Diagnosis,management And Prognostic Analysis Of Renal Cell Carcinoma With Venous Tumor Thrombus

Objective: To investigate the diagnosis,management and prognostic factors of renal cell carcinoma with venous tumor thrombus,in order to provide medical evidence for the choice of best treatment.Methods: 54 cases of renal cell carcinoma with venous tumor thrombus undergoing radical nephrectomy and tumor thrombus removal from June 1,2010 to June 30,2017 in the First Affiliated Hospital of China Medical University were collected.And the clinical data were analyzed retrospectively.The clinical data were integrated into the database.The Kaplan-Meier survival analysis was performed bying SPSS 23.0 statistic software,and the survival curve was plotted,and the Log-rank and Cox proportional hazards models were used for univariate and multivariate prognostic analysis.Results: All 54 patients underwent abdominal enhanced CT/CT angiography,venous tumor thrombosis were detected in 49 cases(90.7%,49/54).5 patients received enhanced MRI scan,the venous tumor thrombus detection rate was 100%(5/5).The venous tumor thrombosis was revealed by color Doppler Ultrasonography in 3 patients.The length of follow-up was 5 to 85 months,13 patients were eventually died from tumor,and 5patients suffered from tumor recurrence or metastasis.The total survival time of 54 patients was 5 to 85 months,the median survival time was 26.5 months.The 1-,3-,and5-year survival rates were 90.3%,74.8%,and 69.8%,respectively.Tumor thrombus grade: Grade 0 47 cases,Grade? 2 cases,Grade? 2 cases,Grade ? 3 cases.The median survival time of patients with renal vein tumor thrombus or vena cava tumor thrombus was 27 and 15 months,respectively,and the result showed that there was significant difference in survival time of patients with difference levels of tumor thrombus(p=0.019).The 5-year survival rate of patients with or without renal fat infiltration was 35% and 79%,respectively.The 5-year survival rate of patients with or without lymph node metastasis was 17.9% and 64.3%,respectively.The 5-year survival rate of patients with or without distant metastasis was 0% and 73.7% respectively.The results of Log-rank prognostic analysis showed that tumor thrombus grade,renal fat infiltration,Fuhrman grading,lymph node metastasis and distant metastasis were relatedto the prognosis of renal cell carcinoma with venous tumor thrombus,and Cox multivariate prognostic analysis showed that lymph node metastasis and distant metastasis were independent risk factor affecting the long-term survival rate of these patients.Conclusion: 1.CT and MRI are routine imagine modalities for the diagnosis of renal carcinoma with venous tumor thrombus,and color Doppler ultrasonography can be used for preliminary screening.2.Patients receiving radical nephrectomy and removal of tumor thrombus without lymph node and distant metastasis might be beneficial.3.The prognosis of patients with renal vein tumor thrombus is better than those with vena cava tumor thrombus,and the target drug therapy might not improve the survival time,and the long-term survival rate might be related to lymph node and distant metastasis.