Hao Xiaodong, Peng Hao, Chao Zheng, Wang Yanan, Xiao Qiugong, Zhang Chunyu, Guo Xiangdong, Xiong Zezhong, Zhou Qiang, Ma Sheng, Zhang Junbiao, Wang Jing, Li Le, Wang Zhihua
Department of Urology, Tongji Hospital Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Urology, Nangong People's Hospital, Nangong, Hebei, China.
Eur J Surg Oncol. 2025 Jan;51(1):109381. doi: 10.1016/j.ejso.2024.109381. Epub 2024 Nov 12.
To investigate preoperative predictors for selecting different surgical approaches in patients with renal cell carcinoma with inferior vena cava (IVC) tumor thrombus (RCC-IVCTT), and to establish and validate corresponding predictive models.
Clinical data of 583 RCC-IVCTT patients were retrospectively analyzed. Of these, 465 cases were used to construct predictive models, and 118 cases were used for validation. Univariate and multivariate analyses identified independent predictors for surgical strategies. Two nomogram prediction models were established based on relevant independent factors to predict surgical approach.
In the development cohort, 342 patients underwent IVC thrombectomy (IVCT), 91 underwent IVC cavectomy (IVCC), and 32 underwent IVC reconstruction (IVCR). Multivariate logistic regression analysis identified the following predictors for inability to perform IVCT: higher Mayo classification of tumor thrombus (TT), IVC wall invasion, presence of bland thrombus, pan-immune-inflammation value (PIV) > 358 × 10, and maximum anteroposterior (AP) diameter of IVC at renal vein ostium (RVo) > 24 mm. Platelet >170 × 10/L and inadequate collateral circulation were predictors for IVCR. The developed model predicted capacity of the nomogram was evaluated in terms of its calibration, discrimination, and clinical utility. The validation set confirmed these findings.
The comprehensive preoperative predictive model for RCC-IVCTT patients aids in preoperative determination of the required surgical approach and necessity for IVC angiography, facilitating perioperative preparation and reducing unnecessary invasive examinations.
探讨肾细胞癌伴下腔静脉（IVC）瘤栓（RCC-IVCTT）患者选择不同手术方式的术前预测因素，并建立和验证相应的预测模型。
回顾性分析583例RCC-IVCTT患者的临床资料。其中465例用于构建预测模型，118例用于验证。单因素和多因素分析确定手术策略的独立预测因素。基于相关独立因素建立两个列线图预测模型以预测手术方式。
在开发队列中，342例患者接受了下腔静脉血栓切除术（IVCT），91例接受了下腔静脉切除术（IVCC），32例接受了下腔静脉重建术（IVCR）。多因素logistic回归分析确定了以下无法进行IVCT的预测因素：肿瘤血栓（TT）的Mayo分级较高、IVC壁侵犯、存在白血栓、全免疫炎症值（PIV）>358×10、肾静脉开口（RVo）处IVC的最大前后径（AP）>24mm。血小板>170×10/L和侧支循环不足是IVCR的预测因素。根据校准、区分度和临床实用性评估了所开发模型对列线图的预测能力。验证集证实了这些发现。
RCC-IVCTT患者的综合术前预测模型有助于术前确定所需的手术方式和IVC血管造影的必要性，便于围手术期准备并减少不必要的侵入性检查。
