Gamboa-Hoil Sergio Isidro, Martínez-Cornelio Andrés, Hernández-Toríz Narciso, Riera-Kinkel Carlos
Oncology Hospital, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City.
Cardiotoracic surgery, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México City.
Curr Health Sci J. 2021 Jan-Mar;47(1):96-100. doi: 10.12865/CHSJ.47.01.15. Epub 2021 Mar 31.
Renal cell carcinoma can invade through the renal vein into the inferior vena cava, and can extend intraluminally, with tumor-thrombus formation.
Retrospective study from January 2003 to August 2016. Surgical outcomes were analyzed. Neves classification was used for patient categorization. Kaplan Meier and Log-Rank test were used for survival analysis.
A total of 134 patients were included, 69 males (51.4%) and 65 females (49%), M:F ratio 1.06:1. Tumor size, bleeding and surgical time were higher in level IV thrombi (mean 16.1cm, 3 064ml and 6.5hrs, respectively), compared to level I (8.5cm, 1033ml and 3.1hrs, respectively). A higher frequency of positive lymph nodes was observed in levels III and IV compared with levels I and II (49% vs. 17.7%, p=0.0001). Distant metastases were observed in 36 pts. (27%). Overall surgical mortality was 4.5%. 5-year overall survival was 63%. We observed a 5-year survival in patients with level I-II 82% and level III and IV 46%.
Our results suggest the benefit for the patient of an aggressive surgical approach with an acceptable mortality and 5-year survival rate. The results obtained justify an aggressive surgical approach to these tumors.
肾细胞癌可通过肾静脉侵犯至下腔静脉，并可在管腔内蔓延，形成肿瘤血栓。
对2003年1月至2016年8月进行回顾性研究。分析手术结果。采用内维斯分类法对患者进行分类。采用卡普兰-迈耶法和对数秩检验进行生存分析。
共纳入134例患者，男性69例（51.4%），女性65例（49%），男女比例为1.06:1。与I级血栓（分别为8.5cm、1033ml和3.1小时）相比，IV级血栓的肿瘤大小、出血量和手术时间更高（分别为16.1cm、3064ml和6.5小时）。与I级和II级相比，III级和IV级患者的阳性淋巴结发生率更高（49%对17.7%，p = 0.0001）。36例患者（27%）出现远处转移。总体手术死亡率为4.5%。5年总生存率为63%。我们观察到I-II级患者的5年生存率为82%，III级和IV级患者为46%。
我们的结果表明，积极的手术方法对患者有益，死亡率和5年生存率可接受。所获得的结果证明对这些肿瘤采取积极的手术方法是合理的。
