Clinical diagnosis and surgical outcome of renal cell carcinoma with inferior vena cava tumor thrombus / 中华泌尿外科杂志

ABSTRACT

Objective To study the diagnosis and surgical outcomes of renal cell carcinoma with inferior vena cava tumor thrombus.Methods The clinical data from 31 cases of renal cell carcinoma with inferior vena cava tumor thrombus were retrospectively reviewed from January 2000 to December 2014.Among them,21 cases were male and 10 cases were female.The mean age ranged from 38 to 79 years,mean 57 years.The location of tumor included right renal in 29 cases and left renal in 2 cases.The distribution of the tumor thrombus was recorded as followlevel Ⅰ in 20 cases,level Ⅱ in 8 cases and level Ⅲ in 3 cases.All patients received radical nephrectomy and tumor thrombectomy.Ipsilateral subcostal oblique incision was chosen in 20 cases.Transrectus incision was chosen in 10 cases.And abdominal transperitoneal L shaped incision was chosen in 1 case.Three patients were given neoadjuvant molecular targeted therapies before operation.Results All patients accepted the operation successfully.There was no death during perioperative period.The pathological diagnosis showed clear cell carcinoma in 30 cases and chromophobe cell tumor in 1 case.The Fuhrman grading showed that 17 cases were grade Ⅱ,8 cases were grade Ⅲ and 5 cases were grade Ⅳ.Among them,the lymphatic metastasis in the renal hilum was found in 5 cases.After operation,16 patients received molecular targeted therapies,including sorafenib in 10 cases and sunitinib in 6 cases.Six patients were given autologous tumor lysate-pulsed dendritic cells co-cultured with cytokine induced killer cells treatment.The median overall survival was 44 months (range 4-60 months).The 1-,3-,and 5-year overall survival rates for all patients were 100％,52％,and 39％,respectively.There were significant differences of the overall survival rates between level Ⅰ / Ⅱ and level Ⅲ tumor thrombi(81.5％ vs 0) (P =0.012).Similar difference was noticed between Fuhrman grade Ⅱ and grade Ⅲ/Ⅳ (94.1％ vs 46.2％)(P =0.003).There was also significant difference between those with or without lymph node metastases (40.0％ vs 80.8 ％) (P =0.0 1 6).Conclusions Radical nephrectomy and tumor thrombectomy could improve the survival of patients of renal cell carcinoma with inferior vena cava tumor thrombus.The overall survival rate might be related to the tumor thrombus level,tumor grade,and local lymph node metastasis.