Influence Of The Extent Of Renal Vein Invasion On The Prognosis Of Patients With Clear-Cell Renal Cell Carcinoma

Objective:To retrospectively analyze the clinical data of patients undergoing radical nephrectomy or partial nephrectoly,and to use medical statistical lethods to compare the effects of vascular invasion of renal clear cell carcinoma(ccRCC)on the prognosis of patients.To understand whether there is a difference in the influence of renal vein invasion degree on the prognosis of renal clear cell carcinoma,guide clinical diagnosis and treatment.and develop better postoperative follow-up and treatment plan for patients.Clinical data is also provided for accurate staging of TNM in renal cell carcinomaMaterials and Methods:The clinical data of 750 patients undergoing radical nephrectony or partial nephrectomy in our hospital from 2002 to 2016 were retrospectively analyzed.A total of 150 cases meeting the study conditions were selected.These patients had preoperative CT or MRI to determine that there were no distant and lymph node metastases.The pathology of all patients is renal clear cell carcinoma.and it can be determined whether the tumor has renal vein and its branch invasion.Among them.30 patients had renal vein invasion.38 patients had renal vein branch invasion.and 28 patients with T3a without renal vein invasion and 54 patients with Tl-2 stage served as controls.If a patient has both a renal vein invasion and a renal vein branch violation.it is attributed to the renal vein invasion sroup.All patients included have complete postoperative follow-up data to determine whether the patient has recurrence or metastasis.If recurrence or metastasis occurs.record the time of occurrence and further confirm the diagnosis to exclude new-onset tumors from other sources.If the patient dies.the time of death is determined in the hospital or in the relevant department of the patient’s community.The clinical data of tyzed by statistical methods.The survival function was compared to determine whether the difference was statistically significant.Results:A total of 150 patients were enrolled in the stud),divided into 4 groups:renal vein invasion(n=30).renal vein branch invasion(n=38).T3a phase without renal vein invasion(n=28).and T1-T2 phase(n=54).The median follow-up time was 34 months.Data indicate that age is not a factor affecting prognosis(P=0.03).Fuhrman grade was a factor influencing the prognosis of renal clear cell carcinoma(P<0.001).and the tumor with venous invasion had a relatively high Fuhrman grade.The diameter of the tumor is also a factor of prognosis.The larger the tumor diameter.the worse the proenosis(p<0.001).The Kaplan-Meier method compared four sets of RFS and CSS.Patients with T1-T2 stage had significantly better RFS than patients with T3a stage with renal vein invasion.renal vein branch invasion.and no renal vein invasion(P=0.01.0.02.and 0.01.respectively).and renal vein invasion and renal vein branching.The RFS of T3a stase with and without renal vein invasion was not statistically significant(P=0.8 and P=0.7).In terms of CSS.it showed similar results.Patients with T1-T2 stage had significantly better RFS than those with renal vein invasion.renal vein branch involvement.and no renal vein invasion(P=0.009.P=0.01.and P=0.01.respectively),and renal vein invasion and There was no statistically significant difference in RFS of T3a between renal vein branch invasion and renal vein invasion(P=0.8 and P=0.07).The Cox risk ratio model showed that patients with T1-2 tumors had a lower probability of recurrence than patients with renal vein branch invasion(HR 0.05,95%Cl 0.02-0.17,p<0.001).Our data did not show that the recurrence rate of patients with renal vein invasion was significantly higher than that of patients with renal vein branch involvement(HR 0.90,95%Cl 0.27-1.74.p≤0.5).After statistical adjustments.the results did not change significantly.Conclusions:1.After our retrospective study,our data indicate that the proenosis difference between renal vein branch and renal vein invasion is not statistically significant,and the prognosis is similar.2.However.the prognosis of both patients is worse than that of pT1-2.indicating that renal vein invasion is a sign of poor prognosis of renal clear cell carcinoma.3.Our data support the staging criteria for renal vein invasion in the eighth edition of AJCC.We believe that it is reasonable to attribute the tumor to the renal vein and its branches to the pT3a phase.