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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (5): 802-811. doi: 10.19723/j.issn.1671-167X.2023.05.005

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Clinicopathologic features and prognosis of young renal tumors with tumor thrombus

Zi-xuan XUE1,Shi-ying TANG1,Min QIU1,*(),Cheng LIU2,*(),Xiao-jun TIAN1,Min LU3,Jing-han DONG1,Lu-lin MA1,Shu-dong ZHANG1   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Urology, Shanghai First People' s Hospital, Shanghai 200940, China
    3. Department of Pathology, Peking University Third Hospital, Beijing 100191, China
  • Received:2023-03-18 Online:2023-10-18 Published:2023-10-09
  • Contact: Min QIU,Cheng LIU E-mail:qiumin@bjmu.edu.cn;liucheng@bjmu.edu.cn

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Abstract:

Objective: To retrospectively analyze clinical data of patients under 40 years old who underwent surgical treatment for renal tumors with tumor thrombus from January 2016 to December 2022 at Peking University Third Hospital, and to evaluate the surgical effect and investigate the relationship between clinicopathological characteristics and prognosis. Methods: The clinical data of 17 young patients with renal tumor thrombus were retrospectively analyzed, and the clinicopathological features and prognosis were summarized. The patients were grouped according to the presence or absence of symptoms, 2017 American Joint Committee on Cancer (AJCC) clinical stage, and postoperative combined adjuvant therapy. Kaplan-Meier method was used to plot the survival curve, and Log-rank test was used to compare the differences in postoperative survival time and progression-free survival time between the different groups. The relationship between clinicopathological features and prognosis was analyzed. Results: All the 17 patients received venous tumor thrombectomy, including 16 patients (94.1%) who underwent radical nephrectomy and 1 patient (5.9%) who underwent partial nephrectomy. Twelve patients (70.6%) had symptoms and 5 (29.4%) had no symptoms before operation. A total of 17 renal tumors were observed, with 2 patients (11.8%) identified as benign and 15 patients (88.2%) classified as malignant. Among the malignant tumors, 1 patient (6.7%) was diagnosed as clear cell carcinoma, while the remaining 14 patients (93.3%) were categorized as non-clear cell carcinoma. In terms of tumor stage, 8 patients (53.3%) were classified as stage Ⅲ according to the AJCC classification, while 7 patients (46.7%) were categorized as stage Ⅳ. Additionally, 6 patients (40%) received multiple adjuvant therapy, while 9 patients (60%) did not undergo such treatment. The follow-up period ranged from 2 to 78 months, with a median follow-up of 41 months. During this time, 3 patients (20%) died. The median survival time after surgery was 39.0 (2.3, 77.8) months, and the progression-free survival time was 16.4 (2.3, 77.8) months. There was no significant difference in postoperative survival time and progression-free survival time among young patients with renal tumor with tumor thrombus, based on the presence of symptoms before surgery (P=0.307, P=0.302), clinical stage of AJCC (P=0.340, P=0.492), and postoperative adjuvant therapy (P=0.459, P=0.253) group. Conclusion: The pathological types of young patients with renal tumor with tumor thrombus are more complex and varied due to symptoms, and the proportion of non-clear cell carcinoma in malignant tumor with tumor thrombus is higher. Symptomatic and non-clear cell carcinoma may be potentially associated with poor prognosis. Surgical operation combined with adjuvant therapy is a relatively safe and effective treatment for young patients with renal tumor and tumor thrombus.

Key words: Young adult, Kidney neoplasms, Tumor thrombus, Clinicopathologic features, Prognosis

CLC Number: 

  • R737.11

Table 1

Preoperative clinical data of 17 young patients with renal tumor and tumor thrombus"

ItemsDataItemsData
GenderPosition
  Male8 (47.1%)  Superior6 (35.2%)
  Female9 (52.9%)  Intermediate3 (17.6%)
Age/years31 (6, 39)  Below-intermediat1 (5.8%)
BMI/(kg/m2)24.1 (11.7, 32.0)  Upper-intermediat7 (41.1%)
Clinical symptomsTumor shape
  Backache8 (47.0%)  Convex profile11 (64.7%)
  Blood urine3 (17.0%)  Endophytic type6 (35.2%)
  Abdominal mass1 (5.8%)Transfer situation
  Physical examination findings5 (29.4%)  Lymph nodes7 (41.1%)
Course of disease/d30 (1, 730)  Adrenal metastasis4 (23.5%)
Previous history  Liver metastasis3 (17.6%)
  Hypertension1 (5.8%)  Multiple metastases1 (5.8%)
  Diabetes1 (5.8%)Inferior vena cava metastasis17 (100.0%)
  Operations5 (29.4%)Mayo classification
  Hepatitis B carrier1 (5.8%)  Ⅰ3 (17.6%)
Smoking history1 (5.8%)  Ⅱ9 (52.9%)
Preoperative assay  Ⅲ5 (29.4%)
  Hemoglobin/(g/L)126 (92, 150)cT stage (n=15)
  Albumin/(g/L)41.4 (28.3, 46.8)  T3a1 (6.7%)
  Scr/(μmol/L)83 (53, 118)  T3b7 (46.7%)
  Affected side GFR/(mL/min)32.1 (12.9, 77.4)  T47 (46.7%)
  Healthy side GFR/(mL/min)69.9 (38.0, 117.6)cN stage (n=15)
Ultrasound B13 (76.4%)  Nx3 (20.0%)
CT (plain scan/enhanced scan/PET-CT)16 (94.2%)  N06 (40.0%)
MRI (plain scan/enhanced scan/CEMRA)13 (76.4%)  N16 (40.0%)
Tumor diameter/cm11.7 (4.0, 17.8)cM stage (n=15)
Tumor thrombus length/cm4.5 (1.5, 12.0)  M011 (73.3%)
Clinical impression  M14 (26.7%)
  Benign renal hamartoma2 (11.8%)2017 AJCC clinical stage
  Malignant renal tumors15 (88.2%)  Ⅲ8 (53.3%)
Side  Ⅳ7 (46.7%)
  Left7 (41.1%)
  Right10 (58.8%)

Table 2

Surgical and pathological data of 17 young patients with renal tumor and thrombus"

ItemsDataItemsData
Surgical methodsHistopathological type
  Radical nephrectomy16 (94.1%)Malignant renal tumors (n=15)
  Partial nephrectomy1 (5.8%)  Clear cell renal carcinoma1 (5.8%)
Thrombectomy17 (100.0%)  Papillary renal cell carcinoma5 (29.4%)
Lymph node dissection6 (35.2%)  Nephroblastoma3 (17.6%)
Adrenalectomize8 (47.1%)  Ewing’s sarcoma3 (17.6%)
Metastasectomy1 (5.8%)  Fumarate hydratase deficient renal cell carcinoma1 (5.8%)
Surgical approach  TFE3-rearanged renal cell carcinoma1 (5.8%)
  Simple laparoscopy4 (23.5%)  Unclassified renal cell carcinoma1 (5.8%)
  Robot-assisted laparoscopy2 (11.7%)Benign renal tumors (n=2)
  Laparoscopy converted to open surgery1 (5.8%)  Epithelioid angiomyolipoma1 (5.8%)
  Open surgery10 (58.8%)  Angiomyolipoma1 (5.8%)
ASA classificationLymphatic metastasis3 (17.6%)
  12 (11.7%)Adrenal metastasis1 (5.8%)
  215 (88.2%)Renal capsule involved9 (52.9%)
Operative time/min294 (148, 561)Vascular involved17 (100.0%)
Surgical bleeding volume/mL600 (20, 4 500)Perineal fat sac involved6 (35.2%)
Surgical blood transfusion volume/mL300 (0, 2 700)Renal sinuses/pelvis involved16 (94.1%)
Plasma transfusion volume/mL400 (0, 1 600)pT stage (n=15)
Postoperative hospital stay/d8 (2, 18)  T3a2 (13.3%)
Postoperative complications  T3b9 (60.0%)
  Fever5 (29.4%)  T44 (26.7%)
  Anemia1 (5.8%)pN stage (n=15)
  Hypokalemia1 (5.8%)  Nx9 (60.0%)
  Hypoalbuminemia2 (11.7%)  N03 (20.0%)
  Lymphatic fistula2 (11.7%)  N13 (20.0%)
  Pulmonary infection1 (5.8%)pM stage (n=15)
  Seroperitoneum1 (5.8%)  M011 (76.4%)
  Intestinal obstruction1 (5.8%)  M14 (23.5%)
  Pulmonary embolism1 (5.8%)Immunohistochemistry14 (82.3%)
Clavien classification system  P504S (+)6 (35.2%)
  Ⅰ8 (47.0%)  Ki-67 (+)6 (35.2%)
  Ⅱ8 (47.0%)  P53(wild-type) (+)5 (29.4%)
  Ⅲ1 (5.8%)  PAX-8 (+)5 (29.4%)
  TFE3 (+)4 (23.5%)

Table 3

Follow-up data of 17 young patients with renal tumor thrombus"

ItemsDataItemsData
Malignant renal tumors (n=15)Postoperative therapy14 (93.3%)
Alive12 (80.0%)  Targeted therapy6 (40.0%)
Dead3 (20.0%)  Chemotherapy1 (6.7%)
Recurrence8 (53.3%)  Immunotherapy1 (6.7%)
  Symptoms3 (20.0%)  Combination therapy6 (40.0%)
  Physical examination findings5 (33.3%)    Radiotherapy+targeted therapy1 (6.7%)
Postoperative metastasis8(53.3%)    Immunotherapy+targeted therapy1 (6.7%)
  Liver2 (13.3%)    Chemotherapy+targeted therapy1 (6.7%)
  Liver+mesentery1 (6.7%)    Radiotherapy+chemotherapy1 (6.7%)
  Liver+bone+pelvic cavity1 (6.7%)    Radiotherapy+targeted+immunotherapy1 (6.7%)
  Bone+lung1 (6.7%)    Surgery+targeted+ chemotherapy1 (6.7%)
  Adrenal gland1 (6.7%)
  Spleen+pancreas+psoas muscle1 (6.7%)Benign renal tumors (n=2)
  Extensive peritoneal metastasis1 (6.7%)  Alive2 (100.0%)
Survival time/month39.0 (2.3, 77.8)  Recurrence0 (0)
Progression-free survival time/month16.4 (2.3, 77.8)  Survival time/month35.2 (19.5, 50.8)
Time to recurrence/month12.0 (4.4, 25.2)  Progression-free survival time/month35.2 (19.5, 50.8)
Duration of treatment/month3 (1, 52)

Figure 1

Kaplan-Meier survival curve of postoperative survival time in young patients with renal tumor and tumor thrombus in symptomatic group and asymptomatic group"

Figure 2

Kaplan-Meier survival curve of postoperative survival time in young patients with renal tumor and tumor thrombus in different AJCC clinical stages AJCC, American Joint Committee on Cancer."

Figure 3

Kaplan-Meier survival curve of postoperative survival time in young patients with renal tumor and tumor thrombus with or without multiple adjuvant therapy"

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