晚期肾细胞癌合并静脉瘤栓根治性切除术后的远期生存及长期随访

Late Survival and Long-Term Follow-Up After Radical Resection of Advanced Renal Cell Carcinoma With Associated Venous Tumor Thrombus.

作者信息

Chao Calvin L, Reddy Nidhi K, Visa Maxime, Kundu Shilajit D, Eskandari Mark K

机构信息

Department of Surgery, Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

Department of Urology, Division of Urologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.

出版信息

J Surg Oncol. 2025 Apr;131(5):917-924. doi: 10.1002/jso.28020. Epub 2024 Nov 26.

DOI:10.1002/jso.28020

PMID:39600112

Abstract

BACKGROUND AND OBJECTIVES

This study evaluates the prognostic value of venous tumor thrombus (VTT) in patients with advanced renal cell carcinoma (RCC) undergoing radical resection and inferior vena cava (IVC) thrombectomy.

METHODS

Retrospective review of patients with radical nephrectomy for RCC and associated VTT (2000-2024). Patients were dichotomized into Neves 0-II (infrahepatic) and Neves III-IV groups (suprahepatic) IVC involvement for univariate analysis.

RESULTS

A total of 64 patients (34 Neves 0-II and 30 Neves III-IV) were analyzed. No significant differences in patient or cancer characteristics. Neves III-IV was associated with greater blood loss (> 2 L) (62.1% vs. 37.9%, p = 0.02), greater intensive care unit length of stay (LOS) (4.4 vs. 1.4 days, p = 0.02), and postoperative LOS (11.0 vs. 6.5 days, p = 0.005). Overall, 30-day mortality was only 1.6% with a mean follow-up of 56.1 months. Local recurrence was 7.8% and IVC patency 96.9%. One-year survival was 82.0%, 5-year survival was 58.4%, and 15-year survival was 42.5% without significant difference between Neves levels.

CONCLUSIONS

Radical nephrectomy with VTT thrombectomy and primary IVC repair is safe with high early survival and low local recurrence. Extent of IVC tumor thrombus extension is not a poor prognostic factor for early or late survival.

摘要

背景与目的

本研究评估静脉瘤栓（VTT）在接受根治性切除术及下腔静脉（IVC）血栓切除术的晚期肾细胞癌（RCC）患者中的预后价值。

方法

回顾性分析2000年至2024年因RCC行根治性肾切除术及相关VTT的患者。将患者分为Neves 0-II（肝下）组和Neves III-IV组（肝上）IVC受累组进行单因素分析。

结果

共分析64例患者（34例Neves 0-II组和30例Neves III-IV组）。患者或癌症特征无显著差异。Neves III-IV组与更多失血（>2L）（62.1%对37.9%，p=0.02）、更长的重症监护病房住院时间（LOS）（4.4天对1.4天，p=0.02）及术后LOS（11.0天对6.5天，p=0.005）相关。总体而言，30天死亡率仅为1.6%，平均随访56.1个月。局部复发率为7.8%，IVC通畅率为96.9%。1年生存率为82.0%，5年生存率为58.4%，15年生存率为42.5%，Neves分级之间无显著差异。