Predictors of Survival in Patients Undergoing Surgery for Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus.

Autor: Pieretti AC; Departments of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX., Ozambela M; Departments of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX., Westerman ME; Departments of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX., Nogueras-Gonzalez GM; Departments of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX., Segarra LA; Departments of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX., Zacharias NM; Departments of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX., Vaporciyan A; Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX., Hofstetter W; Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX., Huynh T; Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX., Aldousari S; Departments of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX., Matin SF; Departments of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX., Karam JA; Departments of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: jakaram@mdanderson.org.
Jazyk: angličtina
Zdroj: Clinical genitourinary cancer [Clin Genitourin Cancer] 2022 Aug; Vol. 20 (4), pp. e330-e338. Date of Electronic Publication: 2022 Feb 09.
DOI: 10.1016/j.clgc.2022.02.001
Abstrakt: Introduction: Surgical resection of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus is a complex procedure with significant morbidity. Patient selection is critical to determining whether the benefits of the procedure outweigh the risks. In this study, we identified and stratified the risk factors that were associated with overall survival (OS) and recurrence-free survival (RFS) in patients undergoing surgical resection of RCC with IVC thrombus.
Methods: We identified all patients with RCC with IVC tumor thrombus (stages cT3b and cT3c) who had undergone radical nephrectomy with tumor thrombectomy between December 1, 1993 and June 30, 2009. Kaplan-Meier method was used to estimate OS and RFS. Cox proportional hazards models were used to determine the association between risk factors and OS. Patients were stratified into 3 groups based on the number of risk factors present at diagnosis.
Results: Two hundred twenty-four patients were included in the study. A total of 45.3% of patients had metastasis at presentation, 84.5% had cT3b, and 90.2% had clear cell RCC. cT3c, cN1, and cM1 were significantly associated with the risk of death. Group 1 patients (0 risk factors) had a median OS duration of 77.6 months (95% CI 50.5-90.4), group 2 (1 risk factor) 26.0 months (95% CI 19.5-35.2), and group 3 (≥2 risk factors) 8.9 months (95% CI 5.2-12.9; P < .001).
Conclusions: Stratification of patients with RCC and IVC thrombus by risk factors allowed us to predict survival duration. In patients with ≥2 risk factors, new treatment strategies with preoperative systemic therapy may improve survival.
(Copyright © 2022. Published by Elsevier Inc.)
Databáze: MEDLINE
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