Miranda Miguel, Polido Joana, Fernandes Miguel, Lopes Filipe, Oliveira Tiago, Lopes Tomé, Costa Luís, Nobre Ângelo, Leitão Tito Palmela, Pedro Luís Mendes, Dos Reis José Palma
Department of Urology, Unidade Local de Saúde Santa Maria, Lisbon, Portugal.
Lisbon School of Medicine, University of Lisbon, Lisbon, Portugal.
Urol Ann. 2024 Oct-Dec;16(4):277-283. doi: 10.4103/ua.ua_113_23. Epub 2024 Oct 16.
Renal cell carcinoma (RCC) often develops a tumor thrombus extending into the inferior vena cava (IVC). Radical nephrectomy with IVC thrombectomy is the standard treatment, although prognostic factors are yet to be properly established.
The objectives of this study were to review the clinicopathological features of surgically treated patients with RCC and IVC thrombus and to investigate potential prognostic factors.
This retrospective analysis covered patients with RCC and IVC thrombus who underwent surgical treatment at a tertiary center over 12 years.
Of the 32 patients included, 56% and 41% had nodal (N1) and metastatic (M1) diseases, respectively. Thrombus level was 1 in 25% and 4 in 21.9% of cases, according to the Mayo classification. The median follow-up was 17.0 months. The median overall survival (OS) was 20.0 months, with a median OS of 36.0 months in M0 patients and 10.0 months in M1 patients (log-rank = 0.029). Stage IV disease (T4 and/or M1 status) (hazard ratio [HR]: 2.85, = 0.021), fat invasion (HR: 2.52, = 0.044), positive margins (HR: 2.54, = 0.037), American Society of Anesthesiologists score (HR: 2.59, = 0.033), tumor size >100 mm (HR: 2.538, = 0.033), and higher neutrophil-to-lymphocyte ratio ( = 0.304, = 0.001) were significantly associated with worse OS in univariate analysis. Thrombus level did not impact prognosis.
Certain clinicopathological factors, but not thrombus level, appear to influence prognosis. Prospective multicentric randomized studies are needed to better stratify patient risk, improve prognostic prediction, and evaluate systemic therapy responses.
肾细胞癌（RCC）常形成延伸至下腔静脉（IVC）的肿瘤血栓。根治性肾切除术联合IVC血栓切除术是标准治疗方法，尽管预后因素尚未完全确立。
本研究的目的是回顾接受手术治疗的RCC合并IVC血栓患者的临床病理特征，并调查潜在的预后因素。
这项回顾性分析涵盖了12年间在一家三级中心接受手术治疗的RCC合并IVC血栓患者。
在纳入的32例患者中，分别有56%和41%患有淋巴结转移（N1）和远处转移（M1）疾病。根据梅奥分类，25%的病例血栓水平为1级，21.9%的病例为4级。中位随访时间为17.0个月。中位总生存期（OS）为20.0个月，M0患者的中位OS为36.0个月，M1患者为10.0个月（对数秩检验=0.029）。IV期疾病（T4和/或M1状态）（风险比[HR]：2.85，P=0.021）、脂肪浸润（HR：2.52，P=0.044）、切缘阳性（HR：2.54，P=0.037）、美国麻醉医师协会评分（HR：2.59，P=0.033）、肿瘤大小>100 mm（HR：2.538，P=0.033）以及较高的中性粒细胞与淋巴细胞比值（P=0.304，P=0.001）在单因素分析中与较差的OS显著相关。血栓水平不影响预后。
某些临床病理因素而非血栓水平似乎影响预后。需要进行前瞻性多中心随机研究，以更好地对患者风险进行分层、改善预后预测并评估全身治疗反应。
