Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (4): 665-670. doi: 10.19723/j.issn.1671-167X.2021.04.007

Previous Articles     Next Articles

Influence of deep invasive tumor thrombus on the surgical treatment and prognosis of patients with non-metastatic renal cell carcinoma complicated with venous tumor thrombus

ZHAO Xun,YAN Ye,HUANG Xiao-juan,DONG Jing-han,LIU Zhuo,ZHANG Hong-xian,LIU Cheng(),MA Lu-lin()   

  1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
  • Received:2021-03-16 Online:2021-08-18 Published:2021-08-25
  • Contact: Cheng LIU,Lu-lin MA E-mail:chengliu@bjmu.edu.cn;malulinpku@163.com
  • Supported by:
    National Natural Science Foundation of China(82070778)

RICH HTML

 11   

PDF (PC)

116

Abstract:

Objective: To evaluate the impact of deep invasive tumor thrombus on the surgical complexity and prognosis of patients with renal cell carcinoma complicated with inferior vena cava tumor thrombus. Methods: We retrospectively reviewed the clinical data of 94 patients with non-metastatic renal cell carcinoma complicated with inferior vena cava tumor thrombus, who underwent surgical treatment in Peking University Third Hospital from January 2017 to June 2020. The patient’s general condition, clinicopathological characteristics, surgery and survival information were collected. The patients were divided into two groups based on the intra-operative findings of tumor thrombus adhesion to the venous wall, of which 64 cases were in the deep invasive tumor thrombus (DITT) group and 30 cases were in the non-invasive tumor thrombus (NITT) group. Chi-square, t test and Mann-Whitney U test were used for categorical and continuous variables respectively. Kaplan-Meier plots and multivariable Cox regressions were performed to evaluate the influence of DITT on the prognosis of the patients with renal cell carcinoma with inferior vena cava tumor thrombus. Results: DITT significantly increase the difficulty of surgery for the patients with renal cell carcinoma with venous tumor thrombus, which was mainly reflected in the longer operation time (362.5 vs. 307.5 min, P=0.010), more surgical bleeding (1 200 vs. 450 mL, P=0.006), more surgical blood transfusion (800 vs. 0 mL, P=0.021), more plasma transfusion (200 vs. 0 mL, P=0.001), a higher proportion of open surgery (70.3% vs. 36.7%, P=0.002), a longer post-operative hospital stay (9.5 vs. 8 days, P=0.036), and a higher proportion of post-operative complications (46.9% vs. 13.8%, P=0.002). DITT was associated with worse overall survival of the patients with renal cell carcinoma with inferior vena cava tumor thrombus (P=0.022). Even in the multivariate analysis, DITT was still a poor prognostic factor for the overall survival of these patients [HR: 4.635 (1.017-21.116), P=0.047]. Conclusion: For patients with non-metastatic renal cell carcinoma with inferior vena cava tumor thrombus, DITT will significantly increase the difficulty of surgery, and may lead to poor prognosis.

Key words: Renal cell carcinoma, Inferior vena cava, Tumor thrombus, Prognosis

CLC Number: 

  • R737.11

Figure 1

Typical CT image appearance of DITT group and NITT group DITT, deep invasive tumor thrombus; NITT, non-invasive tumor thrombus."

Table 1

Comparison of clinical and pathologic features between DITT group and NITT group"

Items DITT (n=64) NITT (n=30) t/U/χ2 P value
Age/years 60.4±8.9 59.4±10.9 0.453 0.652
Gender 3.548 0.060
Male 52 (81.3%) 19 (63.3%)
Female 12 (18.8%) 11 (36.7%)
Side 0.121 0.728
Left 17 (26.6%) 9 (30.0%)
Right 47 (73.4%) 21 (70.0%)
Clinical symptoms 1.294 0.523
No clinical symptoms 13 (20.3%) 7 (23.3%)
Local symptoms 36 (56.3%) 19 (63.3%)
Systemic symptoms 15 (23.4%) 4 (13.3%)
BMI/(kg/m2) 24.7±3.5 24.0±2.8 0.893 0.374
Tumor diameter/cm 8.1±2.9 9.1±2.8 1.684 0.096
Hb/(g/L) 120.3±20.4 130.3±20.7 2.203 0.030
Neu/(×109/L) 4.8±1.7 4.2±1.1 1.784 0.078
Plt/(×109/L) 255.0±118.6 262.7±77.8 0.325 0.746
ALP/(U/L) 91.6±37.6 85.6±22.5 0.802 0.424
Alb/(g/L) 39.1±5.1 40.5±4.4 1.257 0.212
Ca/(mg/L) 2.3±0.2 2.2±0.1 0.552 0.583
SCr/(μmol/L) 100.2±25.3 90.8±20.4 1.766 0.081
SCr after surgery/(μmol/L) 116.5±54.2 101.9±37.7 1.259 0.211
ASA score 5.876 0.053
1 3 (4.7%) 2 (6.7%)
2 50 (78.1%) 28 (93.3%)
3 11 (17.2%) 0 (0)
pN stage 4.099 0.052
N0 56 (87.5%) 30 (100.0%)
N1 8 (12.5%) 0 (0)
Mayo classification 8.755 0.033
Ⅰ 11 (17.2%) 12 (40.0%)
Ⅱ 40 (62.5%) 15 (50.0%)
Ⅲ 8 (12.5%) 0 (0)
Ⅳ 5 (7.8%) 3 (10.0%)
Pathology type 0.424 0.769
Clear cell carcinoma 52 (81.3%) 26 (86.7%)
Non clear cell carcinoma 12 (18.7%) 4 (13.3%)
Fuhrman grade 0.419 0.518
Ⅰ-Ⅱ 27 (42.9%) 15 (50.0%)
Ⅲ-Ⅳ 36 (57.1%) 15 (50.0%)
Surgical approach 9.601 0.002
Laparoscopic surgery 19 (29.7%) 19 (63.3%)
Open surgery 45 (70.3%) 11 (36.7%)
IVC resection 13.464 <0.001
No 42 (65.6%) 30 (100.0%)
Yes 22 (34.4%) 0 (0)
Operative time/min 362.5 (305.3, 429.8) 307.5 (254.5, 374.0) 644.0 0.010
Surgical bleeding volume/mL 1 200 (325, 2 500) 450 (200, 800) 621.0 0.006
Surgical blood transfusion volume/mL 800 (0, 1 600) 0 (0, 600) 689.0 0.021
Plasma transfusion volume/mL 200 (0, 750) 0 (0, 0) 598.0 0.001
Post-operative hospital stay/d 9.5 (7.0, 13.0) 8.0 (6.0, 9.3) 702.5 0.036
Post-operative adjuvant targeted therapy 2.546 0.111
No 23 (35.9%) 16 (53.3%)
Yes 41 (64.1%) 14 (46.7%)
Post-operative complications 9.417 0.002
No 34 (53.1%) 25 (86.2%)
Yes 30 (46.9%) 4 (13.8%)

Table 2

Comparison of surgical features between DITT group and NITT group in Mayo Ⅱ level tumor thrombus subgroup"

Items DITT (n=40) NITT (n=15) U/χ2 P value
Operative time/min 368.5 (306.5, 525.0) 302.0 (258.0, 355.0) 139 0.002
Surgical bleeding volume/mL 1 450 (525, 2 925) 400 (200, 800) 152.5 0.005
Surgical blood transfusion volume/mL 800 (0, 1 600) 0 (0, 400) 202 0.054
Plasma transfusion volume/mL 400 (0, 800) 0 (0, 0) 155 0.003
Post-operative hospital stay/d 11.0 (7.0, 13.0) 8.0 (6.0, 9.0) 190 0.036
Open surgery 30 (75.0%) 4 (26.7%) 10.8 0.001
Post-operative complications 22 (55.0%) 2 (13.3%) 7.7 0.006

Figure 2

Overall survival time between DITT group and NITT group DITT, deep invasive tumor thrombus; NITT, non-invasive tumor thrombus."

Table 3

Multivariate Cox regression analysis of prognosis risk factors for patients with non-metastatic renal cell carcinoma and inferior vena cava tumor thrombus"

Items HR 95%CI P value
DITT 4.635 1.017-21.116 0.047
Mayo classification 2.046 1.161-3.604 0.013
Hb - - 0.484
Non-clear cell carcinoma 4.275 1.495-12.229 0.007
Fuhrman grade (Ⅲ-Ⅳ vs. Ⅰ-Ⅱ) - - 0.719
[1] Ferlay J, Colombet M, Soerjomataram I, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018 [J]. Eur J Cancer, 2018, 103:356-387.
doi: S0959-8049(18)30955-9 pmid: 30100160
[2] Lardas M, Stewart F, Scrimgeour D, et al. Systematic review of surgical management of nonmetastatic renal cell carcinoma with vena caval thrombus [J]. Eur Urol, 2016, 70(2):265-280.
doi: 10.1016/j.eururo.2015.11.034
[3] Quencer KB, Friedman T, Sheth R, et al. Tumor thrombus: incidence, imaging, prognosis and treatment [J]. Cardiovasc Diagn Ther, 2017, 7(Suppl 3):S165-S177.
doi: 10.21037/cdt
[4] González J, Gorin MA, Garcia-Roig M, et al. Inferior vena cava resection and reconstruction: Technical considerations in the surgical management of renal cell carcinoma with tumor thrombus [J]. Urol Oncol, 2014, 32(1): 34.e19-26.
doi: 10.1016/j.urolonc.2013.01.004
[5] Adams LC, Ralla B, Bender YY, et al. Renal cell carcinoma with venous extension: prediction of inferior vena cava wall invasion by MRI [J]. Cancer Imaging, 2018, 18(1):17.
doi: 10.1186/s40644-018-0150-z pmid: 29724245
[6] Psutka SP, Boorjian SA, Thompson RH, et al. Clinical and radiographic predictors of the need for inferior vena cava resection during nephrectomy for patients with renal cell carcinoma and caval tumour thrombus [J]. BJU Int, 2015, 116(3):388-396.
doi: 10.1111/bju.13005 pmid: 25430786
[7] Liu Z, Li L, Hong P, et al. A predictive model for tumor invasion of the inferior vena cava wall using multimodal imaging in patients with renal cell carcinoma and inferior vena cava tumor thrombus [J]. Biomed Res Int, 2020, 2020:9530618.
[8] Li QY, Li N, Huang QB, et al. Contrast-enhanced ultrasound in detecting wall invasion and differentiating bland from tumor thrombus during robot-assisted inferior vena cava thrombectomy for renal cell carcinoma [J]. Cancer Imaging, 2019, 19(1):79.
doi: 10.1186/s40644-019-0265-x
[9] Heng DY, Xie W, Regan MM, et al. External validation and comparison with other models of the international metastatic renal-cell carcinoma database consortium prognostic model: A population-based study [J]. Lancet Oncol, 2013, 14(2):141-148.
doi: 10.1016/S1470-2045(12)70559-4
[10] Xiao R, Xu C, He W, et al. Preoperative anaemia and thrombocytosis predict adverse prognosis in non-metastatic renal cell carcinoma with tumour thrombus [J]. BMC Urol, 2021, 21(1):31.
doi: 10.1186/s12894-021-00796-6
[11] Du S, Huang Q, Yu H, et al. Initial series of robotic segmental inferior vena cava resection in left renal cell carcinoma with caval tumor thrombus [J]. Urology, 2020, 142:125-132.
doi: 10.1016/j.urology.2020.03.053
[12] Gu L, Li H, Wang Z, et al. A systematic review and meta-analysis of clinicopathologic factors linked to oncologic outcomes for renal cell carcinoma with tumor thrombus treated by radical nephrectomy with thrombectomy [J]. Cancer Treat Rev, 2018, 69:112-120.
doi: 10.1016/j.ctrv.2018.06.014
[13] Rodriguez Faba O, Linares E, Tilki D, et al. Impact of microscopic wall invasion of the renal vein or inferior vena cava on cancer-specific survival in patients with renal cell carcinoma and tumor thrombus: A multi-institutional analysis from the International Renal Cell Carcinoma-Venous Thrombus Consortium [J]. Eur Urol Focus, 2018, 4(3):435-441.
doi: S2405-4569(17)30018-4 pmid: 28753848
[14] Wang H, Li X, Huang Q, et al. Prognostic role of bland thrombus in patients treated with resection of renal cell carcinoma with infe-rior vena cava tumor thrombus [J]. Urol Oncol, 2021, 39(5): 302.e1-e7.
doi: 10.1016/j.urolonc.2021.02.005
[1] Lin LAN,Yang HE,Jin-gang AN,Yi ZHANG. Relationship between prognosis and different surgical treatments of zygomatic defects: A retrospective study [J]. Journal of Peking University (Health Sciences), 2022, 54(2): 356-362.
[2] Fei WANG,Xiang ZHU,Bei HE,Hong ZHU,Ning SHEN. Spontaneous remission of follicular bronchiolitis with nonspecific interstitial pneumonia: A case report and literature review [J]. Journal of Peking University (Health Sciences), 2021, 53(6): 1196-1200.
[3] Wei-bo GAO,Mao-jing SHI,Hai-yan ZHANG,Chun-bo WU,Ji-hong ZHU. Relationship between marked hyperferritinemia and hemophagocytic lymphohistiocytosis [J]. Journal of Peking University (Health Sciences), 2021, 53(5): 921-927.
[4] Mei-xiang ZHANG,Wen-zhi SHI,Jian-xin LIU,Chun-jian WANG,Yan LI,Wei WANG,Bin JIANG. Clinical characteristics and prognosis of MLL-AF6 positive patients with acute myeloid leukemia [J]. Journal of Peking University (Health Sciences), 2021, 53(5): 915-920.
[5] Yu TIAN,Xiao-yue CHENG,Hui-ying HE,Guo-liang WANG,Lu-lin MA. Clinical and pathological features of renal cell carcinoma with urinary tract tumor thrombus: 6 cases report and literature review [J]. Journal of Peking University (Health Sciences), 2021, 53(5): 928-932.
[6] Yan-fang JIANG,Jian WANG,Yong-jian WANG,Jia LIU,Yin PEI,Xiao-peng LIU,Ying-fang AO,Yong MA. Mid-to-long term clinical outcomes and predictors after anterior cruciate ligament revision [J]. Journal of Peking University (Health Sciences), 2021, 53(5): 857-863.
[7] XIAO Ruo-tao,LIU Cheng,XU Chu-xiao,HE Wei,MA Lu-lin. Prognostic value of preoperative platelet parameters in locally advanced renal cell carcinoma [J]. Journal of Peking University (Health Sciences), 2021, 53(4): 647-652.
[8] SUN Zheng-hui,HUANG Xiao-juan,DONG Jing-han,LIU Zhuo,YAN Ye,LIU Cheng,MA Lu-lin. Risk factors of renal sinus invasion in clinical T1 renal cell carcinoma patients undergoing nephrectomy [J]. Journal of Peking University (Health Sciences), 2021, 53(4): 659-664.
[9] YU Yan-fei,HE Shi-ming,WU Yu-cai,XIONG Sheng-wei,SHEN Qi,LI Yan-yan,YANG Feng,HE Qun,LI Xue-song. Clinicopathological features and prognosis of fumarate hydratase deficient renal cell carcinoma [J]. Journal of Peking University (Health Sciences), 2021, 53(4): 640-646.
[10] HAN Song-chen,HUANG Zi-xiong,LIU Hui-xin,XU Tao. Renal functional compensation after unilateral radical nephrectomy of renal cell carcinoma [J]. Journal of Peking University (Health Sciences), 2021, 53(4): 680-685.
[11] HONG Peng,TIAN Xiao-jun,ZHAO Xiao-yu,YANG Fei-long,LIU Zhuo,LU Min,ZHAO Lei,MA Lu-lin. Bilateral papillary renal cell carcinoma following kidney transplantation: A case report [J]. Journal of Peking University (Health Sciences), 2021, 53(4): 811-813.
[12] CHEN Huai-an,LIU Shuo,LI Xiu-jun,WANG Zhe,ZHANG Chao,LI Feng-qi,MIAO Wen-long. Clinical value of inflammatory biomarkers in predicting prognosis of patients with ureteral urothelial carcinoma [J]. Journal of Peking University (Health Sciences), 2021, 53(2): 302-307.
[13] Shi-bo LIU,Hui GAO,Yuan-chun FENG,Jing LI,Tong ZHANG,Li WAN,Yan-ying LIU,Sheng-guang LI,Cheng-hua LUO,Xue-wu ZHANG. Clinical features of hydronephrosis induced by retroperitoneal fibrosis: 17 cases reports [J]. Journal of Peking University (Health Sciences), 2020, 52(6): 1069-1074.
[14] Wei-qian CHEN,Xiao-na DAI,Ye YU,Qin WANG,Jun-yu LIANG,Yi-ni KE,Cai-hong YI,Jin LIN. Analysis of clinical features and prognosis in patients with primary Sjögren’s syndrome and autoimmune liver disease [J]. Journal of Peking University (Health Sciences), 2020, 52(5): 886-891.
[15] Ru MA,Xin-bao LI,Feng-cai YAN,Yu-lin LIN,Yan LI. Clinical evaluation of tumor-stroma ratio in pseudomyxoma peritonei from the appendix [J]. Journal of Peking University (Health Sciences), 2020, 52(2): 240-246.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] Author. English Title Test[J]. Journal of Peking University(Health Sciences), 2010, 42(1): 1 -10 .
[2] . [J]. Journal of Peking University(Health Sciences), 2009, 41(2): 188 -191 .
[3] . [J]. Journal of Peking University(Health Sciences), 2009, 41(3): 376 -379 .
[4] . [J]. Journal of Peking University(Health Sciences), 2009, 41(4): 459 -462 .
[5] . [J]. Journal of Peking University(Health Sciences), 2010, 42(1): 82 -84 .
[6] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 319 -322 .
[7] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 333 -336 .
[8] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 337 -340 .
[9] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 225 -328 .
[10] . [J]. Journal of Peking University(Health Sciences), 2007, 39(4): 346 -350 .
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd