Development and validation of a comprehensive predictive model for surgical planning in patients with renal cell carcinoma and inferior vena cava tumor thrombus

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2024-11-12 DOI:10.1016/j.ejso.2024.109381

Xiaodong Hao , Hao Peng , Zheng Chao , Yanan Wang , Qiugong Xiao , Chunyu Zhang , Xiangdong Guo , Zezhong Xiong , Qiang Zhou , Sheng Ma , Junbiao Zhang , Jing Wang , Le Li , Zhihua Wang

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引用次数: 0

Abstract

Objective

To investigate preoperative predictors for selecting different surgical approaches in patients with renal cell carcinoma with inferior vena cava (IVC) tumor thrombus (RCC-IVCTT), and to establish and validate corresponding predictive models.

Methods

Clinical data of 583 RCC-IVCTT patients were retrospectively analyzed. Of these, 465 cases were used to construct predictive models, and 118 cases were used for validation. Univariate and multivariate analyses identified independent predictors for surgical strategies. Two nomogram prediction models were established based on relevant independent factors to predict surgical approach.

Results

In the development cohort, 342 patients underwent IVC thrombectomy (IVCT), 91 underwent IVC cavectomy (IVCC), and 32 underwent IVC reconstruction (IVCR). Multivariate logistic regression analysis identified the following predictors for inability to perform IVCT: higher Mayo classification of tumor thrombus (TT), IVC wall invasion, presence of bland thrombus, pan-immune-inflammation value (PIV) > 358 × 10⁹, and maximum anteroposterior (AP) diameter of IVC at renal vein ostium (RVo) > 24 mm. Platelet >170 × 10⁹/L and inadequate collateral circulation were predictors for IVCR. The developed model predicted capacity of the nomogram was evaluated in terms of its calibration, discrimination, and clinical utility. The validation set confirmed these findings.

Conclusion

The comprehensive preoperative predictive model for RCC-IVCTT patients aids in preoperative determination of the required surgical approach and necessity for IVC angiography, facilitating perioperative preparation and reducing unnecessary invasive examinations.

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开发并验证用于肾细胞癌和下腔静脉肿瘤血栓患者手术规划的综合预测模型

方法回顾性分析了583例RCC-IVCTT患者的临床数据，其中465例用于构建预测模型，118例用于验证。方法回顾性分析了583例RCC-IVCTT患者的临床数据，其中465例用于构建预测模型，118例用于验证。单变量和多变量分析确定了手术策略的独立预测因素。结果在开发队列中，342 名患者接受了 IVC 血栓切除术 (IVCT)，91 名患者接受了 IVC 腔内切除术 (IVCC)，32 名患者接受了 IVC 重建术 (IVCR)。多变量逻辑回归分析确定了以下无法进行 IVCT 的预测因素：肿瘤血栓（TT）的梅奥分类较高、IVC 壁侵犯、存在平滑血栓、泛免疫炎症值（PIV）为 358 × 109，以及肾静脉骨端（RVo）处 IVC 的最大前胸（AP）直径为 24 毫米。血小板 170 × 109/L 和侧支循环不足是 IVCR 的预测因素。从校准、区分度和临床实用性方面评估了所开发的提名图模型的预测能力。结论RCC-IVCTT 患者术前综合预测模型有助于术前确定所需的手术方式和 IVC 血管造影的必要性，有利于围术期准备并减少不必要的侵入性检查。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.