Clinical Outcomes of Venous Tumor Thrombectomy in Renal Cell Carcinoma.

IF 2.8 2区医学 Q2 PERIPHERAL VASCULAR DISEASE

Journal of vascular surgery. Venous and lymphatic disorders Pub Date : 2025-07-17 DOI:10.1016/j.jvsv.2025.102290

Sang Ah Lee, Hyeyeon Jang, Youngjin Han, Yong-Pil Cho, Jun Gyo Gwon

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Abstract

Objective: Renal cell carcinoma (RCC) has a unique feature in which tumor thrombus extends through the vein into the inferior vena cava (IVC). RCC with venous tumor thrombus is classified based on the level of thrombus. The standard treatment involves a combination of radical nephrectomy and tumor thrombectomy, despite the technical challenges associated with this approach. We aimed to evaluate the clinical outcomes based on the tumor thrombus level.

Methods: We conducted a retrospective analysis of patients who underwent tumor resection and thrombectomy for RCC with venous tumor thrombus at a single center between January 2001 and December 2022. Tumor thrombus levels were classified into four levels (I-IV) according to the Mayo Clinic grading system, and patients were grouped based on the hepatic vein level: levels 0, I, and II were categorized as Group 1, while levels III and IV were categorized as Group 2. Survival outcomes were compared between the two groups using the Kaplan-Meier survival analysis.

Results: A total of 287 RCC patients with venous tumor thrombus who underwent tumor resection and thrombectomy were identified. The distribution of patients according to the tumor thrombus level was as follows: 84 patients had level 0 thrombus, 71 had level I, 85 had level II, 19 had level III, and 28 had level IV. This results in 240 patients in group 1 (levels 0, I, II) and 47 patients in group 2 (levels III, IV). The five-year survival rates were 46.7% for group 1 and 53.2% for group 2. The Kaplan-Meier survival analysis showed no significant difference in five-year overall survival between the two groups (p=0.75). However, patients in group 2 had a significantly longer postoperative hospital stay (21.43 ± 23.09 days) compared to group 1 (10.63 ± 6.31 days; p=0.004).

Conclusions: Tumor thrombus level is not a significant prognostic factor in RCC. Aggressive surgical removal should be considered, even for thrombus extending beyond the hepatic vein, given the acceptable prognosis.

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肾细胞癌静脉肿瘤血栓切除术的临床疗效。

目的：肾细胞癌（RCC）有一个独特的特点，即肿瘤血栓通过静脉延伸到下腔静脉（IVC）。有静脉肿瘤血栓的肾小细胞癌根据血栓的程度进行分类。标准治疗包括根治性肾切除术和肿瘤血栓切除术的结合，尽管这种方法存在技术挑战。我们的目的是评估基于肿瘤血栓水平的临床结果。方法：我们回顾性分析了2001年1月至2022年12月在单一中心接受肿瘤切除和静脉肿瘤血栓切除术的RCC患者。根据Mayo Clinic分级系统将肿瘤血栓水平分为4级（I-IV级），并根据肝静脉水平对患者进行分组，0、I、II级为1组，III、IV级为2组。采用Kaplan-Meier生存分析比较两组患者的生存结果。结果：共发现287例合并静脉肿瘤血栓的RCC患者行肿瘤切除和取栓术。按肿瘤血栓水平分布：0级血栓84例，I级血栓71例，II级血栓85例，III级血栓19例，IV级血栓28例。1组（0、I、II级）240例，2组（III、IV级）47例。1组5年生存率为46.7%，2组5年生存率为53.2%。Kaplan-Meier生存分析显示两组5年总生存率无显著差异（p=0.75）。然而，2组患者术后住院时间（21.43±23.09天）明显长于1组（10.63±6.31天）；p = 0.004)。结论：肿瘤血栓水平不是肾癌预后的重要因素。考虑到可接受的预后，即使血栓延伸到肝静脉以外，也应考虑积极手术切除。

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来源期刊

Journal of vascular surgery. Venous and lymphatic disorders SURGERYPERIPHERAL VASCULAR DISEASE&n-PERIPHERAL VASCULAR DISEASE

CiteScore

6.30

自引率

18.80%

发文量

328

审稿时长

71 days

期刊介绍： Journal of Vascular Surgery: Venous and Lymphatic Disorders is one of a series of specialist journals launched by the Journal of Vascular Surgery. It aims to be the premier international Journal of medical, endovascular and surgical management of venous and lymphatic disorders. It publishes high quality clinical, research, case reports, techniques, and practice manuscripts related to all aspects of venous and lymphatic disorders, including malformations and wound care, with an emphasis on the practicing clinician. The journal seeks to provide novel and timely information to vascular surgeons, interventionalists, phlebologists, wound care specialists, and allied health professionals who treat patients presenting with vascular and lymphatic disorders. As the official publication of The Society for Vascular Surgery and the American Venous Forum, the Journal will publish, after peer review, selected papers presented at the annual meeting of these organizations and affiliated vascular societies, as well as original articles from members and non-members.