Analysis Of Surgical Treatment And Prognostic Factors In Patients With Renal Cell Carcinoma With Venous Tumor Thrombus

Objective : To analyze the outcomes of the patients with renal cell carcinoma with venous tumor thrombus after radical nephrectomy with thrombectomy in our institution and identify the independent prognostic factors.Methods : The clinical data of patients with renal cell carcinoma with venous tumor thrombus who underwent surgery in Affiliated Provincial Hospital of Anhui Medical University from May 2013 to September 2022were reviewed and analyzed.The continuous variables were compared by T test or Mann-Whitney U test,and the categorical variables were compared by chi-square test.Survival analysis was estimated using the Kaplan-Meier method,and the statistical comparison was made by Log-rank test.Univariable and multivariable survival analysis were performed using Cox regression model to find independent prognostic factors.Results : A total of 76 patients were studied,including 50 males and 26 females,with an average age of 62 years.Preoperative lymph node metastasis and distant metastasis were detected in 15(20%)and 24(32%)patients,respectively.Perinephric fat invasion occurred in 31 patients(41%),open surgery in 30 patients(40%)and adjuvant therapy in 42patients(55%).The histological cell type was clear cell renal cell carcinoma in 54 patients and non-clear cell subtypes in 22 patients.There were 43,5,12,12 and 4 patients of Mayo clinical grade 0,I,II,III,IV,respectively.Fuhrman grade of clear cell renal cell carcinoma consisted of no patient of grade I,15 patients of grade II,19 patients of grade III and 20 patients of grade IV.The median follow-up time was 24 months.During the follow-up,38patients(50%)died and 48 patients(63.2%)had recurrence or metastasis.The 3-year and 5-year overall survival were 51% and 50%,respectively.Univariate Cox regression analysis showed that: the pathological types of non-clear cell renal cell carcinoma,preoperative distant metastasis and perinephric fat invasion were correlated with overall survival(OS)(P<0.05).Multivariate Cox regression analysis suggested that non-clear cell renal cell carcinoma(P=0.012),perinephric fat invasion(P=0.019)and distant metastasis(P<0.001)were independent risk factors for prognosis.Conclusion: The surgical treatment is generally effective in patients with renal cell carcinoma with venous tumor thrombus,which can improve the prognosis of patients,and the 5-year overall survival is about 50%.Pathological type of non-clear cell renal cell carcinoma,distant metastasis and perinephric fat invasion are independent risk factors for overall survival in patients with renal cell carcinoma with venous tumor thrombus.