Poirier Thomas, Mesnard Benoit, Roumiguie Mathieu, De Vergie Stephane, Geay Cloe, Branchereau Julien, Prudhomme Thomas, Rigaud Jerome
Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France.
Department of Urology, Clinique Pasteur, Toulouse, France.
World J Urol. 2025 Sep 9;43(1):544. doi: 10.1007/s00345-025-05914-9.
In 5-10% of cases, renal cancer extends into the venous system, particularly the inferior vena cava (IVC), which worsens prognosis. This study aims to assess morbidity, mortality, and oncological outcomes of patients treated surgically for renal cancer with IVC extension over a 30-year period, in two experienced centers.
This bicentric, retrospective study analyzed patients treated between 1988 and 2020 for renal cancer involving the IVC. Surgical approach varied based on thrombus level, with CPB mostly employed for thrombi above the hepatic veins.
From 1988 to 2020, 213 patients were treated. Thrombi below the hepatic veins were found in 137 patients (64.3%), while 76 (35.7%) had thrombi above the hepatic veins. Synchronous metastases were identified in 34.3%. Median blood loss was 1.75 L. Transfusions were required in 81.8%.CPB use significantly extended hospital stay (p < 0.001) and increased complication rates (p < 0.01). Morbidity was recorded in 53% of patients. Postoperative mortality within 30 days occurred in 9.4% of cases. Median follow-up was 25 months. The 2- and 5-year OS rates were 50.2% and 29.6%, respectively. In multivariate analysis, M + and pN + status at diagnosis were the primaries prognostics factors for OS (HR = 1.54, p = 0.033 and HR = 2.21, p = 0.002). The 2 and 5 years PFS were 25.3% and 11.7%, respectively.
Renal cancer with IVC extension remains a highly aggressive disease with poor prognosis. While surgery offers a potential cure for some patients, the high rates of perioperative morbidity and mortality remain a challenge.
在5%-10%的病例中，肾癌会侵犯静脉系统，尤其是下腔静脉（IVC），这会使预后恶化。本研究旨在评估在两个经验丰富的中心，30年间接受手术治疗的伴有下腔静脉侵犯的肾癌患者的发病率、死亡率和肿瘤学结局。
这项双中心回顾性研究分析了1988年至2020年间接受治疗的累及下腔静脉的肾癌患者。手术方式根据血栓水平而异，体外循环（CPB）主要用于肝静脉以上的血栓。
1988年至2020年，共治疗213例患者。137例（64.3%）患者的血栓位于肝静脉以下，76例（35.7%）患者的血栓位于肝静脉以上。34.3%的患者发现有同步转移。中位失血量为1.75L。81.8%的患者需要输血。使用CPB显著延长了住院时间（p<0.001）并增加了并发症发生率（p<0.01）。53%的患者记录有发病率。30天内的术后死亡率为9.4%。中位随访时间为25个月。2年和5年总生存率分别为50.2%和29.6%。多因素分析显示，诊断时M+和pN+状态是总生存的主要预后因素（HR=1.54，p=0.033；HR=2.21，p=0.002）。2年和5年无进展生存率分别为25.3%和11.7%。
伴有下腔静脉侵犯的肾癌仍然是一种侵袭性很强、预后很差的疾病。虽然手术为一些患者提供了潜在的治愈机会，但围手术期的高发病率和死亡率仍然是一个挑战。
