肾透明细胞癌与非透明细胞癌伴静脉癌栓患者的临床病理特征及预后比较

doi:10.19723/j.issn.1671-167X.2025.04.003

摘要/Abstract

摘要：

目的: 比较肾透明细胞癌与非透明细胞癌伴静脉癌栓患者的临床病理特征及预后。方法: 连续性纳入2014年1月至2024年2月北京大学第三医院泌尿外科收治的肾细胞癌伴静脉癌栓患者的临床和病理资料进行回顾性分析, 根据病理类型分为透明细胞癌组和非透明细胞癌组, 比较两组患者基线、术中和预后情况。采用Kaplan-Meier方法绘制生存曲线。结果: 共纳入437例患者, 中位年龄58岁, 男性317例, 女性120例, 透明细胞癌组366例, 非透明细胞癌组71例。非透明细胞癌组包括乳头状肾细胞癌38例(53.5%)、嫌色细胞肾细胞癌2例(2.8%)、未分类肾细胞癌11例(15.5%)、分子定义的肾细胞癌19例(26.8%)和肾集合管癌1例(1.4%)。相较于肾透明细胞癌组, 非透明细胞癌组患者发病年龄较早(59岁vs. 55岁, P=0.010), 肿瘤直径更大(8.4 cm vs. 9.5 cm, P=0.025)、淋巴结转移比例较高(56.8% vs. 70.6%, P=0.034)、癌栓分级(P < 0.001)和病理分级较晚(P=0.010)、手术时间较长(272 min vs. 289 min, P=0.023)、总生存期较短(80个月vs. 35个月, P < 0.001)。多因素Cox分析显示与肾细胞癌伴静脉癌栓患者预后相关的因素为病理类型、远处转移、癌栓分级、肉瘤样或横纹肌样分化。两组在性别、体重指数、肿瘤侧别、远处转移、肉瘤样或横纹肌样分化、美国麻醉医师协会评分、手术方式选择、转为开放手术比例、失血量、输注红细胞、输注血浆等方面差异均无统计学意义。结论: 相较于肾透明细胞癌伴静脉癌栓患者, 非透明细胞癌伴静脉癌栓患者发病年龄早、疾病侵袭性强、预后差。

关键词: 肾细胞癌, 静脉癌栓, 回顾性, 预后

Abstract:

Objective: To compare the clinicopathological characteristics and prognostic outcomes between patients with clear cell renal cell carcinoma (ccRCC) and non-clear cell renal cell carcinoma (nccRCC) accompanied by venous tumor thrombus. Methods: A retrospective analysis was conducted on clinical and pathological data from patients with RCC and venous tumor thrombus treated in the Department of Urology at Peking University Third Hospital between January 2014 and February 2024. Patients were stratified into two groups based on pathological type: ccRCC and nccRCC. Comparisons of baseline characteristics, intraoperative situation, and prognosis between the two groups were performed using t-tests, Mann-Whitney U tests, chi-square tests, and Log-rank tests. Survival curves were generated using the Kaplan-Meier method. Results: A total of 437 patients were included, with a median age of 58 years, including 317 males and 120 females. The cohort comprised 366 cases of ccRCC and 71 cases of nccRCC. The non-clear cell group included 38 cases (53.5%) of papillary renal cell carcinoma, 2 cases (2.8%) of chromophobe renal cell carcinoma, 11 cases (15.5%) of unclassified renal cell carcinoma, 19 cases (26.8%) of molecularly defined renal cell carcinoma, and 1 case (1.4%) of collecting duct carcinoma. Compared with the clear cell renal carcinoma group, patients in the non-clear cell carcinoma group demonstrated a younger age at diagnosis (59 years vs. 55 years, P=0.010), larger tumor size (8.4 cm vs. 9.5 cm, P=0.025), higher rates of lymph node metastasis (56.8% vs. 70.6%, P=0.034), more advanced tumor thrombus (P < 0.001) and pathological grading (P=0.010), longer surgical duration (272 minutes vs. 289 minutes, P=0.023), and shorter overall survival (80 months vs. 35 months, P < 0.001). Multivariate Cox analysis indicated that histologic type, distant metastasis, tumor thrombus grading, and sarcomatoid/rhabdoid differentiation were prognostic factors in the renal cell carcinoma patients with venous tumor thrombus. No significant differences were observed between the two groups in terms of gender, body mass index, tumor laterality, distant metastasis, sarcomatoid or rhabdoid differentiation, American Society of Anesthesiologists (ASA) score, surgical approach, conversion to open surgery, blood loss, or transfusion of red blood cells and plasma. Conclusion: Compared with patients with clear cell renal carcinoma and venous tumor thrombus, those with non-clear cell carcinoma and venous tumor thrombus exhibit earlier onset, more aggressive disease progression, and poorer prognosis.

Key words: Renal cell carcinoma, Venous tumor thrombus, Retrospective, Prognosis

中图分类号:

R737.11

郭博达, 陆敏, 王国良, 张洪宪, 刘磊, 侯小飞, 赵磊, 田晓军, 张树栋. 肾透明细胞癌与非透明细胞癌伴静脉癌栓患者的临床病理特征及预后比较[J]. 北京大学学报（医学版）, 2025, 57(4): 644-649.

Boda GUO, Min LU, Guoliang WANG, Hongxian ZHANG, Lei LIU, Xiaofei HOU, Lei ZHAO, Xiaojun TIAN, Shudong ZHANG. Clinicopathological and prognostic differences between clear cell and non-clear cell renal cell carcinoma with venous tumor thrombus[J]. Journal of Peking University (Health Sciences), 2025, 57(4): 644-649.

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参考文献 17

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Variables	Total	ccRCC	nccRCC	P
Number of patients	437 (100.0)	366 (83.8)	71 (16.2)
Age/years	58 (14)	59 (8)	55 (18)	0.010
Gender				0.191
Male	317 (72.5)	270 (73.8)	47 (66.2)
Female	120 (27.5)	96 (26.2)	24 (33.8)
BMI/(kg/m²)	24.0 (4.7)	24.0 (5.0)	24.1 (4.1)	0.734
Tumor laterality				0.194
Left	167 (38.2)	135 (36.9)	32 (45.1)
Right	270 (61.8)	231 (63.1)	39 (54.9)
Histologic type
Clear cell	366 (83.8)	366 (100)	-
Papillary	38 (8.7)	-	38 (53.5)
Chromophobe	2 (0.5)	-	2 (2.8)
Unclassified	11 (2.5)	-	11 (15.5)
Molecularly defined	19 (4.3)	-	19 (26.8)
Collecting duct	1 (0.2)	-	1 (1.4)
Tumor diameter/cm	8.6 (3.8)	8.4 (3.9)	9.5 (4.1)	0.025
N				0.034
N0	177 (40.5)	158 (43.2)	20 (29.4)
N1	260 (59.5)	208 (56.8)	48 (70.6)
M				0.074
M0	315 (72.1)	270 (73.8)	45 (63.4)
M1	122 (27.9)	96 (26.2)	26 (37.6)
Tumor thrombus grading				< 0.001
0	112 (25.6)	97 (26.5)	15 (21.1)
1	73 (16.7)	61 (16.7)	12 (16.9)
2	182 (41.6)	154 (42.1)	28 (39.4)
3	37 (8.5)	25 (6.8)	12 (16.9)
4	33 (7.6)	29 (7.9)	4 (5.7)
Sarcomatoid/rhabdoid differentiation				0.118
Absent	374 (85.6)	309 (84.4)	65 (91.5)
Present	63 (14.4)	57 (15.6)	6 (8.5)
Pathologic grade				0.010
1-2	157 (35.9)	141 (38.5)	16 (22.5)
3-4	280 (64.1)	225 (61.5)	55 (77.5)
ASA grade				0.233
1-2	367 (84.0%)	304 (83.1)	63 (88.7)
3-4	70 (16.0)	62 (16.9)	8 (11.3)

Variables	Total	ccRCC	nccRCC	P
Number of patients	437 (100.0)	366 (83.8)	71 (16.2)
Radical nephrectomy approach				0.112
Open	157 (35.9)	124 (33.9)	33 (46.5)
Laparoscopic	181 (41.4)	158 (43.2)	23 (32.4)
Robotic	99 (22.7)	84 (22.9)	15 (21.1)
Conversion to open surgery^*	8 (2.9)	7 (2.9)	1 (2.6)	>0.999
Duration of surgery/min	273 (171)	272 (164)	289 (170)	0.023
Estimated blood loss/mL	500 (900)	500 (900)	575 (857)	0.361
RBC transfusion/mL	400 (800)	400 (800)	0 (800)	0.316
Plasma transfusion/mL	0 (400)	0 (400)	0 (400)	0.591

Variables	Univariate analysis		Multivariate analysis
Variables	HR (95%CI)	P	HR (95%CI)	P
Age/years
< 60
≥60	1.344 (0.981, 1.841)	0.066
Gender
Male
Female	0.931 (0.651, 1.332)	0.695
BMI/(kg/m²)
< 24
≥24	0.626 (0.456, 0.859)	0.004	0.772 (0.553, 1.078)	0.128
Tumor laterality
Left
Right	0.921 (0.671, 1.264)	0.611
Histologic type
Clear cell
Non-clear cell	2.386 (1.670, 3.409)	< 0.001	2.277 (1.561, 3.321)	< 0.001
Tumor size/cm
< 8.5
≥8.5	1.199 (0.879, 1.637)	0.252
N
N0
N1	1.270 (0.919, 1.756)	0.148
M
M0
M1	2.582 (1.882, 3.543)	< 0.001	2.250 (1.609, 3.146)	< 0.001
Tumor thrombus grading
0
1	1.102 (0.657, 1.848)	0.712	0.986 (0.584, 1.666)	0.958
2	1.246 (0.818, 1.896)	0.306	1.275 (0.824, 1.975)	0.276
3	2.082 (1.207, 3.589)	0.008	1.502 (0.816, 2.766)	0.192
4	2.399 (1.367, 4.211)	0.002	2.208 (1.207, 4.040)	0.010
Sarcomatoid/rhabdoid differentiation
Absent
Present	2.168 (1.454, 3.235)	< 0.001	2.309 (1.520, 3.509)	< 0.001
Pathologic grade
1-2
3-4	1.931 (1.362, 2.738)	< 0.001	1.432 (0.998, 2.056)	0.051
ASA grade
1-2
3-4	1.399 (0.939, 2.083)	0.098
Radical nephrectomy approach
Open
Laparoscopic	1.483 (1.067, 2.060)	0.019	0.872 (0.596, 1.276)	0.481
Robotic	0.884 (0.512, 1.525)	0.657	0.614 (0.349, 1.081)	0.091