肾癌伴静脉瘤栓患者的外科治疗策略及长期疗效观察

Surgical management and long-term outcomes of patients with renal cell carcinoma accompanied with venous tumor thrombus

目的:探讨肾癌伴静脉瘤栓患者的外科治疗策略及长期预后情况。方法:自2000年8月至2011年12月,北京大学第一医院泌尿外科共140名患者行肾癌根治性切除及静脉瘤栓取出术,其中肾静脉瘤栓80例,下腔静脉Ⅰ级瘤栓(肝静脉以下)41例,下腔静脉Ⅱ级瘤栓(肝静脉以上、膈下)13例,下腔静脉Ⅲ级瘤栓(膈上)6例。采用Kaplan-Meier法进行生存分析。结果:114名患者得到随访,随访率81.4%,中位随访时间20.5个月(1～96个月),末次随访时共47例患者死亡,114例患者中位生存期为51个月。肾静脉瘤栓以及下腔静脉Ⅰ～Ⅲ级瘤栓患者,中位生存期分别为57、43、40及27个月,所有患者5年总体生存率及肿瘤特异性生存率分别为40.1%及47.2%,早期静脉瘤栓(肝静脉以下)患者生存时间显著长于晚期瘤栓(肝静脉以上)患者[(54.1±4.8)个月vs.(26.9±5.7)个月,P=0.049)]。结论:肾癌根治性切除及静脉瘤栓取出术是治疗肾癌伴静脉瘤栓的有效方法,可取得较好的远期疗效,早期瘤栓患者术后生存情况显著优于晚期瘤栓患者。

Objective：To evaluate the surgical management and long-term outcomes of patients with renal cell carcinoma and venous tumor thrombus.Methods： From Aug.2000 to Dec.2011,140 patients underwent radical nephrectomy and thrombectomy in our hospital,of whom,80 were with renal vein tumor thrombus,41 with inferior vena caval（IVC）,level Ⅰ tumor thrombus（below hepatic vein）,13 with IVC level Ⅱ tumor thrombus（above hepatic vein but below diaphragm） and 6 with IVC level Ⅲ tumor thrombus（above diaphragm）.The overall and cancer-specific survival rates were analyzed with Kaplan-Meier survival curve method.Results： The follow-up information of the 114 patients was gained.The median follow-up period for all the patients was 20.5 months（1-96）.In the last follow-up,47 patients died.The median survival time for all the patients was 51 months.The median survival time for the patients with renal vein tumor thrombus and IVC level Ⅰto Ⅲ tumor thrombus were 57,43,40 and 27 months.The 5 year overall survival（OS） and cancer-specific survival（CSS） rates for all the patients were 40.1% and 47.2%,respectively.The survival time of the patients with early tumor thrombus（below hepatic vein） was significantly longer than that of the patients with advanced tumor thrombus（above hepatic vein）（54.1±4.8 months vs.26.9±5.7 months,P=0.049）.Conclusion： Radical nephrectomy and thrombectomy are effective therapies for RCC patients with venous extension.The patients can obtain a relatively promising long-term outcome,which is comparable to previous western studies.Long-term outcome of the early tumor thrombus patients is significantly better than that of the advanced tumor thrombus patients.