Clinical significance of clinicopathological features in predicting surgical treatment and risk of complications in renal cancer with venous tumor thrombosis

Abstract

Aim. To study and analyze the surgical results and prognostic factors accompanying radical nephrectomy combined with venous thrombectomy in renal cancer patients with venous tumor thrombosis.Materials and  methods. Retrospective analysis of clinical data of patients with renal cancer and venous tumor thrombosis who underwent surgical treatment at the Clinic of Cardiovascular Surgery and the Clinic of Urology of the I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University) from May 2010 to February 2023. Kaplan–Meier analysis was used to obtain overall survival curves and log-rank tests were used for statistical comparisons; Cox regression models were used for multivariate analysis of survival and complications to find independent risk factors affecting prognosis.Results. A total of 42 patients were included, 15 patients with grade 0–II tumor thrombosis and 27 patients with grade III–IV thrombosis. There were 3 perioperative deaths. The 5-year postoperative survival rate of patients was 68 %. Cox regression analysis: stage Т: HR = 0.515, 95 % confidential interval (CI) 0.111–2.393, p = 0.397; stage N: HR = 1.430, 95 % CI 0.380–5.457, p = 0.592; stage М: HR = 3.312, 95 % CI 0.811–4.561, p = 0,138; time of operation: HR = 1.001, 95 % CI 0.997–1.004, p = 0.771.Conclusion. Kidney cancer patients with venous tumor thrombosis have better surgical treatment results, which may significantly improve their prognosis compared with non-operated patients. Stage N and stage M were important factors directly affecting patients’ survival (HR >1), but the level of tumor thrombosis could not be a factor affecting patients’ survival (HR = 1), but p >0.05, so it was not statistically significant. The level of tumor thrombosis and the duration of surgery affect the intraoperative blood loss, and the greater the intraoperative blood loss, the higher the stage of early postoperative complications and the worse the patient’s prognosis.