BackgroundTo evaluate the impact of deep invasive tumor thrombus (DITT) on the surgical complexity and prognosis of patients with renal cell carcinoma with venous tumor thrombus.MethodsWe retrospectively reviewed clinical data of 138 patients with non-metastatic renal cell carcinoma combined with venous tumor thrombus, who underwent surgical treatment in Peking University Third Hospital from January 2015 to June 2020. Patients were divided into the DITT group (84 patients) and non-invasive tumor thrombus (NITT) group (54 patients). Chi-square, t-test and Mann–Whitney U test were used for categorical and continuous variables, respectively. Kaplan–Meier plots were performed to evaluate the influence of DITT. Univariable and multivariable Cox regressions were conducted to determine independent prognostic factors and then assembled to make a nomogram to predict the survival. The performance of the nomogram was evaluated by Harrell’s consistency index (C-index) and calibration plot.ResultsDeep invasive tumor thrombus significantly increased the difficulty of surgery for patients with renal cell carcinoma with venous tumor thrombus, which is mainly reflected in longer operation time (p < 0.001), more surgical bleeding (p < 0.001), a higher proportion of perioperative blood transfusion (p = 0.006), a higher proportion of open surgery (p = 0.001), a longer postoperative hospital stay (p = 0.003), and a higher proportion of postoperative complications (p = 0.001). DITT (hazard ratio [HR] = 2.781, p = 0.040) was one of the independent risk factors for worse prognosis. Multivariate analysis showed that sarcoma-like differentiation (p = 0.040), tumor thrombus invasion (p = 0.040), low hemoglobin (p = 0.003), and pathological type (p < 0.001) were independent prognostic factors. The nomogram, combining all these predictors, showed powerful prognostic ability with a C-index of 78.8% (CI: 71.2%–86.4%). The predicted risk closely matches the observed recurrence probability.ConclusionDeep invasive tumor thrombus significantly increased the difficulty of surgeries for patients of renal cell carcinoma with venous tumor thrombus, and may lead to poor prognosis.
Background: To compare the surgical and oncologic outcomes between laparoscopic and open radical nephrectomy with venous thrombectomy (LRN-VT, ORN-VT) in patients with renal tumor and venous thrombus. Materials and Methods:We conducted a propensity-matched retrospective cohort study of 302 patients with renal tumor and venous thrombus from January 2014 to January 2021. We compared surgical outcomes and we used the Kalan-Meier method to assess the overall survival (OS), tumor-specific survival (TSS), metastasis-free survival (MFS) and local recurrence-free survival (LRFS). The Pearson chi-square test and Fisher exact test, Wilcoxon rank sum test, Cox proportional hazards regression model and log-rank test were used.Results: After 1:1 matching, 94 patients were identified in each group and baseline characteristics were comparable. The LRN-VT group had less operative time (median 292min vs 326min, P < 0.001), less blood loss (median 500 ml vs 1000 ml, P < 0.001), fewer packed red blood cells transfusion (median 800 ml vs 1200 ml, P < 0.001) and less fresh frozen plasma transfusion (median 400 ml vs 600 ml, P < 0.001). The ORN-VT group had higher complication rate (39.4% vs 21.3%, P = 0.007), higher Clavien grade (P = 0.005) and longer postoperative hospital stay (median 10d vs 8d, P < 0.001). The median time to local recurrence were 36mon after a median follow-up of 31mon in the LRN-VT group and 8mon (IQR 6-15 mon) after a median follow-up of 32mon in the ORN-VT group (P = 0.007). The hazard ratio of LRFS for the LRN-VT group was 0.18 (95% CI 0.05-0.62, P = 0.007).Conclusions: LRN-VT can result in favorable surgical outcomes and a better LRFS compared with ORN-VT.
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