Zapała Łukasz, Sharma Sumit, Kunc Michał, Zapała Piotr, Kłącz Jakub, Korczyński Piotr, Lipowski Michał, Późniak Michał, Suchojad Tomasz, Drewa Tomasz, Matuszewski Marcin, Radziszewski Piotr
Clinic of General, Oncological and Functional Urology, Medical University of Warsaw, 02-005 Warsaw, Poland.
Department of Pathomorphology, Medical University of Gdańsk, 80-214 Gdańsk, Poland.
J Clin Med. 2021 Aug 27;10(17):3852. doi: 10.3390/jcm10173852.
This study aimed to define patients with renal cell cancer and coexisting tumor thrombus in order to address concerns regarding survival and prognostic factors after radical surgery. Several prognostic factors for overall survival (OS) were assessed in patients treated surgically at five institutions from 2012 to 2018. Univariate and multivariate analyses were used to determine the independent risk factors of OS. A total of 142 patients were eligible for further analysis (mean age of 64.75 years, 56% males). Most patients presented with clear cell carcinoma (95%). The Mayo stage was predominantly 0-1 (88%). Distant visceral metastases at the time of diagnosis were present in 36 patients (25%), whereas nodal metastases were present in 24 patients (16.9%). During the follow-up period (mean of 32.5 months), the 3-year OS rate reached 68.2%. The majority of patients received no adjuvant treatment ( = 107). In a multivariable model predicting OS, regional lymph node status ( < 0.001), distant metastases ( = 0.009), tumor grade ( = 0.002), duration of hospitalization ( = 0.016), and Clavien-Dindo grade ( = 0.047) were identified as independent prognostic factors. A subgroup of patients with specific clinicopathological factors may benefit most from the radical surgery, including patients without regional lymph node or distant metastases and with low tumor grades, whereas short hospitalization and low Clavien-Dindo grades represent additional independent prognostic factors.
本研究旨在明确肾细胞癌合并肿瘤血栓的患者，以解决根治性手术后生存及预后因素相关问题。对2012年至2018年在五家机构接受手术治疗的患者的多个总生存（OS）预后因素进行了评估。采用单因素和多因素分析来确定OS的独立危险因素。共有142例患者符合进一步分析条件（平均年龄64.75岁，56%为男性）。大多数患者为透明细胞癌（95%）。梅奥分期主要为0 - 1期（88%）。诊断时远处内脏转移的患者有36例（25%），而有淋巴结转移的患者有24例（16.9%）。随访期间（平均32.5个月），3年总生存率达到68.2%。大多数患者未接受辅助治疗（ = 107）。在预测OS的多变量模型中，区域淋巴结状态（ < 0.001）、远处转移（ = 0.009）、肿瘤分级（ = 0.002）、住院时间（ = 0.016）和Clavien - Dindo分级（ = 0.047）被确定为独立预后因素。具有特定临床病理因素的患者亚组可能从根治性手术中获益最大，包括无区域淋巴结或远处转移且肿瘤分级低的患者，而住院时间短和Clavien - Dindo分级低代表额外的独立预后因素。
