Hirono Masanori, Kobayashi Mikio, Tsushima Tomoyasu, Obara Wataru, Shinohara Nobuo, Ito Keiichi, Eto Masatoshi, Takayama Tatsuya, Fujii Yasuhisa, Nishikido Masaharu, Kimura Go, Kishida Takeshi, Takahashi Masayuki, Miyao Noriomi, Naya Yukio, Abe Takashige, Fujioka Tomoaki, Ito Kazuto, Naito Seiji
Division of Urology, Isesaki Municipal Hospital, 12-1, Tsunatori-hon-machi, 372-0817 Isesaki, Gunma, Japan.
BMC Cancer. 2013 Oct 2;13:447. doi: 10.1186/1471-2407-13-447.
Although the percentage of patients with renal cell carcinoma (RCC) extending into venous systems is unexpectedly high, the prognostic impact and independency of venous tumor thrombus-related factors on overall survival (OS) remain controversial. Furthermore, the prognostic impact of various clinicopathologic factors including tumor thrombus-related factors on OS may change with elapsed years after the intervention and also with follow-up duration of participants. The aim of the study is to explore independent and universal predictive preoperative and intraoperative clinicopathologic factors on OS in patients with RCC extending into venous systems using subgroup analysis in terms of restricted follow-up duration and yearly-based survivors.
Between 1980 and 2009, 292 patients diagnosed with RCC with venous tumor thrombus were retrospectively registered for this study. The prognostic impacts of various clinicopathologic and surgical treatment factors including levels of venous thrombus, venous wall invasion status and likelihood of aggressive cytoreductive operation, were investigated using Kaplan-Meier method and following multivariate Cox proportional hazards model for all patients and those still alive at 1, 2, and 3 years of follow-up. To investigate the impact of follow-up duration on the statistical analyses, multivariate logistic regression analyses were used to explore prognostic factors using restricted data until 1, 2, and 3 years of follow-up.
The median follow-up duration was 40.4 months. The 5-year OS was 47.6%. Several independent predictive factors were identified in each subgroup analysis in terms of yearly-based survival and restricted follow-up duration. The presence of tumor thrombus invading to venous wall was independently related to OS in the full-range follow-up data and in survivors at 2 and 3 years of follow-up. Using restricted follow-up data until 1, 2, and 3 years of follow-up, many independent predictive factors changed with follow-up duration, but surgical category could be universal and independent predictive factors.
The most universal factors affecting improvement both in short-term and long-term survivals could be cytoreductive surgery and absence of venous wall invasion. It may mean that feasible aggressive cytoreductive operation following more reliable preoperative imaging for predicting venous wall invasion status would improve OS for patients with RCC extending into venous systems.
尽管肾细胞癌（RCC）侵犯静脉系统的患者比例出奇地高，但静脉瘤栓相关因素对总生存期（OS）的预后影响及独立性仍存在争议。此外，包括瘤栓相关因素在内的各种临床病理因素对OS的预后影响可能会随着干预后的时间推移以及参与者的随访时间而改变。本研究的目的是通过在有限随访时间和逐年生存者的亚组分析，探讨侵犯静脉系统的RCC患者术前和术中独立且通用的OS预测临床病理因素。
1980年至2009年间，292例诊断为伴有静脉瘤栓的RCC患者被纳入本研究进行回顾性登记。使用Kaplan-Meier法以及多变量Cox比例风险模型，研究包括静脉血栓水平、静脉壁侵犯状态和积极减瘤手术可能性在内的各种临床病理和手术治疗因素对所有患者以及随访1、2和3年时仍存活患者的预后影响。为研究随访时间对统计分析的影响，使用多变量逻辑回归分析，利用截至随访1、2和3年的受限数据探索预后因素。
中位随访时间为40.4个月。5年总生存率为47.6%。在基于逐年生存和有限随访时间的各亚组分析中确定了几个独立预测因素。在全范围随访数据以及随访2年和3年的存活者中，瘤栓侵犯静脉壁与总生存期独立相关。使用截至随访1、2和3年的受限随访数据，许多独立预测因素随随访时间而变化，但手术类别可能是通用且独立的预测因素。
影响短期和长期生存改善的最普遍因素可能是减瘤手术和无静脉壁侵犯。这可能意味着，在进行更可靠的术前成像以预测静脉壁侵犯状态后，实施可行的积极减瘤手术将改善侵犯静脉系统的RCC患者的总生存期。
