肾细胞癌合并下腔静脉瘤栓患者手术治疗的预后因素分析。
Predictors of Survival in Patients Undergoing Surgery for Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus.
机构信息
Departments of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
出版信息
Clin Genitourin Cancer. 2022 Aug;20(4):e330-e338. doi: 10.1016/j.clgc.2022.02.001. Epub 2022 Feb 9.
INTRODUCTION
Surgical resection of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus is a complex procedure with significant morbidity. Patient selection is critical to determining whether the benefits of the procedure outweigh the risks. In this study, we identified and stratified the risk factors that were associated with overall survival (OS) and recurrence-free survival (RFS) in patients undergoing surgical resection of RCC with IVC thrombus.
METHODS
We identified all patients with RCC with IVC tumor thrombus (stages cT3b and cT3c) who had undergone radical nephrectomy with tumor thrombectomy between December 1, 1993 and June 30, 2009. Kaplan-Meier method was used to estimate OS and RFS. Cox proportional hazards models were used to determine the association between risk factors and OS. Patients were stratified into 3 groups based on the number of risk factors present at diagnosis.
RESULTS
Two hundred twenty-four patients were included in the study. A total of 45.3% of patients had metastasis at presentation, 84.5% had cT3b, and 90.2% had clear cell RCC. cT3c, cN1, and cM1 were significantly associated with the risk of death. Group 1 patients (0 risk factors) had a median OS duration of 77.6 months (95% CI 50.5-90.4), group 2 (1 risk factor) 26.0 months (95% CI 19.5-35.2), and group 3 (≥2 risk factors) 8.9 months (95% CI 5.2-12.9; P < .001).
CONCLUSIONS
Stratification of patients with RCC and IVC thrombus by risk factors allowed us to predict survival duration. In patients with ≥2 risk factors, new treatment strategies with preoperative systemic therapy may improve survival.
简介
肾细胞癌（RCC）合并下腔静脉（IVC）血栓的外科切除术是一种复杂的手术，具有较高的发病率。患者选择对于确定手术的益处是否超过风险至关重要。在这项研究中，我们确定并分层了与接受 RCC 合并 IVC 血栓切除术的患者的总生存（OS）和无复发生存（RFS）相关的危险因素。
方法
我们确定了 1993 年 12 月 1 日至 2009 年 6 月 30 日期间接受根治性肾切除术和肿瘤血栓切除术的所有 IVC 肿瘤血栓（分期 cT3b 和 cT3c）的 RCC 患者。Kaplan-Meier 法用于估计 OS 和 RFS。Cox 比例风险模型用于确定危险因素与 OS 之间的关联。根据诊断时存在的危险因素数量，将患者分为 3 组。
结果
本研究共纳入 224 例患者。有 45.3%的患者在就诊时发生转移，84.5%为 cT3b，90.2%为透明细胞 RCC。cT3c、cN1 和 cM1 与死亡风险显著相关。第 1 组（无危险因素）的中位 OS 持续时间为 77.6 个月（95%CI 50.5-90.4），第 2 组（1 个危险因素）为 26.0 个月（95%CI 19.5-35.2），第 3 组（≥2 个危险因素）为 8.9 个月（95%CI 5.2-12.9；P<0.001）。
结论
根据危险因素对 RCC 合并 IVC 血栓患者进行分层，可以预测生存时间。在有≥2 个危险因素的患者中，术前全身治疗的新治疗策略可能会改善生存。
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