Hutchinson Ryan, Rew Charles, Chen Gong, Woldu Solomon, Krabbe Laura-Maria, Meissner Matthew, Sheth Kunj, Singla Nirmish, Shakir Nabeel, Master Viraj A, Karam Jose A, Matin Surena F, Borregales Leonardo D, Wood Christopher, Masterson Timothy, Thompson R Houston, Boorjian Stephen A, Leibovich Bradley C, Abel E Jason, Bagrodia Aditya, Margulis Vitaly
Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX.
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Urology. 2018 May;115:119-124. doi: 10.1016/j.urology.2018.02.019. Epub 2018 Feb 27.
To characterize the presence of bland (nontumor) thrombus in advanced renal cell carcinoma and assess the impact of this finding on cancer-specific survival.
A multi-institutional database of patients treated with nephrectomy with caval thrombectomy for locally-advanced renal tumors was assembled from 5 tertiary care medical centers. Using clinicopathologic variables including patient age, body mass index, Eastern Cooperative Oncology Group performance status, tumor stage, grade, nodal status and histology, and nearest-neighbor and multiple-matching propensity score matched cohorts of bland thrombus vs nonbland thrombus patients were assessed. Multivariable analysis for predictors of cancer-specific survival was performed.
From an initial cohort of 579 patients, 446 met inclusion criteria (174 with bland thrombus, 272 without). At baseline, patients with bland thrombus had significantly worse performance status, higher tumor stage, higher prevalence of regional nodal metastases and higher nuclear grade (P < .01 for all). In both nearest-neighbor and multiple-matching propensity score matched cohorts, the presence of bland thrombus presence was associated with inferior median cancer-specific survival (28.1 months vs 156.8 months, and 28.1 months vs 76.7 months, P < .001 for both). The presence of bland thrombus remained independently associated with an increased risk of cancer-specific mortality on multivariable analysis (hazard ratio 4.33, 95% confidence interval 2.79-6.73, P < .001).
Presence of bland thrombus is associated with adverse survival outcomes in patients treated surgically for renal tumors with venous tumor thrombus. These findings may have important implications in patient counseling, selection for surgery and inclusion in clinical trials.
明确晚期肾细胞癌中单纯性（非肿瘤性）血栓的存在情况，并评估这一发现对癌症特异性生存的影响。
从5家三级医疗中心收集了接受肾切除术及腔静脉血栓切除术治疗局部晚期肾肿瘤患者的多机构数据库。利用包括患者年龄、体重指数、东部肿瘤协作组体能状态、肿瘤分期、分级、淋巴结状态和组织学等临床病理变量，对单纯性血栓患者与非单纯性血栓患者进行最近邻匹配和多匹配倾向评分匹配队列评估。对癌症特异性生存的预测因素进行多变量分析。
在最初的579例患者队列中，446例符合纳入标准（174例有单纯性血栓，272例无）。基线时，有单纯性血栓的患者体能状态明显更差，肿瘤分期更高，区域淋巴结转移患病率更高，核分级更高（所有P均<0.01）。在最近邻匹配和多匹配倾向评分匹配队列中，单纯性血栓的存在均与较差的中位癌症特异性生存相关（分别为28.1个月对156.8个月，以及28.1个月对76.7个月，两者P均<0.001）。多变量分析显示，单纯性血栓的存在仍然独立地与癌症特异性死亡风险增加相关（风险比4.33，95%置信区间2.79 - 6.73，P<0.001）。
对于接受手术治疗伴有静脉肿瘤血栓的肾肿瘤患者，单纯性血栓的存在与不良生存结局相关。这些发现可能对患者咨询、手术选择及纳入临床试验具有重要意义。
