Zhang Yu, Tian XiaoJun, Bi Hai, Yan Ye, Liu Zhuo, Liu Cheng, Zhang ShuDong, Ma LuLin
Department of Urology, Peking University Third Hospital, Beijing, China.
Front Oncol. 2022 Mar 24;12:765092. doi: 10.3389/fonc.2022.765092. eCollection 2022.
To demonstrate the progression-free survival (PFS) of nonmetastatic renal cell carcinoma (RCC) patients with venous thrombus after radical nephrectomy and venous thrombectomy (RN-VT) and to develop and validate a nomogram to predict the PFS of patients after RN-VT.
We reported our prospective follow-up data of RCC patients with venous thrombus from January 2014 to September 2020 (n = 199). We used the Kaplan-Meier method to assess the PFS. The Cox proportional hazards regression model was used to determine the predictors. Nomograms predicting the PFS was established, and external validation was performed. Calibration curves and decision curves were generated to assess the predictive efficacy and clinical benefit.
After a median follow-up of 32 months, 79 patients (39.7%) had disease progression and the median PFS was 41.0 months (95% CI 34.8-53.2 months). The 1-year, 3-year, and 5-year PFS rates were 78.4%, 45.4%, and 30.0%, respectively. Multivariate analysis showed that Fuhrman grade [grade 4: hazard ratio (HR) 1.92, 95% CI 1.10-3.34, P = 0.02], pathological type (papillary RCC: HR 3.02, 95% CI 1.79-5.10, P < 0.001), perinephric fat invasion (HR 1.54, 95% CI 1.12-2.10, P = 0.007), sarcomatoid differentiation (HR 2.97, 95% CI 1.24-7.13, P = 0.02) were associated with a worse PFS, and adjuvant therapy (HR 0.32, 95% CI 0.18-0.59, P < 0.001) could lead to a better PFS. A nomogram based on the predictors was externally validated to have good discrimination and calibration, and it could improve PFS prediction to obtain a clinical benefit.
We constructed and validated a nomogram to predict the 1-year, 3-year, and 5-year PFS of M0 RCC patients with venous thrombus after surgery. The model can help identify patients who can benefit the most from surgery and develop the criteria for clinical trial enrollment.
探讨根治性肾切除术联合静脉血栓切除术（RN-VT）治疗非转移性肾细胞癌（RCC）合并静脉血栓患者的无进展生存期（PFS），并建立和验证预测RN-VT术后患者PFS的列线图。
我们报告了2014年1月至2020年9月RCC合并静脉血栓患者的前瞻性随访数据（n = 199）。采用Kaplan-Meier法评估PFS。使用Cox比例风险回归模型确定预测因素。建立预测PFS的列线图并进行外部验证。生成校准曲线和决策曲线以评估预测效能和临床获益。
中位随访32个月后，79例患者（39.7%）出现疾病进展，中位PFS为41.0个月（95%CI 34.8 - 53.2个月）。1年、3年和5年PFS率分别为78.4%、45.4%和30.0%。多因素分析显示，Fuhrman分级[4级：风险比（HR）1.92，95%CI 1.10 - 3.34，P = 0.02]、病理类型（乳头状RCC：HR 3.02，95%CI 1.79 - 5.10，P < 0.001）、肾周脂肪浸润（HR 1.54，95%CI 1.12 - 2.10，P = 0.007）、肉瘤样分化（HR 2.97，95%CI 1.24 - 7.13，P = 0.02）与较差的PFS相关，辅助治疗（HR 0.32，95%CI 0.18 - 0.59，P < 0.001）可导致更好的PFS。基于预测因素的列线图经外部验证具有良好的区分度和校准度，可改善PFS预测以获得临床获益。
我们构建并验证了一个预测M0期RCC合并静脉血栓患者术后1年、3年和5年PFS的列线图。该模型有助于识别能从手术中获益最大的患者，并制定临床试验入组标准。
