（RCC）后的临床结局。
本研究共纳入55例累及IVC的RCC患者（41例男性和14例女性；平均年龄59.3岁），这些患者于1983年至2005年在日本的一家机构接受了根治性肾切除术和肿瘤血栓切除术。血栓水平分类如下：I级，肝下；II级，肝内；III级，肝上；IV级，延伸至心房。对这些患者的临床病理数据进行回顾性分析，以确定与生存相关的因素。
分别有11例和18例患者被诊断为有淋巴结转移和远处转移。22例患者血栓位于I级，20例位于II级，10例位于III级，3例位于IV级。病理检查显示，34例和21例患者分别为透明细胞癌和非透明细胞癌，42例、9例和4例分别为pT3b、pT3c和pT4，6例、35例和14例分别为1级、2级和3级。这55例患者的癌症特异性1年、3年和5年生存率分别为74.5%、51.4%和30.3%。在检查的几个因素中，单因素分析显示临床分期（P = 0.047）、淋巴结转移（P = 0.016）､组织学亚型（P = 0.034）和肿瘤分级（P < 0.001）与癌症特异性生存显著相关。此外，多因素分析表明，无论单因素分析确定的其他显著因素如何，临床分期（P = 0.037）和肿瘤分级（P < 0.001）是癌症特异性生存的独立预测因素。
在累及IVC的RCC患者中，以肿瘤分级而非肿瘤延伸为特征的生物学侵袭性可能具有更大的潜在预后重要性；因此，对于肿瘤血栓延伸至IVC的高级别RCC患者，应考虑更强化的多模式治疗。
