Analysis of Clinicopathological Factors Influencing Survival in Patients with Renal Cell Carcinoma and Venous Tumor Thrombus

Construction of the prognostic model in non-metastatic renal cancer patients with venous tumor thrombus

Background

Venous system invasion is a prominent characteristic of local progression in renal cancer and treatment-naïve renal cancer patients with venous tumor thrombus (VTT) gained short natural course and poor prognosis. This study aimed to investigate the efficacy of the surgery and prognostic factors in non-metastatic renal cancer patients with VTT and to construct a nomogram prognostic model.

Methods

Clinical data of 114 non-metastatic renal cancer patients with VTT who underwent surgical treatment from January 2011 to September 2022 were retrospectively analyzed. In order to find independent risk factors of prognosis, survival analysis was performed via univariate and multivariate Cox regression models and Kaplan-Meier method. Nomogram prognostic model was established to calculate patients' risk scores. Receiver operating characteristic curve and decision curve analysis were conducted to evaluate the efficacy of the prognostic model.

Results

A total of 114 patients were included in this study and there were 48, 12, 25, 23, and 6 cases of grade 0-IV VTT. No perioperative death occurred. The 3-year probabilities of overall survival (OS) and 5-year probabilities of OS were 67% and 43.8%, respectively. Multivariate Cox regression analysis revealed that kidney tumor diameter, preoperative lactate dehydrogenase (LDH), and preoperative neutrophils were independent risk factors. Nomogram was constructed to predict prognosis in renal cancer patients with VTT based on above indicators and Mayo VTT grading. The area under the ROC curve of 1-, 2-, 3-, and 5-year OS of the patients were 0.82, 0.67, 0.57, and 0.55 respectively.

Conclusions

Surgical treatment enables renal cancer patients with VTT to gain a better prognosis. Kidney tumor diameter, preoperative LDH, and preoperative neutrophils were independent risk factors. The nomogram perfects the Mayo grading, and provides a reliable reference for evaluation of prognosis of renal cancer patients with VTT.

Clinical significance of clinicopathological features in predicting surgical treatment and risk of complications in renal cancer with venous tumor thrombosis

Aim. To study and analyze the surgical results and prognostic factors accompanying radical nephrectomy combined with venous thrombectomy in renal cancer patients with venous tumor thrombosis.

Materials and  methods. Retrospective analysis of clinical data of patients with renal cancer and venous tumor thrombosis who underwent surgical treatment at the Clinic of Cardiovascular Surgery and the Clinic of Urology of the I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University) from May 2010 to February 2023. Kaplan–Meier analysis was used to obtain overall survival curves and log-rank tests were used for statistical comparisons; Cox regression models were used for multivariate analysis of survival and complications to find independent risk factors affecting prognosis.

Results. A total of 42 patients were included, 15 patients with grade 0–II tumor thrombosis and 27 patients with grade III–IV thrombosis. There were 3 perioperative deaths. The 5-year postoperative survival rate of patients was 68 %. Cox regression analysis: stage Т: HR = 0.515, 95 % confidential interval (CI) 0.111–2.393, p = 0.397; stage N: HR = 1.430, 95 % CI 0.380–5.457, p = 0.592; stage М: HR = 3.312, 95 % CI 0.811–4.561, p = 0,138; time of operation: HR = 1.001, 95 % CI 0.997–1.004, p = 0.771.

Conclusion. Kidney cancer patients with venous tumor thrombosis have better surgical treatment results, which may significantly improve their prognosis compared with non-operated patients. Stage N and stage M were important factors directly affecting patients’ survival (HR >1), but the level of tumor thrombosis could not be a factor affecting patients’ survival (HR = 1), but p >0.05, so it was not statistically significant. The level of tumor thrombosis and the duration of surgery affect the intraoperative blood loss, and the greater the intraoperative blood loss, the higher the stage of early postoperative complications and the worse the patient’s prognosis.

Prognostic value of systemic immune-inflammation index in non-metastatic clear cell renal cell carcinoma with tumor thrombus

This study aims to determine the prognostic value of SII for non-metastatic clear cell renal cell carcinoma (ccRCC) patients with venous tumor thrombus (VTT). We retrospectively collected and analyzed 328 non-metastatic ccRCC patients with VTT who underwent radical nephrectomy and thrombectomy from 3 tertiary centers in China between 2011 to 2021. Kaplan-Meier analyses and Cox proportional hazard analyses were used to determine its prognostic value for overall survival (OS) and disease free survival (DFS). The Harrell concordance index (C-index), receiver operating characteristic curve (ROC) analysis, and decision curve analysis (DCA) were used to evaluate its role in the improvement of prognostic accuracy of the existing models. Nomogram models containing the SII were then developed and evaluated by R. Patients were divided into low-SII and high-SII groups based on the SII optimal cut-off value 912 calculated by the Youden index in all patients. Higher SII was correlated with more symptoms, longer surgical time, higher WHO/ISUP grade, and longer tumor diameter. Kaplan-Meier analyses revealed significant differences in OS and DFS between two groups. Multivariate analyses revealed that SII was an independent prognostic factor for OS (HR:2.220, p=0.002) and DFS (HR:1.846, p=0.002). Compared with other indicators, SII had a superior accuracy (c-index=0.630 for OS and 0.595 for DFS). It also improved the performance of models for predicting OS and DFS (all p <0.01). Based on the results of LASSO Cox regression analysis, we constructed a nomogram to predict OS and it performed well on both the training cohort (AUC=0.805) and the validation cohort (AUC=0.795). Risk stratification based on nomogram can distinguish patients with different risks (all p <0.001). Preoperative SII is an independent predictive factor for OS and DFS of non-metastatic ccRCC patients with VTT. It can be used to improve the performance of current risk models.