The value of a postoperative nomogram based on the primary tumor score for overall survival of patients with renal cell carcinoma and inferior vena cava tumor thrombus.

BACKGROUND

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.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.