Guo B, Lu M, Wang G, Zhang H, Liu L, Hou X, Zhao L, Tian X, Zhang S
Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Department of Pathology, Peking University Third Hospital, Peking University School of Basic Medical Sciences, Beijing, 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2025 Aug 18;57(4):644-649. doi: 10.19723/j.issn.1671-167X.2025.04.003.
To compare the clinicopathological characteristics and prognostic outcomes between patients with clear cell renal cell carcinoma (ccRCC) and non-clear cell renal cell carcinoma (nccRCC) accompanied by venous tumor thrombus.
A retrospective analysis was conducted on clinical and pathological data from patients with RCC and venous tumor thrombus treated in the Department of Urology at Peking University Third Hospital between January 2014 and February 2024. Patients were stratified into two groups based on pathological type: ccRCC and nccRCC. Comparisons of baseline characteristics, intraoperative situation, and prognosis between the two groups were performed using -tests, Mann-Whitney tests, chi-square tests, and Log-rank tests. Survival curves were generated using the Kaplan-Meier method.
A total of 437 patients were included, with a median age of 58 years, including 317 males and 120 females. The cohort comprised 366 cases of ccRCC and 71 cases of nccRCC. The non-clear cell group included 38 cases (53.5%) of papillary renal cell carcinoma, 2 cases (2.8%) of chromophobe renal cell carcinoma, 11 cases (15.5%) of unclassified renal cell carcinoma, 19 cases (26.8%) of molecularly defined renal cell carcinoma, and 1 case (1.4%) of collecting duct carcinoma. Compared with the clear cell renal carcinoma group, patients in the non-clear cell carcinoma group demonstrated a younger age at diagnosis (59 years 55 years, =0.010), larger tumor size (8.4 cm 9.5 cm, =0.025), higher rates of lymph node metastasis (56.8% 70.6%, =0.034), more advanced tumor thrombus ( < 0.001) and pathological grading (=0.010), longer surgical duration (272 minutes 289 minutes, =0.023), and shorter overall survival (80 months 35 months, < 0.001). Multivariate Cox analysis indicated that histologic type, distant metastasis, tumor thrombus grading, and sarcomatoid/rhabdoid differentiation were prognostic factors in the renal cell carcinoma patients with venous tumor thrombus. No significant differences were observed between the two groups in terms of gender, body mass index, tumor laterality, distant metastasis, sarcomatoid or rhabdoid differentiation, American Society of Anesthesiologists (ASA) score, surgical approach, conversion to open surgery, blood loss, or transfusion of red blood cells and plasma.
Compared with patients with clear cell renal carcinoma and venous tumor thrombus, those with non-clear cell carcinoma and venous tumor thrombus exhibit earlier onset, more aggressive disease progression, and poorer prognosis.
比较伴有静脉瘤栓的透明细胞肾细胞癌（ccRCC）与非透明细胞肾细胞癌（nccRCC）患者的临床病理特征及预后结果。
对2014年1月至2024年2月在北京大学第三医院泌尿外科接受治疗的肾细胞癌伴静脉瘤栓患者的临床和病理资料进行回顾性分析。根据病理类型将患者分为两组：ccRCC和nccRCC。采用t检验、Mann-Whitney检验、卡方检验和Log-rank检验对两组患者的基线特征、术中情况及预后进行比较。采用Kaplan-Meier法绘制生存曲线。
共纳入437例患者，中位年龄58岁，其中男性317例，女性120例。队列包括366例ccRCC和71例nccRCC。非透明细胞组包括38例（53.5%）乳头状肾细胞癌、2例（2.8%）嫌色肾细胞癌、11例（15.5%）未分类肾细胞癌、19例（26.8%）分子定义肾细胞癌和1例（1.4%）集合管癌。与透明细胞肾癌组相比，非透明细胞癌组患者诊断时年龄更小（59岁对55岁，P = 0.010），肿瘤更大（8.4 cm对9.5 cm，P = 0.025），淋巴结转移率更高（56.8%对70.6%，P = 0.034），肿瘤栓子更高级（P < 0.001）和病理分级更高（P = 0.010），手术时间更长（272分钟对289分钟，P = 0.023），总生存期更短（80个月对35个月，P < 0.001）。多因素Cox分析表明，组织学类型、远处转移、肿瘤栓子分级和肉瘤样/横纹肌样分化是伴有静脉瘤栓的肾细胞癌患者的预后因素。两组在性别、体重指数、肿瘤侧别、远处转移、肉瘤样或横纹肌样分化、美国麻醉医师协会（ASA）评分、手术方式、转为开放手术、失血量或红细胞及血浆输注方面无显著差异。
与伴有静脉瘤栓的透明细胞肾癌患者相比，伴有静脉瘤栓的非透明细胞癌患者发病更早，疾病进展更具侵袭性，预后更差。
