Department of Urology, Emory University School of Medicine, Atlanta, GA.
Department of Urology, University of Louisville School of Medicine, Louisville, KY.
Clin Genitourin Cancer. 2023 Aug;21(4):475-482.e4. doi: 10.1016/j.clgc.2023.04.005. Epub 2023 Apr 19.
Renal cell carcinoma (RCC) with tumor thrombosis often requires nephrectomy and tumor thrombectomy. As an extensive and potentially morbid operation, patient preoperative functional reserve and body composition is an important consideration. Sarcopenia is a risk factor for increased postoperative complications, systemic therapy toxicity, and death solid organ tumors, including RCC. The influence of sarcopenia in RCC patients with tumor thrombus is not well defined. This study evaluates the prognostic ability of sarcopenia regarding surgical outcomes and complications in patients undergoing surgery for RCC with tumor thrombus.
We retrospectively analyzed patients with nonmetastatic RCC and tumor thrombus undergoing radical nephrectomy and tumor thrombectomy. Skeletal muscle index (SMI; cm/m) was measured on preoperative CT/MRI. Sarcopenia was defined using body mass index- and sex-stratified thresholds optimally fit via a receiver-operating characteristic analysis for survival. Associations between preoperative sarcopenia and overall (OS), cancer-specific survival (CSS), and 90-day major complications were determined using multivariable analysis.
115 patients were analyzed, with median (IQR) age and body mass index of 69 (56-72) and 28.6 kg/m (23.6-32.9), respectively. 96 (83.4%) of the cohort had ccRCC. Sarcopenia was associated with shorter median OS (P = .0017) and CSS (P = .0019) in Kaplan-Meier analysis. In multivariable analysis, preoperative sarcopenia was prognostic of shorter OS (HR = 3.38, 95% confidence interval [CI] 1.61-7.09) and CSS (HR = 5.15, 95% CI 1.46-18.18). Notably, 1 unit increases in SMI were associated with improved OS (HR = 0.97, 95% CI 0.94-0.999) but not CSS (HR = 0.95, 95% CI 0.90-1.01). No significant relationship between preoperative sarcopenia and 90-day major surgical complications was observed in this cohort (HR = 2.04, 95% CI 0.65-6.42).
Preoperative sarcopenia was associated with decreased OS and CSS in patients surgically managed for nonmetastatic RCC and VTT, however, was not predictive of 90-day major postoperative complications. Body composition analysis has prognostic utility for patients with nonmetastatic RCC and venous tumor thrombus undergoing surgery.
肾细胞癌（RCC）合并肿瘤血栓通常需要进行肾切除术和肿瘤血栓切除术。作为一种广泛且潜在的病态手术，患者术前的功能储备和身体成分是一个重要的考虑因素。肌肉减少症是增加术后并发症、全身治疗毒性和死亡的风险因素，包括实体器官肿瘤，如 RCC。肌肉减少症在 RCC 合并肿瘤血栓患者中的影响尚未明确。本研究评估了肌肉减少症对接受 RCC 合并肿瘤血栓手术患者的手术结果和并发症的预后能力。
我们回顾性分析了接受根治性肾切除术和肿瘤血栓切除术的非转移性 RCC 合并肿瘤血栓患者。术前 CT/MRI 测量骨骼肌指数（SMI；cm/m）。肌肉减少症使用通过接受者操作特征分析为生存优化的按体重指数和性别分层的最佳阈值来定义。使用多变量分析确定术前肌肉减少症与总生存期（OS）、癌症特异性生存期（CSS）和 90 天主要并发症之间的相关性。
共分析了 115 例患者，中位（IQR）年龄和体重指数分别为 69（56-72）和 28.6kg/m（23.6-32.9）。队列中有 96（83.4%）例为 ccRCC。肌肉减少症与 Kaplan-Meier 分析中的中位 OS（P=0.0017）和 CSS（P=0.0019）较短相关。多变量分析显示，术前肌肉减少症与 OS（HR=3.38，95%CI 1.61-7.09）和 CSS（HR=5.15，95%CI 1.46-18.18）较短相关。值得注意的是，SMI 增加 1 个单位与 OS 改善相关（HR=0.97，95%CI 0.94-0.999），但与 CSS 无关（HR=0.95，95%CI 0.90-1.01）。在该队列中，术前肌肉减少症与 90 天主要手术并发症之间无显著相关性（HR=2.04，95%CI 0.65-6.42）。
术前肌肉减少症与非转移性 RCC 和 VTT 手术患者的 OS 和 CSS 降低相关，但不能预测 90 天的主要术后并发症。对于接受非转移性 RCC 和静脉肿瘤血栓手术的患者，身体成分分析具有预后价值。
