Wang Hanfeng, Chen Xinran, Wang Kailong, Cao Wenzhe, Huang Qingbo, Peng Cheng, Jia Tongyu, Liang Qiyang, Wang Baojun, Gu Liangyou, Zhang Xu, Ma Xin
Department of Urology, The Third Medical Center, Chinese PLA General Hospital.
Medical School of Chinese PLA, Beijing.
Int J Surg. 2024 Jan 1;110(1):4-10. doi: 10.1097/JS9.0000000000000832.
Venous thromboembolism (VTE) is a principal cause of mortality and adverse oncologic outcomes in patients with renal tumor and inferior vena cava tumor thrombus (RT-IVCTT). However, the preoperative thrombotic risk factors in these patients remain not fully characterized.
To identify preoperative thrombotic risk factors in patients with RT-IVCTT.
PATIENTS/METHODS: Two hundred fifty-seven consecutive postsurgical patients with RT-IVCTT aged 18-86 years were enrolled between January 2008 and September 2022. Clinicopathological variables were retrospectively reviewed. A multivariate logistic regression model was performed. Preoperative hemoglobin, neutrophils, and serum albumin levels were analyzed as both continuous and categorical variables.
VTE was identified in 63 patients (24.5%). On both continuously and categorically coded variables, advanced IVC thrombus (OR 3.2, 95% CI: 1.4-7.0; OR 2.7, 95% CI: 1.2-6.1), renal sinus fat invasion (OR 3.4, 95% CI: 1.6-7.0; OR 3.7, 95% CI: 1.8-7.7), IVC wall invasion (OR 3.6, 95% CI: 1.6-7.9; OR 4.3, 95% CI: 1.9-10.0), IVC blockage status of greater than 75% (OR 5.2, 95% CI: 1.7-15.8; OR 6.1, 95% CI: 1.9-19.7), and higher neutrophils (OR 1.3, 95% CI: 1.0-1.7; OR 2.4, 95% CI: 1.1-5.4) were significantly associated with increased VTE risk in patients with RT-IVCTT. Except hemoglobin, categorically coded serum albumin (OR 0.36, 95% CI: 0.17-0.75) was validated as an independent risk factor for VTE.
This study provided an insight of risk factors contributing to preoperative VTE in patients with RT-IVCTT, which may be beneficial for optimizing strategies to manage VTE in clinical practice.
静脉血栓栓塞症（VTE）是肾肿瘤合并下腔静脉肿瘤血栓（RT-IVCTT）患者死亡及不良肿瘤学结局的主要原因。然而，这些患者术前的血栓形成危险因素仍未完全明确。
确定RT-IVCTT患者术前的血栓形成危险因素。
患者/方法：纳入2008年1月至2022年9月期间连续收治的257例年龄在18 - 86岁的RT-IVCTT术后患者。对临床病理变量进行回顾性分析。采用多因素logistic回归模型。术前血红蛋白、中性粒细胞及血清白蛋白水平作为连续变量和分类变量进行分析。
63例患者（24.5%）发生VTE。在连续编码变量和分类编码变量中，下腔静脉血栓进展（比值比[OR] 3.2，95%置信区间[CI]：1.4 - 7.0；OR 2.7，95% CI：1.2 - 6.1）、肾窦脂肪浸润（OR 3.4，95% CI：1.6 - 7.0；OR 3.7，95% CI：1.8 - 7.7）、下腔静脉壁浸润（OR 3.6，95% CI：1.6 - 7.9；OR 4.3，95% CI：1.9 - 10.0）、下腔静脉阻塞程度大于75%（OR 5.2，95% CI：1.7 - 15.8；OR 6.1，95% CI：1.9 - 19.7）以及较高的中性粒细胞水平（OR 1.3，95% CI：1.0 - 1.7；OR 2.4，95% CI：1.1 - 5.4）与RT-IVCTT患者VTE风险增加显著相关。除血红蛋白外，分类编码的血清白蛋白（OR 0.36，95% CI：0.17 - 0.75）被证实为VTE的独立危险因素。
本研究揭示了RT-IVCTT患者术前VTE的危险因素，这可能有助于优化临床实践中VTE的管理策略。
