Clinical and radiographic predictors of the need for inferior vena cava resection during nephrectomy for patients with renal cell carcinoma and caval tumour thrombus
Clinical and radiographic predictors of the need for inferior vena cava resection during nephrectomy for patients with renal cell carcinoma and caval tumour thrombus
复制标题
DOI：
10.1111/bju.13005
复制
发表时间：
2015-09-01
影响因子：
4.5
通讯作者：
Leibovich, Bradley C.
中科院分区：
文献类型：
--
作者：
Psutka, Sarah P.;Boorjian, Stephen A.;Leibovich, Bradley C.
目的探讨肾细胞癌（RCC）静脉瘤栓切除术中需要行下腔静脉（IVC）部分或环形切除并进行复杂血管重建的临床和影像学预测因素2000年至2010年期间在马约诊所接受根治性肾切除术和肿瘤血栓切除术的（I-IV级）静脉肿瘤血栓患者。术前影像学检查由两名放射科医生中的一名重新审查，该放射科医生对患者的外科手术细节不知情。单变量和多变量相关性的临床和影像学特征与下腔静脉切除进行了评估的逻辑回归。二次分析被用来评估该模型的能力，以预测组织学入侵的IVC的肿瘤thrombois.ResultsOf 172例患者，38（22%）进行IVC切除手术在肾切除术。根据术前影像学确定最佳影像学阈值，以预测是否需要切除IVC，包括肾静脉口（RVo）处的肾静脉直径为15.5 mm，IVC的最大前后（AP）直径为34.0 mm，RVo处IVC的AP和冠状直径分别为24 mm和19 mm。在多变量分析中，右侧肿瘤的存在（比值比3.3; P = 0.017），RVo处IVC的AP直径>= 24.0 mm（比值比4.4; P = 0.017），以及RVo处IVC完全闭塞的影像学识别（比值比4.9; P < 0.001）与下腔静脉切除的风险显著增加相关。该模型的c指数为0.81。结论我们提出了一个多变量模型的影像学特征与肿瘤血栓切除术中下腔静脉切除的需要。在等待外部验证的情况下，该模型可用于术前规划、患者咨询和血管外科同事的计划参与，以预测复杂血管修复的需求。
ObjectiveTo evaluate the clinical and radiographic predictors of the need for partial or circumferential resection of the inferior vena cava (IVC) requiring complex vascular reconstruction during venous tumour thrombectomy for renal cell carcinoma (RCC).Patients and MethodsData were collected on 172 patients with RCC and IVC (levels I-IV) venous tumour thrombus who underwent radical nephrectomy with tumour thrombectomy at the Mayo Clinic between 2000 and 2010. Preoperative imaging was re-reviewed by one of two radiologists blinded to details of the patient's surgical procedure. Univariable and multivariable associations of clinical and radiographic features with IVC resection were evaluated by logistic regression. A secondary analysis was used to assess the ability of the model to predict histological invasion of the IVC by the tumour thrombus.ResultsOf the 172 patients, 38 (22%) underwent IVC resection procedures during nephrectomy. Optimum radiographic thresholds were determined to predict the need for IVC resection based on preoperative imaging included a renal vein diameter at the renal vein ostium (RVo) of 15.5 mm, maximum anterior-posterior (AP) diameter of the IVC of 34.0 mm and AP and coronal diameters of the IVC at the RVo of 24 and 19 mm, respectively. On multivariable analysis, the presence of a right-sided tumour (odds ratio 3.3; P = 0.017), an AP diameter of the IVC at the RVo of >= 24.0 mm (odds ratio 4.4; P = 0.017), and radiographic identification of complete occlusion of the IVC at the RVo (odds ratio 4.9; P < 0.001) were associated with a significantly increased risk of IVC resection. The c-index for the model was 0.81.ConclusionsWe present a multivariable model of the radiographic features associated with the need for IVC resection during tumour thrombectomy. Pending external validation, this model may be used for preoperative planning, patient counselling and planned involvement of vascular surgical colleagues in anticipation of the need for complex vascular repair.