Department of Urology, Peking University Third Hospital, 49 North Garden Road, Haidian, Beijing, 100191, People's Republic of China.
Department of Ultrasound, Peking University Third Hospital, Haidian District, Beijing, 100191, People's Republic of China.
BMC Surg. 2021 Dec 28;21(1):443. doi: 10.1186/s12893-021-01448-0.
To explore the effect of tumor thrombus growing against the direction of venous return (GADVR) tumor thrombus on the choice of surgical approach, the impact on the complexity of the surgery and the prognosis.
We retrospectively analyzed the clinicopathological data of 213 patients, who underwent surgery in a single center of Peking University Third Hospital between January 2016 and June 2020. For right renal cell carcinoma (RCC) and venous tumor thrombus (VTT), imaging revealed a filling defect in the left renal vein, which was significantly enhanced in enhanced imaging, suggesting that the tumor thrombus grew against the direction of venous return into the left renal vein. For left RCC and VTT, at least one of the left renal vein branches has tumor thrombus. The branches include the left adrenal vein, the left gonadal vein (testicular vein or ovarian vein), and the left ascending lumbar vein. The patients were divided into two groups according to whether they were GADVR tumor thrombus, and we compare the clinicopathological characteristics of GADVR tumor thrombus and non-GADVR tumor thrombus. Univariate and multivariate Cox regression analyses were performed to explore the risk factors that affect the prognosis of patients with RCC and VTT. Kaplan-Meier plots were conducted to evaluate the effect of GADVR on progression-free survival (PFS).
Compared with non-GADVR tumor thrombus, patients with GADVR tumor thrombus had a higher proportion of open surgery (76.2% vs. 52.1%, P = 0.035), a higher proportion of tumor thrombus adhering to the inferior vena cava (IVC) vessel wall (81% vs. 45.8%, P = 0.002), a higher proportion of segmental resection of the IVC vessel wall (61.9% vs. 15.6%, P < 0.001); higher preoperative serum creatinine value (110.0 μmol/L vs. 91.0 μmol/L, P = 0.015), a higher proportion of tumor thrombus combined with bland thrombus (non-tumor thrombus) (57.1% vs. 19.8%, P < 0.001). In terms of surgical complexity, patients with GADVR tumor thrombus had a longer median operation time (379 min vs. 308 min, P = 0.038), more median surgical blood loss (1400 mL vs. 600 mL, P = 0.018), and more postoperative complications (52.4% vs. 30.7%, P = 0.045). Multivariate Cox regression analysis showed that GADVR tumor thrombus, symptoms, postoperative serum creatinine, distant metastasis, sarcomatoid feature, pathological type, lymph node dissection were independent risk factors for PFS. Patients with GADVR tumor thrombus's median survival time was 14.0 months, while patients with non-GADVR tumor thrombus were 32.0 months (P = 0.016). GADVR tumor thrombus is an independent risk factor for PFS in patients with RCC and VTT.
GADVR tumor thrombus is a characteristic feature of tumor thrombus, with an incidence of 9.9%. It has a higher proportion of open surgery and higher surgical complexity, which is an independent risk factor for PFS.
探讨肿瘤栓子沿静脉回流方向生长（GADVR）对手术方式选择、手术复杂性及预后的影响。
我们回顾性分析了 2016 年 1 月至 2020 年 6 月在北京大学第三医院单一中心接受手术的 213 例患者的临床病理资料。对于右肾癌（RCC）和静脉瘤栓（VTT），影像学显示左肾静脉有充盈缺损，增强成像明显增强，提示瘤栓沿静脉回流方向生长进入左肾静脉。对于左 RCC 和 VTT，至少有一支左肾静脉分支有瘤栓。这些分支包括左肾上腺静脉、左性腺静脉（睾丸静脉或卵巢静脉）和左升主动脉静脉。根据是否存在 GADVR 瘤栓，将患者分为两组，并比较 GADVR 瘤栓和非 GADVR 瘤栓的临床病理特征。采用单因素和多因素 Cox 回归分析探讨影响 RCC 和 VTT 患者预后的危险因素。通过 Kaplan-Meier 图评估 GADVR 对无进展生存期（PFS）的影响。
与非 GADVR 瘤栓相比，GADVR 瘤栓患者开放性手术的比例更高（76.2% vs. 52.1%，P = 0.035），瘤栓与下腔静脉（IVC）血管壁黏附的比例更高（81% vs. 45.8%，P = 0.002），IVC 血管壁节段切除的比例更高（61.9% vs. 15.6%，P < 0.001）；术前血清肌酐值更高（110.0 μmol/L vs. 91.0 μmol/L，P = 0.015），瘤栓合并软血栓（非瘤栓）的比例更高（57.1% vs. 19.8%，P < 0.001）。在手术复杂性方面，GADVR 瘤栓患者的中位手术时间更长（379 分钟 vs. 308 分钟，P = 0.038），中位手术出血量更多（1400 毫升 vs. 600 毫升，P = 0.018），术后并发症更多（52.4% vs. 30.7%，P = 0.045）。多因素 Cox 回归分析显示，GADVR 瘤栓、症状、术后血清肌酐、远处转移、肉瘤样特征、病理类型、淋巴结清扫是 PFS 的独立危险因素。GADVR 瘤栓患者的中位生存时间为 14.0 个月，而非 GADVR 瘤栓患者为 32.0 个月（P = 0.016）。GADVR 瘤栓是 RCC 和 VTT 患者 PFS 的独立危险因素。
GADVR 瘤栓是一种肿瘤栓子的特征性表现，发生率为 9.9%。它具有更高的开放性手术比例和更高的手术复杂性，是 PFS 的独立危险因素。
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