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非转移性肾细胞癌中的IV级肿瘤血栓？不，谢谢。II级更好。从一例病例报告中吸取的教训。

Level IV tumor thrombus in non-metastatic renal cell cancer? No, thanks. Level II is better. Lessons learned from a case report.

作者信息

Galosi Andrea Benedetto, Papaveri Alessio, Castellani Daniele, Agostini Edoardo, Burattini Luciano, Dell'Atti Lucio

机构信息

Department of Specialist Clinical Science and Odontostomatology, Urology Division, Università Politecnica delle Marche, Via conca 71, 60126, Ancona, Italy.

Department of Molecular and Clinical Science, Medical Oncology Division, Università Politecnica delle Marche, Via conca 71, 60126, Ancona, Italy.

出版信息

Urol Case Rep. 2021 Mar 25;37:101660. doi: 10.1016/j.eucr.2021.101660. eCollection 2021 Jul.

DOI:10.1016/j.eucr.2021.101660
PMID:33868935
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8044637/
Abstract

Up to 19% of patients with renal cell carcinoma present with a venous thrombus at diagnosis and 1% have a thrombus extending above the diaphragm. The higher the thrombus level, the more challenging the surgery. Cavoatrial tumor thrombus usually requires circulatory arrest and sometimes cardiopulmonary by-pass. We present a case of non-metastatic renal cell carcinoma with a cavoatrial tumor thrombus in a patient who was unfit for cardiac surgery. Eight months of targeted molecular therapy downsized the tumor thrombus to inferior vena cava and allowed us to perform a radical nephrectomy with minimal cavothomy for thrombus resection.

摘要

高达19%的肾细胞癌患者在诊断时伴有静脉血栓，1%的患者血栓延伸至膈肌上方。血栓水平越高，手术难度越大。腔房肿瘤血栓通常需要循环阻断，有时还需要体外循环。我们报告一例非转移性肾细胞癌合并腔房肿瘤血栓的病例，该患者不适合心脏手术。八个月的靶向分子治疗使肿瘤血栓缩小至下腔静脉，使我们能够进行根治性肾切除术，并通过最小限度的腔静脉切开术切除血栓。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d33/8044637/35a21f929fdb/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d33/8044637/563d9c2dcf99/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d33/8044637/828a34688ac6/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d33/8044637/35a21f929fdb/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d33/8044637/563d9c2dcf99/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d33/8044637/828a34688ac6/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5d33/8044637/35a21f929fdb/gr3.jpg

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本文引用的文献

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Outcomes based on age in patients with metastatic renal cell carcinoma treated with first line targeted therapy or checkpoint immunotherapy: Older patients more prone to toxicity.基于一线靶向治疗或检查点免疫治疗的转移性肾细胞癌患者的年龄相关结局：老年患者更容易发生毒性反应。
J Geriatr Oncol. 2021 Jun;12(5):827-833. doi: 10.1016/j.jgo.2020.12.008. Epub 2020 Dec 31.
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Presurgical Pazopanib Improves Surgical Outcomes for Renal Cell Carcinoma With High-level IVC Tumor Thrombosis.术前帕唑帕尼改善高水平 IVC 肿瘤血栓形成的肾细胞癌手术结果。
In Vivo. 2019 Nov-Dec;33(6):2013-2019. doi: 10.21873/invivo.11698.
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Systematic Review of Surgical Management of Nonmetastatic Renal Cell Carcinoma with Vena Caval Thrombus.
系统评价手术治疗合并腔静脉瘤栓的非转移性肾细胞癌
Eur Urol. 2016 Aug;70(2):265-80. doi: 10.1016/j.eururo.2015.11.034. Epub 2015 Dec 23.
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Preoperative multivariable prognostic models for prediction of survival and major complications following surgical resection of renal cell carcinoma with suprahepatic caval tumor thrombus.术前多变量预后模型用于预测伴有肝上腔静脉瘤栓的肾细胞癌手术切除后的生存情况和主要并发症。
Urol Oncol. 2015 Sep;33(9):388.e1-9. doi: 10.1016/j.urolonc.2015.04.010. Epub 2015 May 23.
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The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus.梅奥诊所对肾细胞癌合并静脉瘤栓患者的手术治疗、并发症及预后的经验。
BJU Int. 2004 Jul;94(1):33-41. doi: 10.1111/j.1464-410X.2004.04897.x.