Medical School of Chinese PLA, Beijing 100853, China.; Department of Urology/State Key Laboratory of Kidney Diseases, the First Medical Center, Chinese PLA General Hospital, Beijing 100853.
Department of Urology, Air Force Medical Center, Beijing 100142, China.
Urol Oncol. 2021 May;39(5):302.e1-302.e7. doi: 10.1016/j.urolonc.2021.02.005. Epub 2021 Mar 5.
To assess the impact of the presence of bland thrombus (BT) on prognosis of patients treated with resection of renal cell carcinoma (RCC) with inferior vena cava tumor thrombus (IVCTT).
The medical records of a total of 145 consecutive postsurgical RCC patients with level I-IV IVCTT were reviewed from January 2008 to August 2018. Associations of BT with clinicopathological variables were estimated by chi-square test or Student's t-test. Kaplan-Meier method and multivariate Cox proportional hazard model were used. The eighth TNM staging system, "Spiess PE" model, University of California at Los Angeles Integrated Staging System and Stage, Size, Grade, and Necrosis (SSIGN) score were selected to assess whether BT could improve their predictive abilities.
BT was observed in 34 (23.4%) patients and was significantly associated with increased levels of IVCTT (P = 0.004) and invasion of IVC wall (P = 0.030). Multivariable Cox analyses revealed that tumor grade, T stage, M stage, tumor thrombus consistency and BT were independent risk factors for both progression-free survival and overall survival. The concordance indexes ranged from a low of 0.652 in TNM to a high of 0.731 in SSIGN, and integrating BT into each base model led to an increased predictive accuracies of 6.2% for TNM (P = 0.025), 4.0% for "Spiess PE" model (P = 0.069), 2.1% for University of California at Los Angeles Integrated Staging System (P = 0.149) and 1.2% for SSIGN (P = 0.290), respectively.
Presence of BT was independently associated with survival in postsurgical patients with RCC-IVCTT. Routine consideration of BT as an adjunct to TNM staging system may be suggested.
评估肾细胞癌（RCC）合并下腔静脉瘤栓（IVCTT）患者中存在无细胞性血栓（BT）对预后的影响。
回顾性分析 2008 年 1 月至 2018 年 8 月期间共 145 例连续接受 RCC 术后治疗的 IVCTT 分级为 I-IV 级患者的病历资料。采用卡方检验或学生 t 检验评估 BT 与临床病理变量之间的相关性。采用 Kaplan-Meier 方法和多因素 Cox 比例风险模型进行分析。选择第八版 TNM 分期系统、“Spiess PE”模型、加利福尼亚大学洛杉矶分校整合分期系统（UCLA）和分期、大小、分级和坏死（SSIGN）评分来评估 BT 是否能提高其预测能力。
34 例（23.4%）患者存在 BT，且 BT 与 IVCTT 分级升高（P=0.004）和 IVC 壁侵犯（P=0.030）显著相关。多因素 Cox 分析显示，肿瘤分级、T 分期、M 分期、肿瘤栓子一致性和 BT 是无进展生存期和总生存期的独立危险因素。一致性指数从 TNM 的低值 0.652 到 SSIGN 的高值 0.731 不等，将 BT 纳入每个基础模型可分别使 TNM（P=0.025）、“Spiess PE”模型（P=0.069）、UCLA 整合分期系统（P=0.149）和 SSIGN（P=0.290）的预测准确率提高 6.2%、4.0%、2.1%和 1.2%。
BT 的存在与 RCC-IVCTT 术后患者的生存独立相关。建议将 BT 作为 TNM 分期系统的辅助手段常规考虑。
