Zhang Rongjin, Liu Zhuo, Zhang Min, Li Nan, Liu Chang, Zhang Yongyue, Sun Yang, Zhang Shudong, Wang Shumin
Department of Ultrasound, Peking University Third Hospital, Beijing, China.
Department of Urology, Peking University Third Hospital, Beijing, China.
Urol Oncol. 2025 Mar;43(3):190.e21-190.e28. doi: 10.1016/j.urolonc.2024.10.031. Epub 2024 Nov 26.
Radical surgery can achieve remarkable improvements in the survival of patients with renal cell carcinoma (RCC) and inferior vena cava tumor thrombus (IVCTT); however, not all patients can obtain the desired results. Therefore, identifying patients with poor survival after surgery is crucial for guiding follow-up adjuvant therapies and patient counseling.
To evaluate the impact of primary tumor score based on tumor necrosis and tumor thrombus morphology on overall survival (OS), and create a postoperative prognostic model for patients with RCC and IVCTT.
This retrospective study included 182 patients with RCC and IVCTT who underwent radical nephrectomy and thrombectomy (RNTE). Preoperative contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), ultrasound imaging, and clinical records were collected. Kaplan-Meier analysis was used to evaluate the overall survival (OS). Prognostic factors for OS were identified by univariate and multivariate analyses using the Cox proportional hazards regression model. A nomogram was developed and internally calibrated using the bootstrap resampling method.
The mean follow-up time was 24.1 months (1-84.5 months), and 34.1% (62 of 182) of the patients died of all causes. The primary tumor score possesses a superior prognostic value for the primary tumor compared with the level of IVCTT and tumor size. Multivariate Cox regression analysis showed that primary tumor score, distant metastasis, nonclear cell subtype, sarcomatoid degeneration, preoperative anemia grade, and ASA level were independent prognostic factors. Based on these factors, a nomogram was built; the concordance index was 0.77, and the AUC for predicting 1-3 years OS were 0.80, 0.81, and 0.78, respectively.
Primary tumor score is a independent prognostic factors for patients with RCC and IVCTT. Combined with 5 easily acquired prognostic factors, a postoperative nomogram was developed and internally validated, and can be used to select patients who may benefit from adjuvant therapy or aggressive surveillance regimens.
根治性手术可显著提高肾细胞癌（RCC）合并下腔静脉瘤栓（IVCTT）患者的生存率；然而，并非所有患者都能获得理想的效果。因此，识别术后生存不良的患者对于指导后续辅助治疗和患者咨询至关重要。
评估基于肿瘤坏死和瘤栓形态的原发肿瘤评分对总生存期（OS）的影响，并为RCC合并IVCTT患者创建术后预后模型。
这项回顾性研究纳入了182例接受根治性肾切除术和血栓切除术（RNTE）的RCC合并IVCTT患者。收集术前增强计算机断层扫描（CT）、磁共振成像（MRI）、超声成像和临床记录。采用Kaplan-Meier分析评估总生存期（OS）。使用Cox比例风险回归模型通过单因素和多因素分析确定OS的预后因素。开发了一个列线图，并使用自助重采样方法进行内部校准。
平均随访时间为24.1个月（1 - 84.5个月），34.1%（182例中的62例）患者死于各种原因。与IVCTT水平和肿瘤大小相比，原发肿瘤评分对原发肿瘤具有更好的预后价值。多因素Cox回归分析显示，原发肿瘤评分、远处转移、非透明细胞亚型、肉瘤样变性、术前贫血分级和ASA水平是独立的预后因素。基于这些因素构建了一个列线图；一致性指数为0.77，预测1 - 3年OS的AUC分别为0.80、0.81和0.78。
原发肿瘤评分是RCC合并IVCTT患者的独立预后因素。结合5个易于获得的预后因素，开发并内部验证了一个术后列线图，可用于选择可能从辅助治疗或积极监测方案中获益的患者。
