Michele Nicolazzini, Mattia Longoni, Fabian Falkenbach, Andrea Marmiroli, Quynh Chi Le, Calogero Catanzaro, Federico Polverino, Jordan A Goyal, Alberto Briganti, Markus Graefen, Gennaro Musi, Felix K H Chun, Riccardo Schiavina, Nicola Longo, Fred Saad, Shahrokh F Shariat, Carlotta Palumbo, Alessandro Volpe, Pierre I Karakiewicz
{"title":"肾细胞癌伴肿瘤血栓根治性切除和取栓术后肿瘤特异性死亡率的组织学亚型分析。","authors":"Michele Nicolazzini, Mattia Longoni, Fabian Falkenbach, Andrea Marmiroli, Quynh Chi Le, Calogero Catanzaro, Federico Polverino, Jordan A Goyal, Alberto Briganti, Markus Graefen, Gennaro Musi, Felix K H Chun, Riccardo Schiavina, Nicola Longo, Fred Saad, Shahrokh F Shariat, Carlotta Palumbo, Alessandro Volpe, Pierre I Karakiewicz","doi":"10.1016/j.euf.2025.08.007","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objective: </strong>We tested the effect of histological subtypes on cancer-specific mortality (CSM) after radical nephrectomy (RN) with thrombectomy for nonmetastatic renal cell carcinoma with tumor thrombus (RCC-TT) within the Surveillance, Epidemiology and End Results database (2010-2021).</p><p><strong>Methods: </strong>We used propensity score matching (PSM), multivariable competing-risk regression (CRR) analyses, and cumulative incidence functions to test differences in CSM between papillary RCC (pRCC) and clear-cell RCC (ccRCC), and between chromophobe RCC (chRCC) and ccRCC.</p><p><strong>Key findings and limitations: </strong>Of 5516 patients with nonmetastatic RCC-TT, 180 (3.3%), 186 (3.4%), and 5150 (93%) harbored pRCC, chRCC, and ccRCC, respectively. TT was limited to the renal vein in 135 (75%), 168 (91%), and 4457 (87%) patients with pRCC, chRCC, and ccRCC, respectively. After 1:3 PSM, 180 (100%) pRCC cases were compared with 540 (11%) ccRCC cases. The 5-yr CSM rate was 43% in pRCC versus 26% in ccRCC. Multivariable CRR revealed that pRCC independently predicted higher CSM relative to ccRCC (hazard ratio [HR] 1.81, 95% confidence interval [CI] 1.31-2.50; p < 0.001). After 1:3 PSM, 186 (100%) chRCC cases were compared with 558 (11%) ccRCC cases. The 5-yr CSM rate was 14% in chRCC versus 19% in ccRCC. Multivariable CRR revealed no significant difference in CSM between chRCC and ccRCC (HR 0.62, 95% CI 0.37-1.03; p = 0.07). 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引用次数: 0
摘要
背景和目的：我们在监测、流行病学和最终结果数据库（2010-2021）中测试了组织学亚型对非转移性肾细胞癌伴肿瘤血栓（RCC-TT）根治性肾切除术（RN）合并血栓切除术后癌症特异性死亡率（CSM）的影响。方法：采用倾向评分匹配（PSM）、多变量竞争风险回归（CRR）分析和累积发生率函数检验乳头状RCC （pRCC）和透明细胞RCC （ccRCC）、憎色RCC （chRCC）和ccRCC之间CSM的差异。主要发现和局限性：在5516例非转移性RCC-TT患者中，分别有180例（3.3%）、186例（3.4%）和5150例（93%）存在pRCC、chRCC和ccRCC。分别有135例（75%）、168例（91%）和4457例（87%）pRCC、chRCC和ccRCC患者的TT局限于肾静脉。1:3 PSM后，pRCC为180例（100%），ccRCC为540例（11%）。pRCC的5年CSM率为43%，而ccRCC为26%。多变量CRR显示，相对于ccRCC， pRCC独立预测较高的CSM（风险比[HR] 1.81, 95%可信区间[CI] 1.31-2.50; p < 0.001）。1:3 PSM后，186例（100%）chRCC与558例（11%）ccRCC比较。5年CSM率在chRCC中为14%，在ccRCC中为19%。多变量CRR显示，chRCC和ccRCC的CSM无显著差异（HR 0.62, 95% CI 0.37-1.03; p = 0.07）。局限性包括该研究的回顾性性质以及缺乏疾病进展和后续治疗的数据。结论及临床意义：对于接受RN取栓治疗的RCC-TT患者，pRCC独立预测的CSM率比ccRCC高1.8倍，而chRCC和ccRCC之间的CSM率无显著差异。在TT环境下，对于pRCC或chRCC患者应考虑辅助治疗。
Cancer-specific Mortality After Radical Nephrectomy and Thrombectomy for Renal Cell Carcinoma with Tumor Thrombus According to Histological Subtypes.
Background and objective: We tested the effect of histological subtypes on cancer-specific mortality (CSM) after radical nephrectomy (RN) with thrombectomy for nonmetastatic renal cell carcinoma with tumor thrombus (RCC-TT) within the Surveillance, Epidemiology and End Results database (2010-2021).
Methods: We used propensity score matching (PSM), multivariable competing-risk regression (CRR) analyses, and cumulative incidence functions to test differences in CSM between papillary RCC (pRCC) and clear-cell RCC (ccRCC), and between chromophobe RCC (chRCC) and ccRCC.
Key findings and limitations: Of 5516 patients with nonmetastatic RCC-TT, 180 (3.3%), 186 (3.4%), and 5150 (93%) harbored pRCC, chRCC, and ccRCC, respectively. TT was limited to the renal vein in 135 (75%), 168 (91%), and 4457 (87%) patients with pRCC, chRCC, and ccRCC, respectively. After 1:3 PSM, 180 (100%) pRCC cases were compared with 540 (11%) ccRCC cases. The 5-yr CSM rate was 43% in pRCC versus 26% in ccRCC. Multivariable CRR revealed that pRCC independently predicted higher CSM relative to ccRCC (hazard ratio [HR] 1.81, 95% confidence interval [CI] 1.31-2.50; p < 0.001). After 1:3 PSM, 186 (100%) chRCC cases were compared with 558 (11%) ccRCC cases. The 5-yr CSM rate was 14% in chRCC versus 19% in ccRCC. Multivariable CRR revealed no significant difference in CSM between chRCC and ccRCC (HR 0.62, 95% CI 0.37-1.03; p = 0.07). Limitations include the retrospective nature of the study and a lack of data on disease progression and subsequent treatment.
Conclusions and clinical implications: For patients with RCC-TT treated with RN with thrombectomy, pRCC independently predicted a 1.8-fold higher CSM rate in comparison to ccRCC, with no significant difference in CSM rates between chRCC and ccRCC. Adjuvant therapy should be considered for patients with pRCC or chRCC in the TT setting.
期刊介绍：
European Urology Focus is a new sister journal to European Urology and an official publication of the European Association of Urology (EAU).
EU Focus will publish original articles, opinion piece editorials and topical reviews on a wide range of urological issues such as oncology, functional urology, reconstructive urology, laparoscopy, robotic surgery, endourology, female urology, andrology, paediatric urology and sexual medicine. The editorial team welcome basic and translational research articles in the field of urological diseases. Authors may be solicited by the Editor directly. All submitted manuscripts will be peer-reviewed by a panel of experts before being considered for publication.
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