Rabinowitz Matthew J, Esfandiary Tina, Cheaib Joseph, Patel Sunil H, Alam Ridwan, Metcalf Meredith, Enikeev Dmitry, Pierorazio Phillip M, Ged Yasser M A, Allaf Mohamad E, Singla Nirmish
Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Urology, NYU Grossman School of Medicine, New York, NY, USA.
Eur Urol Open Sci. 2022 Jul 25;43:28-34. doi: 10.1016/j.euros.2022.07.001. eCollection 2022 Sep.
Renal cell carcinoma (RCC) can exhibit a unique vascular tropism that enables tumor thrombus extension into the inferior vena cava (IVC). While most RCC subtypes that form tumor thrombi are of clear cell (cc) histology, non-clear cell (ncc) subtypes can also exhibit this unique growth pattern.
To characterize clinicopathologic differences and survival outcomes among patients with IVC tumor thrombus arising from ccRCC versus nccRCC.
Patients diagnosed with IVC tumor thrombus secondary to RCC in our institutional experience from 2003 to 2021 were identified.
Clinicopathologic characteristics were compared by histology. Perioperative and oncologic outcomes including recurrence-free (RFS), overall (OS), and cancer-specific (CSS) survival were assessed using multivariable Cox regression analyses.
The analyzed cohort included 103 patients (82 ccRCC and 21 nccRCC). There were no significant differences in baseline demographic parameters. Patients with nccRCC were more likely to have regional lymph node involvement (42.9% vs 20.7%, = 0.037). No differences in perioperative outcomes, IVC resection, or IVC reconstruction were observed between groups. The median follow-up time was 30 mo. The median RFS was 30 (nccRCC) versus 53 (ccRCC) mo ( = 0.1). There was no significant difference in OS or CSS. This study was limited by its small sample size.
Patients with IVC tumor thrombus arising from ccRCC and nccRCC exhibit similar perioperative and oncologic outcomes. While surgical appropriateness was not impacted by histologic subtype, multimodal strategies are needed to improve outcomes for patients with tumor thrombus.
Renal cell carcinoma (RCC) can uniquely invade vasculature and form a tumor thrombus. This study examined the difference in outcomes of patients with tumor thrombus based on RCC subtype (clear cell vs non-clear cell). We found that patients exhibited similar surgical and survival outcomes regardless of RCC type.
肾细胞癌（RCC）可表现出独特的血管嗜性，使肿瘤血栓延伸至下腔静脉（IVC）。虽然形成肿瘤血栓的大多数RCC亚型为透明细胞（cc）组织学类型，但非透明细胞（ncc）亚型也可表现出这种独特的生长模式。
描述由ccRCC与nccRCC引起的IVC肿瘤血栓患者的临床病理差异和生存结果。
设计、设置和参与者：确定了2003年至2021年在我们机构经验中诊断为继发于RCC的IVC肿瘤血栓的患者。
按组织学比较临床病理特征。使用多变量Cox回归分析评估围手术期和肿瘤学结果，包括无复发生存期（RFS）、总生存期（OS）和癌症特异性生存期（CSS）。
分析的队列包括103例患者（82例ccRCC和21例nccRCC）。基线人口统计学参数无显著差异。nccRCC患者更易出现区域淋巴结受累（42.9%对20.7%，P = 0.037）。两组间在围手术期结果、IVC切除或IVC重建方面未观察到差异。中位随访时间为30个月。中位RFS在nccRCC组为30个月，在ccRCC组为53个月（P = 0.1）。OS或CSS无显著差异。本研究受样本量小的限制。
由ccRCC和nccRCC引起的IVC肿瘤血栓患者表现出相似的围手术期和肿瘤学结果。虽然手术适宜性不受组织学亚型影响，但需要多模式策略来改善肿瘤血栓患者的预后。
肾细胞癌（RCC）可独特地侵犯脉管系统并形成肿瘤血栓。本研究检查了基于RCC亚型（透明细胞与非透明细胞）的肿瘤血栓患者的预后差异。我们发现，无论RCC类型如何，患者的手术和生存结果相似。
