Radiologic indicators prior to renal cell cancer thrombectomy: Implications for vascular reconstruction and mortality.
Radiologic indicators prior to renal cell cancer thrombectomy: Implications for vascular reconstruction and mortality.
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DOI：
10.4103/0974-7796.184888
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发表时间：
2016-07
期刊：
影响因子：
0.7
通讯作者：
Liss MA
中科院分区：
文献类型：
--
作者：
Overholser S;Raheem O;Zapata D;Kaushik D;Rodriguez R;Derweesh IH;Liss MA
肾癌可能会侵犯下腔静脉（IVC），从而导致更复杂的手术干预。我们研究了可能预测手术前血管重建和未来肾癌特异性死亡率的放射学发现。影像学检查结果包括马约诊所血管重建的风险因素：右侧肿瘤、肾静脉口处IVC前后径≥ 24.0 mm和IVC完全闭塞的影像学鉴定。其他因素包括肝静脉腔内血栓和转移。沿着其他人口统计学因素，分析包括血管重建的卡方分析和死亡率的logistic回归。为最显著的放射学因素创建Kaplan-Meier曲线。2007年4月至2015年2月，37名患者在两家机构接受了IVC肿瘤血栓切除术。我们发现，马约风险因素为0、1、2和3，血管重建比例分别为0%、0%、12.5%和13.6%（P = 0.788）。在多变量分析中，肝静脉受累是肾细胞癌特异性死亡率最重要的决定因素，控制了肝静脉处IVC的大小、肺转移和Fuhrman分级（P = 0.02，Log-rank P = 0.002）。马约风险因素不能预测我们的II-IV级IVC血栓行IVC血栓切除术的小型队列中的血管重建。癌栓进入肝静脉腔内是加速死亡的重要危险因素。
Renal cancer may invade the inferior vena cava (IVC) creating more complex surgical intervention. We investigate radiologic findings that may predict vascular reconstruction prior to surgery and future renal cancer-specific mortality. Radiologic findings included Mayo Clinic risk factors for vascular reconstruction: Right-sided tumor, anteroposterior diameter of the IVC at the ostium of the renal vein ≥24.0 mm, and radiologic identification of complete occlusion of the IVC. Additional factors included thrombus in the lumen of the hepatic veins and metastasis. Along with other demographic factors, analysis included Chi-squared analysis for vascular reconstruction and logistic regression for mortality. A Kaplan–Meier curve was created for the most significant radiologic factor. Thirty-seven patients underwent IVC tumor thrombectomy at two institutions from April 2007 to February 2015. We found that Mayo risk factors of 0, 1, 2, and 3 and the proportions of vascular reconstruction of 0%, 0%, 12.5%, and 13.6%, respectively (P = 0.788). Hepatic vein involvement was the most significant determinate of renal cell carcinoma-specific mortality in multivariable analysis, controlling for the size of IVC at the hepatic veins, pulmonary metastasis, and Fuhrman grade (P = 0.02, Log-rank P = 0.002). Mayo risk factors did not predict vascular reconstruction in our small cohort of Level II–Level IV IVC thrombus undergoing IVC thrombectomy. Tumor thrombus traveling into the lumen of the hepatic veins was a significant risk factor for accelerated mortality.