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Journal of Peking University (Health Sciences) ›› 2026, Vol. 58 ›› Issue (4): 692-699. doi: 10.19723/j.issn.1671-167X.2026.04.003

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Clinicopathological features and prognostic factors associated with long-term survival (≥5 years) in patients with clear cell renal cell carcinoma and venous tumor thrombus

Zhiming DU1, Weiliang ZHANG1, Lei ZHAO1, Min QIU1, Lulin MA1, Ye YAN1, Huiying HE2, Ruiyang XIE1,*(), Shudong ZHANG1,*()   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Pathology, Peking University Third Hospital, Beijing 100191, China
  • Received:2026-02-25 Online:2026-08-18 Published:2026-06-05
  • Contact: Ruiyang XIE, Shudong ZHANG
  • Supported by:
    Beijing Municipal Natural Science Foundation(7254443); National Natural Science Foundation of China(82504235)

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Abstract:

Objective: To characterize the clinicopathological features of long-term survivors among patients with clear cell renal cell carcinoma (ccRCC) and venous tumor thrombus (VTT) who underwent surgical treatment, and to explore potential prognostic factors beyond tumor-related variables, with particular emphasis on host-related inflammatory and nutritional indicators. Methods: The patients with ccRCC and VTT who underwent radical nephrectomy combined with tumor thrombectomy at Peking University Third Hospital between 2014 and 2019 were retrospectively analyzed. The patients were stratified into a long-term survival group (overall survival ≥60 months) and a non-long-term survival group (overall survival < 60 months). The following parameters were compared between the two groups: clinical characteristics (age, sex, body mass index, Mayo classification), pathological features (T stage, M stage, histological grade, sarcomatoid change, perirenal fat invasion), perioperative parameters (surgical approach, operative time, intraoperative blood loss, complications), and laboratory parameters (platelet count, albumin, neutrophil count, etc.). Optimal cutoff values for continuous variables, such as age, body mass index (BMI), platelet count and serum albumin level, were determined using X-tile software based on the minimum P-value principle. Subsequently, Kaplan-Meier survival analysis with Log-rank test was performed within the long-term survival cohort to evaluate the association of the above-mentioned factors with long-term survival. Results: Long-term survival was achieved in 13.9% of 397 patients with ccRCC and VTT. Significant differences were observed between the long-term survival group (n=55) and the non-long-term survival group (n=342) in baseline platelet count (P=0.040), pathological T stage (P=0.001), histological grade (P=0.006), surgical approach (P < 0.001), as well as receipt of systemic therapy (P=0.028), treatment timing (P=0.003), and treatment regimen (P < 0.001). Regarding T stage, the long-term survival group had a significantly higher proportion of pT3a tumors (63.6% vs. 42.4%) and a significantly lower proportion of pT4 tumors (10.9% vs. 33.0%) compared with the non-long-term survival group. The long-term survival group also had a higher proportion of low-grade tumors (G1/G2: 50.9% vs. 31.9%). Regarding surgical approach, laparoscopic surgery predominated in the long-term survival group (35/55, 63.6%), whereas the non-long-term survival group had a more balanced distribution, including open surgery (102/342, 29.8%), laparoscopic surgery (123/342, 36.0%), and robotic surgery (117/342, 34.2%). Regarding systemic therapy, in the long-term survival group, 26 patients (47.3%) received systemic therapy, all of whom (100.0%) received adjuvant therapy. In the non-long-term survival group, 215 patients (62.9%) received systemic therapy, of whom 160 (74.4%) received adjuvant therapy and 55 (25.6%) received neoadjuvant therapy. Regarding treatment regimen, the long-term survival group was predominantly treated with targeted monotherapy (25/26, 96.2%), whereas the non-long-term survival group had a higher proportion of targeted therapy plus immunotherapy combination (64/215, 29.8%). The median follow-up time for the long-term survival group was 81.7 months. Further subgroup analysis of this group showed that age < 70 years (P=0.038), BMI≥18.5 kg/m2 (P=0.032), platelet count 159×109/L-273×109/L (P=0.003), and albumin level >41.4 g/L (P=0.028) were significantly associated with better long-term survival, whereas Mayo classification of tumor thrombus showed no significant association with long-term survival (P=0.250). Conclusion: A subset of patients with ccRCC and VTT can achieve long-term survival. Beyond pathological tumor stage and grade, patient-related inflammatory and nutritional status may be associated with long-term survival. Exploring prognostic factors related to long-term survival may help further optimize risk stratification and treatment strategies for high-risk patients.

Key words: Carcinoma, renal cell, Neoplasm invasiveness, Venous thrombosis, Prognosis, Cancer survivors

CLC Number: 

  • R737.11

Table 1

Comparison of clinical characteristics between the long-term and the non-long-term survival ccRCC patients with VTT"

Items OS≥60 months (n=55) OS < 60 months (n=342) P value
Age/years, M (P25, P75) 59 (54, 65) 61 (55, 68) 0.290
Sex, n(%) 0.400
  Male 43 (78.2) 249 (72.8)
  Female 12 (21.8) 93 (27.2)
BMI/(kg/m2), M (P25, P75) 23 (21, 27) 24 (22, 27) 0.230
Surgical approach, n(%) < 0.001
  Open surgery 20 (36.4) 102 (29.8)
  Laparoscopic surgery 35 (63.6) 123 (36.0)
  Robotic surgery 0 (0) 117 (34.2)
Systemic therapy, n(%) 0.028
  Yes 26 (47.3) 215 (62.9)
  No 29 (52.7) 127 (37.1)
M stage at diagnosis, n(%) 0.060
  M0 45 (81.8) 238 (69.6)
  M1 10 (18.2) 104 (30.4)
Mayo classification, n(%) 0.370
  0 15 (27.3) 90 (26.3)
  Ⅰ 15 (27.3) 51 (14.9)
  Ⅱ 17 (30.8) 152 (44.4)
  Ⅲ 4 (7.3) 24 (7.0)
  Ⅳ 4 (7.3) 25 (7.3)
Intraoperative blood loss/mL, M (P25, P75) 400 (120, 1 300) 500 (200, 1 200) 0.660
Operative time/min, M (P25, P75) 251 (187, 363) 266 (195, 366) 0.800
Perioperative complications, n(%) 0.180
  Yes 13 (23.6) 110 (32.2)
  No 42 (76.4) 232 (67.8)
Clavien-Dindo grade of complications, n(%) 0.890
  0 42 (76.4) 232 (67.8)
  Ⅰ 3 (5.5) 22 (6.4)
  Ⅱ 9 (16.4) 74 (21.6)
  Ⅲ 0 (0) 4 (1.2)
  Ⅳ 1 (1.8) 8 (2.3)
  Ⅴ 0 (0) 2 (0.6)
Laboratory parameters, M (P25, P75)
  Preoperative serum creatinine/(μmol/L) 76 (88, 110) 91 (76, 107) 0.820
  Serum creatinine at 1 week postoperatively/(μmol/L) 86 (106, 117) 100 (83, 121) 0.760
  Baseline hemoglobin/(g/L) 115 (127, 142) 124 (106, 140) 0.150
  Baseline platelet count/(×109/L) 172 (203, 259) 240 (186, 309) 0.040
  Baseline neutrophil count/(×109/L) 4.4 (3.3, 5.2) 4.5 (3.4, 5.5) 0.430
  Baseline albumin/(g/L) 40 (35, 43) 40 (36, 43) 0.680

Table 2

Comparison of pathological characteristics between the long-term and the non-long-term survival ccRCC patients with VTT"

Items OS≥60 months (n=55) OS < 60 months (n=342) P value
Side, n(%) 0.440
  Left 17 (30.9) 124 (36.3)
  Right 38 (69.1) 218 (63.7)
pT stage, n(%) 0.001
  pT3a 35 (63.6) 145 (42.4)
  pT3b 11 (20.0) 44 (12.9)
  pT3c 3 (5.5) 40 (11.7)
  pT4 6 (10.9) 113 (33.0)
pN stage, n(%) 0.070
  pN0 55 (100.0) 323 (94.4)
  pN1 0 (0) 19 (5.6)
Histopathological grade, n(%) 0.006
  G1/G2 28 (50.9) 109 (31.9)
  G3/G4 27 (49.1) 233 (68.1)
Median tumor diameter/cm, M (P25, P75) 8.3 (6.4, 10.0) 8.4 (6.3, 10.3) 0.810
Sarcomatoid change, n(%) 0.810
  Yes 8 (14.5) 54 (15.8)
  No 47 (85.5) 288 (84.2)
Perinephric fat invasion, n(%) 0.190
  Yes 12 (21.8) 104 (30.4)
  No 43 (78.2) 238 (69.6)

Table 3

Comparison of treatment timing and regimen between the long-term and the non-long-term survival ccRCC patients with VTT receiving systemic therapy"

Items Receiving systemic therapy (n=241) P value
OS≥60 months (n=26) OS < 60 months (n=215)
Treatment timing, n(%) 0.003
  Adjuvant systemic therapy 26 (100.0) 160 (74.4)
  Neoadjuvant systemic therapy 0 (0) 55 (25.6)
Treatment regimen, n(%) < 0.001
  Targeted therapy (TKI monotherapy) 25 (96.2) 150 (69.8)
  Immunotherapy (PD-1/PD-L1 monotherapy) 0 (0) 1 (0.4)
  Targeted therapy plus immunotherapy combination 1 (3.8) 64 (29.8)

Figure 1

Overall survival of long-term and non-long-term ccRCC, clear cell renal cell carcinoma; VTT, venous tumor thrombus; OS, overall survival."

Figure 2

Overall survival and related risk factors in long-term survival ccRCC patients with VTT (≥60 months) ccRCC, clear cell renal cell carcinoma; VTT, venous tumor thrombus; BMI, body mass index; ISUP, International Society of Urological Pathology; PLT, platelet; ALB, albumin."

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