Zhao Xun, Yan Ye, Dong Jing-Han, Liu Zhuo, Zhang Hong-Xian, Liu Cheng, Ma Lu-Lin
Department of Urology, Peking University Third Hospital, Beijing, China.
Front Oncol. 2022 Feb 9;12:833780. doi: 10.3389/fonc.2022.833780. eCollection 2022.
To evaluate the impact of deep invasive tumor thrombus (DITT) on the surgical complexity and prognosis of patients with renal cell carcinoma with venous tumor thrombus.
We retrospectively reviewed clinical data of 138 patients with non-metastatic renal cell carcinoma combined with venous tumor thrombus, who underwent surgical treatment in Peking University Third Hospital from January 2015 to June 2020. Patients were divided into the DITT group (84 patients) and non-invasive tumor thrombus (NITT) group (54 patients). Chi-square, -test and Mann-Whitney test were used for categorical and continuous variables, respectively. Kaplan-Meier plots were performed to evaluate the influence of DITT. Univariable and multivariable Cox regressions were conducted to determine independent prognostic factors and then assembled to make a nomogram to predict the survival. The performance of the nomogram was evaluated by Harrell's consistency index (C-index) and calibration plot.
Deep invasive tumor thrombus significantly increased the difficulty of surgery for patients with renal cell carcinoma with venous tumor thrombus, which is mainly reflected in longer operation time ( < 0.001), more surgical bleeding ( < 0.001), a higher proportion of perioperative blood transfusion ( = 0.006), a higher proportion of open surgery ( = 0.001), a longer postoperative hospital stay ( = 0.003), and a higher proportion of postoperative complications ( = 0.001). DITT (hazard ratio [HR] = 2.781, = 0.040) was one of the independent risk factors for worse prognosis. Multivariate analysis showed that sarcoma-like differentiation ( = 0.040), tumor thrombus invasion ( = 0.040), low hemoglobin ( = 0.003), and pathological type ( < 0.001) were independent prognostic factors. The nomogram, combining all these predictors, showed powerful prognostic ability with a C-index of 78.8% (CI: 71.2%-86.4%). The predicted risk closely matches the observed recurrence probability.
Deep invasive tumor thrombus significantly increased the difficulty of surgeries for patients of renal cell carcinoma with venous tumor thrombus, and may lead to poor prognosis.
评估深度浸润性肿瘤血栓（DITT）对肾细胞癌伴静脉瘤栓患者手术复杂性及预后的影响。
回顾性分析2015年1月至2020年6月在北京大学第三医院接受手术治疗的138例非转移性肾细胞癌合并静脉瘤栓患者的临床资料。患者分为DITT组（84例）和非浸润性肿瘤血栓（NITT）组（54例）。分别采用卡方检验、t检验和曼-惠特尼检验分析分类变量和连续变量。采用Kaplan-Meier曲线评估DITT的影响。进行单因素和多因素Cox回归分析以确定独立预后因素，然后汇总制作列线图以预测生存率。通过Harrell一致性指数（C指数）和校准图评估列线图的性能。
深度浸润性肿瘤血栓显著增加了肾细胞癌伴静脉瘤栓患者的手术难度，主要表现为手术时间更长（P<0.001）、手术出血量更多（P<0.001）、围手术期输血比例更高（P = 0.006）、开放手术比例更高（P = 0.001）、术后住院时间更长（P = 0.003）以及术后并发症比例更高（P = 0.001）。DITT（风险比[HR]=2.781，P = 0.040）是预后较差的独立危险因素之一。多因素分析显示，肉瘤样分化（P = 0.040）、肿瘤血栓浸润（P = 0.040）、低血红蛋白（P = 0.003）和病理类型（P<0.001）是独立预后因素。结合所有这些预测因素的列线图显示出强大的预后能力，C指数为78.8%（CI：71.2%-86.4%）。预测风险与观察到的复发概率密切匹配。
深度浸润性肿瘤血栓显著增加了肾细胞癌伴静脉瘤栓患者的手术难度，并可能导致预后不良。
