Navratil Pavel, Chalupnik Jiri, Louda Miroslav, Habal Petr, Zacek Pavel, Brodak Milos, Pacovsky Jaroslav
Department of Urology, University Hospital Hradec Kralove, Sokolska 581, Hradec Kralove, 500 05, Czech Republic.
Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czech Republic.
BMC Urol. 2025 Jul 14;25(1):169. doi: 10.1186/s12894-025-01854-z.
Renal cell carcinoma (RCC) is a prevalent kidney malignancy known for its aggressive nature and potential to extend into the renal vein or inferior vena cava (IVC), affecting patient prognosis and treatment strategies.
To assess the long-term outcomes and effectiveness of radical nephrectomy with IVC thrombectomy in patients with RCC presenting with level I-IV IVC thrombus.
A retrospective analysis was conducted on 164 adult patients treated for RCC with IVC thrombectomy at a tertiary care center from January 2004 to December 2023. Data including demographics, clinical characteristics, tumor specifics, surgical details, complications, and survival rates were meticulously reviewed.
Among the patients, the mean age was 63.7 years, predominantly male (69.5%). The histological profile showed a majority of clear cell carcinoma (95.7%), with most tumors located on the right side (71.3%). Thrombus levels were distributed across I-IV, with 41 (25%) patients presenting with level I, 33 (20.1%) with level II, 55 (33.5%) with level III, and 35 (21.4%) with level IV thrombi. The mean operation time and blood loss increased with thrombus level. Perioperative complications were recorded in 57.3% of patients, and over half of the patients experienced disease recurrence (54.9%). The overall 5-year survival rate stood at 42.1%, with notably better survival in patients with level I thrombi.
Radical nephrectomy with IVC thrombectomy provides a potential for long-term control in patients with RCC and IVC thrombus, although it is associated with significant morbidity. Multidisciplinary care and expert surgical intervention are crucial for improving patient outcomes. The variability in survival rates across thrombus levels underscores the need for individualized treatment approaches.
肾细胞癌（RCC）是一种常见的肾脏恶性肿瘤，以其侵袭性和延伸至肾静脉或下腔静脉（IVC）的可能性而闻名，这会影响患者的预后和治疗策略。
评估对伴有I-IV级IVC血栓的RCC患者进行根治性肾切除术联合IVC血栓切除术的长期疗效和有效性。
对2004年1月至2023年12月在一家三级医疗中心接受RCC伴IVC血栓切除术治疗的164例成年患者进行回顾性分析。仔细审查了包括人口统计学、临床特征、肿瘤细节、手术细节、并发症和生存率等数据。
患者的平均年龄为63.7岁，以男性为主（69.5%）。组织学特征显示大多数为透明细胞癌（95.7%），大多数肿瘤位于右侧（71.3%）。血栓水平分布在I-IV级，41例（25%）患者为I级血栓，33例（20.1%）为II级，55例（33.5%）为III级，35例（21.4%）为IV级血栓。平均手术时间和失血量随血栓水平增加而增加。57.3%的患者记录了围手术期并发症，超过一半的患者出现疾病复发（54.9%）。总体5年生存率为42.1%，I级血栓患者的生存率明显更好。
根治性肾切除术联合IVC血栓切除术为RCC伴IVC血栓患者提供了长期控制的可能性，尽管它与显著的发病率相关。多学科护理和专业的手术干预对于改善患者预后至关重要。不同血栓水平患者生存率的差异强调了个体化治疗方法的必要性。
