Diagnosis And Prognosis Of Renal Cell Carcinoma With Venous Tumor Thrombus

Objective: To investigate the diagnosis and prognosis of renal cell carcinoma with venous tumor thrombus.Methods: the clinical data of 45 cases of renal cell carcinoma with venous tumor thrombus in our hospital from January 2010 to December 2016 were retrospectively analyzed.All of them were treated with surgery,including male in 29 cases and female in 16 cases.Age 43-85 years old,mean 57 years old.The data were used to calculate the overall survival rate of patients with Kaplan-Meier,,prognostic factors were identified by univariate and multivariate analysis.Results: The 1-,3-,5-overall survival rate of patients with renal cell carcinoma with venous thrombosis was 88.6%,67.1%,49.1%.The level of tumor thrombus: 0 cases of grade I,grade I in 9 cases,grade II in 9 cases,grade III in 5 cases,postoperative application of targeted drugs in the treatment of 3 cases.After operation,3 cases were treated with targeted drug therapy,1 cases underwent lateral renal artery embolization before operation,and 2 cases were operated by extracorporeal circulation and multidisciplinary support operation.Postoperative pathological results showed clear cell carcinoma in 39 cases and clear cell carcinoma in 6 cases(including 1 cases of pyeluria,1 cases of renal tubular carcinoma,3 cases of renal papillary carcinoma,1 cases of sarcomatoid carcinoma,1 cases of mesenchymal malignant tumors).No deaths during the perioperative period..The results showed that there was no significant difference in the survival rate and prognosis of the cancer thrombus.The 5 year survival rate of the patients with or without lymph node metastasis was 14.6% and 58.6%,respectively.The survival rate of the patients with distant metastasis was 5,and the rate of survival was 0%,and the rate of survival was 54.3%.Univariate analysis showed that ECOG score,tumor stage,lymph node metastasis,distant metastasis,perirenal fat infiltration is associated with the prognosis of patients after operation,the results of multivariate analysis showed that lymph node metastasis(P < 0.05)and distant metastasis(P < 0.05)is the effect of postoperative patient survival independent risk factor.Conclusion: radical nephrectomy with thrombectomy is still the main way for the treatment of renal cell carcinoma with venous tumor thrombus,thrombus level and postoperative targeted drug application is not independent factors affecting postoperative survival period,survival may be associated with lymph node metastasis and distant metastasis after operation.