Department of Urology, Dongguk University, Seoul National University College of Medicine, Seoul, Korea.
Int Braz J Urol. 2013 May-Jun;39(3):353-63. doi: 10.1590/S1677-5538.IBJU.2013.03.08.
To study the surgical outcomes of radical nephrectomy with thrombectomy and to determine prognostic factors for survival of Korean patients with renal cell carcinoma (RCC) and venous tumor thrombus.
A total of 124 patients with RCC and venous tumor thrombus who underwent radical nephrectomy and thrombectomy were included in this retrospective study. Cancer-specific survival (CSS) and recurrence-free survival (RFS) rates were analyzed retrospectively according to various prognostic factors.
The median overall follow-up period for all patients was 29.0 months; the median survival period was 50.0 months. The 2-, 5- and 10-year CSS rates for all patients were 64.2%, 47.1% and 31.7%, respectively. Those for 76 patients (pN0/xM0) without metastasis at presentation were 80.9%, 64.5% and 44.9%, respectively. For all patients, lower body mass index (BMI), higher Fuhrman grade, presence of symptoms, perinephric fat invasion, invasion of inferior vena cava (IVC) wall, lymph node (LN) involvement and distant metastasis at presentation were independent predictors for decreased CSS on multivariate analysis, while thrombus level was not. For non-metastatic patients, lower BMI, presence of symptoms and tumor size were independently associated with decreased CSS. In terms of RFS, lower BMI, presence of perinephric fat invasion were prognostic factors for recurrence.
Our data suggest that obesity is independently associated with better survival or lower risk of tumor recurrence in Korean patients undergoing radical nephrectomy with tumor thrombectomy. Also, our results indicate that Fuhrman grade, presence of symptoms, perinephric fat invasion and invasion of IVC wall, LN involvement and distant metastasis at presentation are independent predictors for survival.
研究根治性肾切除术联合血栓切除术的手术效果，并确定韩国肾细胞癌（RCC）伴静脉肿瘤血栓患者的生存预后因素。
本回顾性研究共纳入 124 例行根治性肾切除术和血栓切除术的 RCC 伴静脉肿瘤血栓患者。根据各种预后因素，回顾性分析癌症特异性生存（CSS）和无复发生存（RFS）率。
所有患者的中位总随访时间为 29.0 个月；中位生存时间为 50.0 个月。所有患者的 2 年、5 年和 10 年 CSS 率分别为 64.2%、47.1%和 31.7%。76 例（pN0/xM0）无转移患者的 CSS 率分别为 80.9%、64.5%和 44.9%。对于所有患者，较低的体重指数（BMI）、较高的 Fuhrman 分级、存在症状、肾周脂肪浸润、侵犯下腔静脉（IVC）壁、淋巴结（LN）受累和远处转移是多因素分析中 CSS 降低的独立预测因素，而血栓水平不是。对于无转移患者，较低的 BMI、存在症状和肿瘤大小与 CSS 降低独立相关。就 RFS 而言，较低的 BMI、肾周脂肪浸润是复发的预后因素。
我们的数据表明，肥胖与韩国行根治性肾切除术联合肿瘤血栓切除术患者的生存或肿瘤复发风险降低独立相关。此外，我们的结果表明，Fuhrman 分级、存在症状、肾周脂肪浸润和 IVC 壁侵犯、LN 受累和远处转移是生存的独立预测因素。
