Oncologic Outcomes Following Surgical Resection of Renal Cell Carcinoma with Inferior Vena Caval Thrombus Extending Above the Hepatic Veins: A Contemporary Multicenter Cohort
Oncologic Outcomes Following Surgical Resection of Renal Cell Carcinoma with Inferior Vena Caval Thrombus Extending Above the Hepatic Veins: A Contemporary Multicenter Cohort
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DOI：
10.1016/j.juro.2014.03.111
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发表时间：
2014-10-01
影响因子：
6.6
通讯作者：
Leibovich, Bradley C.
中科院分区：
文献类型：
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作者：
Haddad, Ahmed Q.;Wood, Christopher G.;Leibovich, Bradley C.
目的：肾细胞癌病例中的肝上下腔静脉癌栓历来预示着预后不良。随着高水平血栓患者围手术期治疗的进步，推测当代结局将会得到改善。我们评估了在大容量中心接受 III-IV 级下腔静脉血栓治疗的肾细胞癌患者的当代手术治疗的长期肿瘤学结果。 材料和方法：我们检查了 2000 年 1 月至 2013 年 6 月在 4 个三级转诊中心接受手术治疗的肾细胞癌和 III-IV 级血栓患者的临床和病理数据。通过 Kaplan-Meier 和多变量 Cox 回归分析评估生存结果和相关预后变量。结果：我们确定了 166 名患者，其中 69 名患者患有 III 级血栓，97 名患者患有 IV 级血栓。中位术后随访时间为 27.8 个月。无淋巴结或远处转移证据的患者 (pN0/X, M0) 的 5 年癌症特异性生存率为 49.0%，总生存率为 42.2%。根据肿瘤血栓水平或病理肿瘤分期，生存率没有差异。多变量分析中与肾癌死亡风险增加相关的变量包括区域淋巴结转移（HR 3.94，p < 0.0001）、全身转移（HR 2.39，p = 0.01）、肿瘤4级（HR 2.25，p = 0.02）、组织学组织坏死（HR 3.11，p = 0.004）和术前血清碱性增加磷酸酶（HR 2.30，p = 0.006）。结论：对于肝静脉以上肾细胞癌血栓无转移的患者，现代手术治疗可实现近 50% 的 5 年生存率。与死亡率增加相关的因素包括淋巴结/远处转移、晚期、组织学坏死和术前血清碱性磷酸酶升高。这些发现支持采用积极的手术方法来治疗患有晚期肿瘤血栓的肾细胞癌患者。
Purpose: Suprahepatic inferior vena caval tumor thrombus in renal cell carcinoma cases has historically portended a poor prognosis. With advances in perioperative treatment of patients with high level thrombus contemporary outcomes are hypothesized to be improved. We evaluated long-term oncologic outcomes of contemporary surgical treatment of patients with renal cell carcinoma in whom level III-IV inferior vena caval thrombus was managed at high volume centers.Materials and Methods: We examined clinical and pathological data on patients with renal cell carcinoma and level III-IV thrombus treated with surgery from January 2000 to June 2013 at 4 tertiary referral centers. Survival outcomes and associated prognostic variables were assessed by Kaplan-Meier and multivariate Cox regression analyses.Results: We identified 166 patients, including 69 with level III and 97 with level IV thrombus. Median postoperative followup was 27.8 months. Patients with no evidence of nodal or distant metastasis (pN0/X, M0) had 5-year 49.0% cancer specific survival and 42.2% overall survival. There was no difference in survival based on tumor thrombus level or pathological tumor stage. Variables associated with an increased risk of death from kidney cancer on multivariate analysis were regional nodal metastases (HR 3.94, p < 0.0001), systemic metastases (HR 2.39, p = 0.01), tumor grade 4 (HR 2.25, p = 0.02), histological tissue necrosis (HR 3.11, p = 0.004) and increased preoperative serum alkaline phosphatase (HR 2.30, p = 0.006).Conclusions: Contemporary surgical management achieves almost 50% 5-year survival in patients without metastasis who have renal cell carcinoma thrombus above the hepatic veins. Factors associated with increased mortality included nodal/distant metastases, advanced grade, histological necrosis and increased preoperative serum alkaline phosphatase. These findings support an aggressive surgical approach to the treatment of patients with renal cell carcinoma who have advanced tumor thrombus.