Jiao Qilong, Peng Cheng, Cao Ben, Song Jialong, Wang Shuoyu, Shi Changwei, Kang Huanhuan, Li Xiubin, Ding Xiaohui, Wang Baojun, Gu Liangyou, Wang Haiyi, Zhang Xu, Ma Xin, Huang Qingbo
School of Medicine, Nankai University, Tianjin, China.
Department of Urology, The Third Medical Center, Chinese PLA General Hospital, Beijing, China.
Ann Surg Oncol. 2025 Aug 5. doi: 10.1245/s10434-025-17985-4.
Renal tumor and inferior vena cava tumor thrombus (RT-IVCTT), as a unique model for investigating congestive renal injury, remains largely unexplored. Although chronic kidney disease significantly correlates with postoperative adverse events and long-term prognosis in both renal tumor and pan-cancer settings, there is no large-scale evidence specifically addressing RT-IVCTT. This study aimed to identify risk factors of preoperative renal dysfunction (pre-RD) and evaluate its contribution as a predictor for prognosis in patients with RT-IVCTT.
Consecutive postoperative patients with RT-IVCTT and no evidence of distant metastasis (n = 208) were retrospectively enrolled between June 2013 and June 2023. Preoperative estimated glomerular filtration rate (pre-eGFR) (mL/min/1.73 m) was classified into four categories: ≥ 120, 90-120, 60-90, and < 60, and clinical data were analyzed to determine a meaningful cutoff. Multivariate logistic and Cox regression models were employed to identify risk factors of pre-RD and prognosis in patients with RT-IVCTT, respectively.
Pre-RD, defined as pre-eGFR < 90 mL/min/1.73 m, was found in 59 patients (28.4%). Pre-RD was associated with increased operative time, intraoperative blood transfusion, extended intensive care unit stay, major complications and long-term survival. Age > 56 years, body mass index > 24 kg/m, left-sided tumors, and IVC obstruction > 75% were independent risk factors for pre-RD. Survival analysis revealed that pre-RD was an independent risk factor for poorer overall survival.
Pre-RD is an independent risk factor for diminished long-term survival after surgery. Hemodynamic changes from IVC obstruction are associated with pre-RD. eGFR-based renal function assessments may improve perioperative management. Chinese Clinical Trial Registry: ChiCTR2400089649.
肾肿瘤合并下腔静脉瘤栓（RT-IVCTT）作为研究充血性肾损伤的独特模型，在很大程度上仍未得到充分探索。尽管慢性肾脏病在肾肿瘤和泛癌环境中均与术后不良事件及长期预后显著相关，但尚无专门针对RT-IVCTT的大规模证据。本研究旨在确定术前肾功能不全（pre-RD）的危险因素，并评估其作为RT-IVCTT患者预后预测指标的作用。
回顾性纳入2013年6月至2023年6月期间连续收治的术后RT-IVCTT患者且无远处转移证据者（n = 208）。术前估计肾小球滤过率（pre-eGFR）（mL/min/1.73 m²）分为四类：≥120、90 - 120、60 - 90及<60，并分析临床数据以确定有意义的临界值。分别采用多因素逻辑回归和Cox回归模型确定RT-IVCTT患者pre-RD的危险因素及预后情况。
59例患者（28,4%）存在pre-RD（定义为pre-eGFR<90 mL/min/1.73 m²）。Pre-RD与手术时间延长、术中输血、重症监护病房停留时间延长、主要并发症及长期生存相关。年龄>56岁、体重指数>24 kg/m²、左侧肿瘤及下腔静脉阻塞>75%是pre-RD的独立危险因素。生存分析显示，pre-RD是总体生存较差的独立危险因素。
Pre-RD是术后长期生存降低的独立危险因素。下腔静脉阻塞引起的血流动力学变化与pre-RD相关。基于eGFR的肾功能评估可能改善围手术期管理。中国临床试验注册中心：ChiCTR2400089649。
