Faria-Costa Gabriel, Freitas Rui, Braga Isaac, Alzamora Maria Ana, Magalhães Sanches, Carvalho João, Correia Jorge, Silva Vítor Moreira, Lobo Francisco, Henrique Rui, Morais António
Department of Urology, Unidade Local de Saúde de Matosinhos, 4464-513 Matosinhos, Portugal.
Department of Surgery and Physiology, Faculty of Medicine of University of Porto, 4200-319 Porto, Portugal.
J Clin Med. 2024 Oct 20;13(20):6260. doi: 10.3390/jcm13206260.
The purpose of this study is to report the experience of a single Portuguese oncology center in the management of patients with renal cell carcinoma (RCC) and venous tumor thrombus (VTT). This is a retrospective analysis of all patients with RCC and VTT surgically treated in our center between 2008 and 2023. Only patients with VTT up to level III (Mayo Clinic classification) were included. Patient, tumor characteristics and peri-operative outcome data were registered. Administration of systemic therapy was performed upon progression. Survival analysis was conducted with the collected data. A total of 64 patients (n = 16 women) were included in this study. The mean age at diagnosis was 66.3 ± 10.7 years old. The VTT level was 0, I, II and III in 40 (62.5%), 12 (18.7%), 6 (9.4%) and 6 (9.4%) patients, respectively. Nine patients (14.1%) had distant metastasis at diagnosis. No peri-operative deaths occurred, and the major complication rate was 3.1%. Histology revealed 98.4% of clear cell RCC, with sarcomatoid differentiation present in 12.5% of the cases. A negative margin status was achieved in 54 (84.4%) patients. Systemic therapy was administered in 24 (37.5%) patients during follow-up. The median progression-free (PFS), cancer-specific (CSS) and overall (OS) survival were 23, 60 and 48 months, respectively. In multivariable analysis, significant predictors of CSS were tumor size, sarcomatoid differentiation and collecting system invasion. Radical nephrectomy with VTT excision up to level III is a feasible and safe procedure. Patients with large tumor size, sarcomatoid differentiation and collecting system invasion are at the highest risk and should be closely monitored.
本研究的目的是报告葡萄牙一家肿瘤中心在肾细胞癌（RCC）合并静脉瘤栓（VTT）患者管理方面的经验。这是一项对2008年至2023年期间在我们中心接受手术治疗的所有RCC合并VTT患者的回顾性分析。仅纳入VTT达Ⅲ级（梅奥诊所分类）的患者。记录患者、肿瘤特征及围手术期结局数据。疾病进展时进行全身治疗。对收集的数据进行生存分析。本研究共纳入64例患者（n = 16例女性）。诊断时的平均年龄为66.3±10.7岁。VTT分级为0级、Ⅰ级、Ⅱ级和Ⅲ级的患者分别有40例（62.5%）、12例（18.7%）、6例（9.4%）和6例（9.4%）。9例患者（14.1%）诊断时存在远处转移。围手术期无死亡发生，主要并发症发生率为3.1%。组织学检查显示98.4%为透明细胞RCC，12.5%的病例存在肉瘤样分化。54例（84.4%）患者切缘阴性。随访期间24例（37.5%）患者接受了全身治疗。无进展生存期（PFS）、癌症特异性生存期（CSS）和总生存期（OS）的中位数分别为23个月、60个月和48个月。多变量分析中，CSS的显著预测因素为肿瘤大小、肉瘤样分化和集合系统侵犯。根治性肾切除术联合VTT切除至Ⅲ级是一种可行且安全的手术。肿瘤体积大、肉瘤样分化和集合系统侵犯的患者风险最高，应密切监测。
