Zhang Yu, Tian XiaoJun, Bi Hai, Hong Peng, Liu Zhuo, Yan Ye, Liu Cheng, Ma LuLin
Department of Urology, Peking University Third Hospital, Beijing, China.
J Oncol. 2022 Mar 17;2022:9191659. doi: 10.1155/2022/9191659. eCollection 2022.
To evaluate the long-term oncologic outcomes of renal cell carcinoma (RCC) patients with venous thrombus after radical nephrectomy and venous thrombectomy (RN-VT) and to determine the prognostic factors.
We reported our follow-up data of RCC patients with venous thrombus from January 2014 to September 2020. We used the Kaplan-Meier method to assess the overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). The Cox proportional hazards regression model and competing risk model were used.
After a median follow-up of 31 mon, eight-five patients (31.5%) died, and cancer-specific deaths occurred in 60 patients (22.2%). The 1 yr and 3 yr CSS were 89.3% and 72.7%, respectively. The median OS was 56.0 mon (95% CI 47.6-64.3 mon), and the 1 yr, 3 yr, and 5 yr OS were 87.0%, 62.1%, and 44.8%, respectively. For M1 patients, the median OS was 27.0 mon (95% CI 22.0-42.0 mon), and the 1 yr, 3 yr, and 5 yr OS were 78.0%, 41.5%, and 23.3%, respectively. For M0 patients, the median RFS was 38.0 mon (95% CI 32.5-43.5 mon), and the 1 yr and 3 yr RFS were 81.2% and 52.3%, respectively. Multivariate analyses showed that papillary RCC (HR 2.95, 95% CI 1.80-4.82, < 0.001) or other RCC (HR 3.88, 95% CI 2.03-7.41, < 0.001), perinephric fat invasion (HR 1.53, 95% CI 1.03-2.26, = 0.04), sarcomatoid differentiation (HR 2.85, 95% CI 1.64-4.95, < 0.001), Fuhrman grade 3 (HR 2.10, 95% CI 1.28-3.44, = 0.003) or 4 (HR 3.55, 95% CI 2.09-6.03, < 0.001), and distant metastasis (HR 1.76, 95% CI 1.18-2.63, = 0.006) were associated with a worse CSS. Adjuvant therapy (HR 0.63, 95% CI 0.43-0.92, = 0.02) was associated with a better CSS.
RCC patients can have an acceptable long-term survival after RN-VT. Prognostic factors influencing CSS included nonclear cell RCC histology, higher Fuhrman grade, sarcomatoid differentiation, perinephric fat invasion, distant metastasis, and adjuvant therapy.
评估根治性肾切除术联合静脉血栓切除术（RN-VT）治疗的肾细胞癌（RCC）合并静脉血栓患者的长期肿瘤学结局，并确定预后因素。
我们报告了2014年1月至2020年9月期间RCC合并静脉血栓患者的随访数据。我们采用Kaplan-Meier法评估总生存期（OS）、癌症特异性生存期（CSS）和无复发生存期（RFS）。使用Cox比例风险回归模型和竞争风险模型。
中位随访31个月后，85例患者（31.5%）死亡，60例患者（22.2%）发生癌症特异性死亡。1年和3年CSS分别为89.3%和72.7%。中位OS为56.0个月（95%CI 47.6-64.3个月），1年、3年和5年OS分别为87.0%、62.1%和44.8%。对于M1期患者，中位OS为27.0个月（95%CI 22.0-42.0个月），1年、3年和5年OS分别为78.0%、41.5%和23.3%。对于M0期患者，中位RFS为38.0个月（95%CI 32.5-43.5个月），1年和3年RFS分别为81.2%和52.3%。多因素分析显示，乳头状RCC（HR 2.95，95%CI 1.80-4.82，P<0.001）或其他RCC（HR 3.88，95%CI 2.03-7.41，P<0.001）、肾周脂肪浸润（HR 1.53，95%CI 1.03-2.26，P=0.04）、肉瘤样分化（HR 2.85，95%CI 1.64-4.95，P<0.001）、Fuhrman分级3级（HR 2.10，95%CI 1.28-3.44，P=0.003）或4级（HR 3.55，95%CI 2.09-6.03，P<0.001）以及远处转移（HR 1.76，95%CI 1.18-2.63，P=0.006）与较差的CSS相关。辅助治疗（HR 0.63，95%CI 0.43-0.92，P=0.02）与较好的CSS相关。
RN-VT术后RCC患者可获得可接受的长期生存。影响CSS的预后因素包括非透明细胞RCC组织学类型、较高的Fuhrman分级、肉瘤样分化、肾周脂肪浸润、远处转移和辅助治疗。
