Choi Don Kyoung, Jeon Hwang Gyun, Jeong Chang Wook, Kwak Cheol, Song Cheryn, Chung Jinsoo, Hong Sung Kyu, Hong Sung-Hoo, Seo Seong Il
Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea.
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Int J Urol. 2017 Feb;24(2):102-109. doi: 10.1111/iju.13272. Epub 2017 Jan 22.
To evaluate the impact of morphological features of inferior vena cava thrombus on the overall survival and cancer-specific survival (cancer-specific survival of patients with renal cell carcinoma).
We retrospectively analyzed the records of 156 renal cell carcinoma patients with inferior vena cava thrombus who underwent radical nephrectomy and thrombectomy from 1998 to 2013 at five tertiary centers. Inferior vena cava thrombi were classified as spherical (type I) and spiculated (type II) according to morphological features on computed tomography or magnetic resonance imaging. Multivariate cox regression models were used to quantify the impact of prognostic factors on overall survival and cancer-specific survival.
Type I was found in 29 patients (18.6%), and type II in 127 patients (81.4%). Median follow up was 38.2 months (interquartile range 12-57). Demographic characteristics were not significantly different, except for the cranial thrombus height (P = 0.003). On multivariate analysis, Eastern Cooperative Oncology Group performance score, clinical tumor size, distant metastasis, histologic subtype, thrombus morphology and remnant venous thrombus significantly affected overall survival in pN M patients (all P < 0.05). Among the pN / M patients, clinical tumor size, histologic subtype, thrombus morphology and remnant venous thrombus significantly affected overall survival (all P < 0.05). In terms of cancer-specific survival, Eastern Cooperative Oncology Group performance score, clinical tumor size, distant metastasis, histologic subtype and thrombus morphology significantly affected cancer-specific survival in pN M patients (all P < 0.05). In patients with pN / M , body mass index, clinical tumor size, histological subtype, thrombus morphology and remnant venous thrombus significantly affected cancer-specific survival (all P < 0.05).
Clinical tumor size, histological subtype, and thrombus morphology are independent predictors of overall survival and cancer-specific survival in renal cell carcinoma patients with inferior vena cava thrombus. These factors might be helpful for the surgeon's determination to improve therapeutic efficacy.
评估下腔静脉血栓的形态学特征对总生存期及癌症特异性生存期（肾细胞癌患者的癌症特异性生存期）的影响。
我们回顾性分析了1998年至2013年期间在5个三级中心接受根治性肾切除术和血栓切除术的156例伴有下腔静脉血栓的肾细胞癌患者的记录。根据计算机断层扫描或磁共振成像的形态学特征，将下腔静脉血栓分为球形（I型）和毛刺状（II型）。采用多变量cox回归模型量化预后因素对总生存期和癌症特异性生存期的影响。
29例（18.6%）为I型，127例（81.4%）为II型。中位随访时间为38.2个月（四分位间距12 - 57）。除颅侧血栓高度外（P = 0.003），人口统计学特征无显著差异。多变量分析显示，东部肿瘤协作组体能状态评分、临床肿瘤大小、远处转移、组织学亚型、血栓形态及残余静脉血栓对pN M患者的总生存期有显著影响（均P < 0.05）。在pN / M患者中，临床肿瘤大小、组织学亚型、血栓形态及残余静脉血栓对总生存期有显著影响（均P < 0.05）。在癌症特异性生存期方面，东部肿瘤协作组体能状态评分、临床肿瘤大小、远处转移、组织学亚型及血栓形态对pN M患者的癌症特异性生存期有显著影响（均P < 0.05）。在pN / M患者中，体重指数、临床肿瘤大小、组织学亚型、血栓形态及残余静脉血栓对癌症特异性生存期有显著影响（均P < 0.05）。
临床肿瘤大小、组织学亚型及血栓形态是伴有下腔静脉血栓的肾细胞癌患者总生存期和癌症特异性生存期的独立预测因素。这些因素可能有助于外科医生确定提高治疗效果的方案。
