Ge Liyuan, Tian Xiaojun, Ma Jing, Zhao Guojiang, Song Yimeng, Zhang Shudong, Ma Lulin
Department of Urology.
Department of Ultrasonography, Peking University Third Hospital, Haidian District, Beijing, PR China.
Medicine (Baltimore). 2019 Sep;98(37):e17172. doi: 10.1097/MD.0000000000017172.
The aim of the study was to report the experience and outcomes of Xp11.2 translocation renal cell carcinoma (tRCC) patients with tumor thrombus undergoing radical nephrectomy and thrombectomy.Between January 2017 and December 2017, 66 consecutive patients with RCC and venous thrombus involvement received surgical treatment at Peking University Third Hospital. Of which, 5 patients were confirmed of Xp11.2 tRCC, 61 patients were diagnosed of non-tRCC subtypes including 45 ccRCCs, 10 pRCCs, and 6 other subtypes. Demographic, clinical, operation, pathological and follow-up data were extracted for analysis. Prognostic factors were identified by Cox regression analysis.All the patients received radical nephrectomy and thrombectomy successfully. During a median follow-up of 18 months, 5 patients in non-tRCC group and 1 patient in tRCC group died of disease progression. Survival analysis revealed that Xp11.2 tRCC patients experienced shorter DFS than non-tRCC patients, however, there is no significant difference in OS between two groups. Xp11.2 tRCC histological subtype and presence of metastasis at diagnosis were identified as independent negative factors of DFS by multivariate analysis.Radical nephrectomy with thrombectomy provides an acceptable efficacy for tRCC patients with tumor thrombus extending into the venous system. In addition, multimodality treatment should be considered for advanced Xp11.2 RCCs as this subtype was a negative prognostic factor of DFS.
本研究旨在报告接受根治性肾切除术和血栓切除术的Xp11.2易位性肾细胞癌(tRCC)合并肿瘤血栓患者的经验和结果。2017年1月至2017年12月,66例连续性肾细胞癌合并静脉血栓累及患者在北京医科大学第三医院接受了手术治疗。其中,5例确诊为Xp11.2 tRCC,61例诊断为非tRCC亚型,包括45例透明细胞肾细胞癌(ccRCC)、10例乳头状肾细胞癌(pRCC)和6例其他亚型。提取人口统计学、临床、手术、病理和随访数据进行分析。通过Cox回归分析确定预后因素。所有患者均成功接受了根治性肾切除术和血栓切除术。在中位随访18个月期间,非tRCC组有5例患者、tRCC组有1例患者死于疾病进展。生存分析显示,Xp11.2 tRCC患者的无病生存期(DFS)短于非tRCC患者,然而,两组总生存期(OS)无显著差异。多因素分析确定Xp11.2 tRCC组织学亚型和诊断时有无转移为DFS的独立负性因素。对于肿瘤血栓延伸至静脉系统的tRCC患者,根治性肾切除术联合血栓切除术具有可接受的疗效。此外,对于晚期Xp11.2肾细胞癌应考虑多模式治疗,因为该亚型是DFS的负性预后因素。