无远处转移肾癌伴肾静脉瘤栓的长期疗效和预测影响因素

Observation of Long-term Outcomes of Renal Cell Carcinoma With Renal Vein Tumor Thrombus Without Distant Metastasis and the Factors Affecting Prognosis

目的探讨无远处转移肾癌伴肾静脉瘤栓患者行开腹根治性肾切除联合瘤栓取出术的预后影响因素。方法回顾性分析2000年1月~2014年9月我院113例术后病理证实为肾癌伴肾静脉瘤栓的临床资料,均为Mayo 0级瘤栓,采用Kaplan-Meier生存分析,Cox比例风险模型评价肾癌伴肾静脉瘤栓的预后。结果 106例获得随访,随访率93.8%（106/113）,中位随访时间61个月（12~186个月）,36例死亡,中位生存127个月（5~186个月）,5年肿瘤特异性生存率（cancer-specific survival,CSS）为61.3%,10年CSS为50.4%。Cox比例风险模型结果显示副瘤综合征（β=2.457,P=0.000）、Fuhrman分级（G3/4）（β=2.617,P=0.000）和肾周脂肪受累（β=1.369,P=0.002）是肾癌伴肾静脉瘤栓患者的独立预后因素,同时伴有3项危险因素的患者中位生存仅14个月。结论术前无远处转移的肾癌伴肾静脉瘤栓患者行开腹根治性肾切除联合瘤栓取出术后预后良好,伴有副瘤综合征,高Fuhrman分级和肾周脂肪受累的患者预后差。

Objective To discuss the correlative factors of renal cell carcinoma with renal vein tumor thrombus without distant metastasis treated by open radical nephrectomy combined with embolectomy. Methods A total of 113 cases of renal cell carcinoma with renal vein tumor thrombus confirmed by postoperatively pathological examination from January 2000 to September 2014 were retrospectively analyzed. All the patients had grade 0 thrombus by using the Mayo classification system. Survival analysis was estimated with the Kaplan-Meier method. Univariable and multivariable survival analyses were performed by using the Cox proportional hazard regression model to estimate the prognostic factors of renal cell carcinoma with renal vein thrombus. Results A total of 106 cases（ 93. 8%） were followed up with a median follow-up time of 61 months（ range,12- 186 months）. During the follow-up,36 patients died. The median survival time was 127 months（ range,5- 186 months）. The cancer-specific survival for 5 years was 61. 3% and for10 years was 50. 4%. Paraneoplasitc syndrome（ β = 2. 457,P = 0. 000）,Fuhrman grade（ G3 /4）（ β = 2. 617,P = 0. 000） and perirenal fat invasion（ β = 1. 369,P = 0. 002） were independent prognostic factors,and the median survival time in patients with above all three independent prognostic factors was 14 months. Conclusions Renal cell carcinoma with renal vein tumor thrombus without distant metastasis treated by open radical nephrectomy combined with embolectomy has relatively good prognosis. And patients with paraneoplasitc syndrome,higher Fuhrman grade（ G3 /4） or perirenal fat invasion have bad prognosis.