肾癌伴下腔静脉瘤栓患者术后长期随访报告  

Long-term follow-up outcomes following surgical resection of renal cell carcinoma patients with inferior vena cava thrombus

作　　者：柯鑫文 胡志全[1] 曾星[1] 魏先[1] 唐华科 沈源清 甘家骅 KE Xinwen HU Zhiquan ZENG Xing et al(Department of Urology, Tongji Hospital, Tongji Medical College ,Huazhong University of Science and Technology, Wuhan 430030, Chin)

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030

出　　处：《临床外科杂志》2017年第2期120-123,共4页Journal of Clinical Surgery

摘　　要：目的分析肾癌伴下腔静脉瘤栓患者的手术治疗策略及长期预后。方法行肾癌根治性切除及腔静脉瘤栓取出术患者107例,采用美国梅约医学中心的静脉瘤栓分级方法:Ⅰ级55例、Ⅱ级26例、Ⅲ级16例、Ⅳ级10例。采用Kaplan-Meier法进行生存分析,Log-rank检验法比较不同级别瘤栓生存时间差异,采用Cox比例风险模型分析影响肾癌伴腔静脉瘤栓患者生存预后的危险因素。结果88例患者得到完整随访资料,中位随访时间59.8个月(3~143个月),中位生存期为50.1个月。Ⅰ~Ⅳ级瘤栓患者中位生存期分别为56.8、48.1、41.9及23.3个月,5年总体生存率及肿瘤特异性生存率分别为41.9%及47.7%,低级别瘤栓(Ⅰ~Ⅱ级瘤栓)患者5年肿瘤特异性生存时间明显长于高级别(Ⅲ~Ⅳ级瘤栓患者),P<0.05。在多因素回归分析中,瘤栓级别和Fuhrman分级是独立预后因素。结论对于无远处转移的患者,肾癌根治性切除及腔静脉瘤栓取出术是治疗肾癌伴腔静脉瘤栓的有效方法。瘤栓级别和Fuhrman分级是影响患者预后的独立因素。Objective To explore the surgical methods and long-term prognosis of renal cell car- cinoma（RCC） patients with inferior vena cava thrombus. Methods 107 patients underwent radical ne- phrectomy and inferior vena cava thromhectomy in our hospital, of which 55,26,16 and 10 patients had a level of ⅠⅡ,Ⅲ and IV inferior vena cava tumor thrombus respectively according to American Mayo clinical clasification system. Survival was calculated by the Kaplan-Meier method, and comparison of dif- ferent level of tumor boh survival time was performed with Log-rank statistics. The prognostic risk factors of these patients were assessed by means of Cox regression models. Results Follow-up information was a- vailable in 88 patients. The median follow-up period and median survial time for all patients were 59.8 months（ range from 3 to 143 months ）and 50.1 months respectively. The median survial time for the pa- tients with level I to IV inferior vena cava thrombus were 56.8,48.1,41.9 and 23.3 months repeetive- ly. The 5 year overall survival（OS） and cancer specific survival（CSS） for all patients were 41.9% and 47.7 %, respectively. The survival time of the patients with lower grade thrombus （ level Ⅰ and Ⅱ ） was sig- nificantly longer than that of the patients with higher grade thrombus（ level Ⅲ and Ⅳ ） ,P 〈 0.05. Multiva- riate Cox regression model identified the grade of tumor thrombus and Furhman rank of tumor as independ- ent prognostic factors. Conclusion Radical nephreetomy and inferior vena cava thrombectomy is an effec- tive therapy for RCC patients without distant metastasis ,which can support promising long-term outcomes. The grade of tumor thrombus and Furhman rank of tumor were evaluated as independent prognostic fac- tors.

关 键 词：肾癌 静脉瘤栓 外科治疗 预后因素 

分 类 号：R737.11[医药卫生—肿瘤]