Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Surg Oncol. 2014 Aug;110(2):145-50. doi: 10.1002/jso.23612. Epub 2014 Apr 3.
To evaluate the impact of surgery on the prognosis of metastatic renal cell carcinoma (mRCC) with inferior vena cava (IVC) thrombus.
In this retrospective study, the medical records of 45 patients who presented with synchronous mRCC with IVC thrombus, between 2005 and 2012, were reviewed. Twenty-eight patients underwent radical nephrectomy with IVC thrombectomy followed by targeted therapy (group 1) and 17 received targeted therapy alone (group 2). Cox proportional hazards regression models served to estimate the prognostic significance of variables.
The median progression-free survival of group 1 and group 2 was 4.1 and 3.5 months, respectively (P = 0.672). Their median overall survival was 17.3 and 19.7 months, respectively (P = 0.353). Multivariate analysis revealed that non-clear cell type RCC (HR = 3.46, P = 0.007) and lymph node metastasis (HR = 2.31, P = 0.003) independently predicted progression-free survival, and Karnofsky performance status (HR = 3.82, P = 0.013) and non-clear cell type RCC (HR = 4.01, P = 0.003) independently predicted overall survival. Surgical resection of the primary renal mass with IVC thrombus did not affect the probability of progression or overall mortality.
Our limited data set would suggest a limited role for surgery in this patient population and that a prospective study in this group may define the role of surgery.
评估手术对合并下腔静脉（IVC）血栓的转移性肾细胞癌（mRCC）患者预后的影响。
本回顾性研究分析了 2005 年至 2012 年间就诊的 45 例合并 IVC 血栓的同步性 mRCC 患者的病历资料。28 例患者接受根治性肾切除术联合 IVC 血栓切除术和靶向治疗（1 组），17 例患者仅接受靶向治疗（2 组）。Cox 比例风险回归模型用于评估变量的预后意义。
1 组和 2 组的中位无进展生存期分别为 4.1 和 3.5 个月（P=0.672），中位总生存期分别为 17.3 和 19.7 个月（P=0.353）。多因素分析显示，非透明细胞型 RCC（HR=3.46，P=0.007）和淋巴结转移（HR=2.31，P=0.003）独立预测无进展生存期，而 Karnofsky 表现状态（HR=3.82，P=0.013）和非透明细胞型 RCC（HR=4.01，P=0.003）独立预测总生存期。原发肾肿瘤合并 IVC 血栓的手术切除并未影响进展或总死亡率的概率。
我们有限的数据表明，手术在该患者人群中的作用有限，对该人群进行前瞻性研究可能有助于明确手术的作用。
