Prognostic role of bland thrombus in patients treated with resection of renal cell carcinoma with inferior vena cava tumor thrombus
Prognostic role of bland thrombus in patients treated with resection of renal cell carcinoma with inferior vena cava tumor thrombus
复制标题
DOI：
10.1016/j.urolonc.2021.02.005
复制
发表时间：
2021-05-21
影响因子：
2.7
通讯作者：
Wang, Baojun
中科院分区：
文献类型：
--
作者：
Wang, Hanfeng;Li, Xintao;Wang, Baojun
目的：为评估无血栓（BT）的存在对肾细胞癌（RCC）伴下腔静脉癌栓（IVCTT）切除术患者预后的影响，材料与方法：回顾性分析2008年1月至2018年8月间连续145例RCC术后IVCTT I ~ IV级患者的病历。通过卡方检验或Student t检验估计BT与临床病理变量的关联。采用Kaplan-Meier法和多因素考克斯比例风险模型。采用美国加州大学洛杉矶分校TNM分期系统的第8期“Spiess PE”模型和分期、大小、分级和坏死（SSIGN）评分评估BT是否能提高其预测能力。34例出现BT（23.4%），与IVCTT水平升高（P = 0.004）和IVC壁侵犯（P = 0.030）显著相关。多因素考克斯分析显示肿瘤分级、T分期、M分期、癌栓一致性和BT是无进展生存期和总生存期的独立危险因素。一致性指数从TNM的0.652到SSGN的0.731不等，将BT整合到每个基础模型中导致TNM的预测准确率提高6.2（P = 0.025），“Spiess PE”模型为4.0%（P = 0.069），加州大学洛杉矶分校综合分期系统为2.1%结论：BT的存在与RCC-IVCTT术后患者的生存率独立相关。建议常规考虑BT作为TNM分期系统的辅助。(C)2021爱思唯尔公司All rights reserved.
Objectives: To assess the impact of the presence of bland thrombus (BT) on prognosis of patients treated with resection of renal cell carcinoma (RCC) with inferior vena cava tumor thrombus (IVCTT).Materials and methods: The medical records of a total of 145 consecutive postsurgical RCC patients with level I-IV IVCTT were reviewed from January 2008 to August 2018. Associations of BT with clinicopathological variables were estimated by chi-square test or Student's t-test. Kaplan-Meier method and multivariate Cox proportional hazard model were used. The eighth TNM staging system, "Spiess PE" model, University of California at Los Angeles Integrated Staging System and Stage, Size, Grade, and Necrosis (SSIGN) score were selected to assess whether BT could improve their predictive abilities.Results: BT was observed in 34 (23.4%) patients and was significantly associated with increased levels of IVCTT (P = 0.004) and invasion of IVC wall (P = 0.030). Multivariable Cox analyses revealed that tumor grade, T stage, M stage, tumor thrombus consistency and BT were independent risk factors for both progression-free survival and overall survival. The concordance indexes ranged from a low of 0.652 in TNM to a high of 0.731 in SSIGN, and integrating BT into each base model led to an increased predictive accuracies of 6.2% for TNM (P = 0.025), 4.0% for "Spiess PE" model (P = 0.069), 2.1% for University of California at Los Angeles Integrated Staging System (P = 0.149) and 1.2% for SSIGN (P = 0.290), respectively.Conclusions: Presence of BT was independently associated with survival in postsurgical patients with RCC-IVCTT. Routine consideration of BT as an adjunct to TNM staging system may be suggested. (C) 2021 Elsevier Inc. All rights reserved.