肾癌伴下腔静脉瘤栓患者的治疗效果及预后分析

Surgical therapy for renal cell carcinoma with tumor embolism of the inferior vena cava and its prognostic factors

目的 探讨肾癌伴下腔静脉瘤栓外科处理的治疗效果及预后相关因素.方法 回顾性分析2006年1月至2013年6月经肾癌根治性切除及下腔静脉瘤栓取出手术治疗的37例患者的临床及病理资料.Ⅰ级瘤栓11例,Ⅱ级瘤栓13例,Ⅲ级瘤栓6例,Ⅳ级瘤栓7例.术前发生淋巴结或远处转移10例（27.03％）,未转移27例（72.97％）.结果 37例成功行肾癌根治性切除及下腔静脉瘤栓取出术,32例（86.5％）获得随访,中位随访时间21个月（3～82个月）.末次随访时18例死亡,37例中位生存期为24个月.各级别瘤栓中位生存期分别为Ⅰ级瘤栓33个月,Ⅱ级瘤栓28个月,Ⅲ级瘤栓13个月,Ⅳ级瘤栓11个月.低级别瘤栓（肝静脉以下）患者生存时间明显长于高级别瘤栓患者（肝静脉以上）,P=0.013.单因素分析中,高级别瘤栓（P=0.013 3）、术前淋巴结或远处转移（P=0.005 6）、高Fuhrman分级（P＜0.000 1）在统计学上是影响疾病特异性生存的重要预后因素.在多因素分析中,独立的预后因素是瘤栓分级（P=0.0165）和Fuhrman分级（P=0.0107）,而术前是否转移不是独立的预后因素.结论 对于无淋巴结和远处转移的肾癌伴下腔静脉瘤栓患者,积极行肾癌根治性切除及下腔静脉瘤栓取出术可以取得良好疗效.瘤栓分级和Fuhrman分级是影响患者预后的重要独立因素.

Objective To investigete the efficacy of radical nephrectomy and inferior vena cava thrombectomy and their prognostic factors.Methods We performed a retrospective study of 37 patients undergoing surgery between Jan 2006 and Jun 2013.The tumor embolism was level Ⅰ in 11 cases,level Ⅱ in 13 cases,level Ⅲ in 6 cases and level Ⅳ in 7 cases.Ten patients suffered from lymph node or distant metastasis before surgery and twenty-seven had no metastasis.Results All of the 37 patients successfully received radical nephrectomy plus thrombectomy.Thirty-two patients were followed up and the median follow-up period was 21 months （3-82）.In the last follow-up,18 patients died.The median survival for all the patients was 24 months.The median survival for the patients with Ⅰ to Ⅳ IVC thrombus were 33,28,13 and 11 months.The survival of the patients with low level tumor thrombus （below hepatic vein） was significantly longer than that of patients with high level tumor thrombus （P=0.013）.On univariate analysis,high level tumor embolism,lymph node or distant metastases and high Fuhrman grade were statistically significant prognostic factors predicting overall survival.Only high level tumor embolism （P =0.016 5） and high Fuhrman grade （P=0.010 7） were independent prognostic factors on multivariate analysis.Conclusions Radical nephrectomy and thrombectomy are effective treatment for RCC patients with IVC thrombus without lymph node or distant metastasis.The level of tumor thrombus and high Fuhrman grade are significant prognostic factors related with overall survival.