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Zhao X, Yan Y, Xie W, Zhao L, Zhang S, Liu J, Liu C, Ma L. The Application of CT Radiomics in the Diagnosis of Vein Wall Invasion in Patients With Renal Cell Carcinoma Combined With Tumor Thrombus. Oncologist 2024; 29:151-158. [PMID: 37672362 PMCID: PMC10836321 DOI: 10.1093/oncolo/oyad243] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/21/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE The objective of this study was to explore the application of radiomics combined with machine learning to establish different models to assist in the diagnosis of venous wall invasion in patients with renal cell carcinoma and venous tumor thrombus and to evaluate the diagnostic efficacy. MATERIALS AND METHODS We retrospectively reviewed the data of 169 patients in Peking University Third Hospital from March 2015 to January 21, who was diagnosed as renal mass with venous invasion. According to the intraoperative findings, 111 patients were classified to the venous wall invasion group and 58 cases in the non-invasion group. ITK-snap was used for tumor segmentation and PyRadiomics 3.0.1 package was used for feature extraction. A total of 1598 features could be extracted from each CT image. The patients were divided into training set and testing set by time. The elastic-net regression with 4-fold cross-validation was used as a dimension-reduction method. After feature selection, a support vector machines (SVM) model, a logistic regression (LR) model, and an extra trees (ET) model were established. Then the sensitivity, specificity, accuracy, and the area under the curve (AUC) were calculated to evaluate the diagnostic performance of each model on the testing set. RESULTS Patients before September 2019 were divided into the training set, of which 88 patients were in the invasion group and 42 patients were in the non-invasion group. The others were in the testing set, of which 32 patients were in the invasion group and 16 patients were in the non-invasion group. A total of 34 radiomics features were obtained by the elastic-net regression. The SVM model had an AUC value of 0.641 (95% CI, 0.463-0.769), a sensitivity of 1.000, and a specificity of 0.062. The LR model had an AUC value of 0.769 (95% CI, 0.620-0.877), a sensitivity of 0.913, and a specificity of 0.312. The ET model had an AUC value of 0.853 (95% CI, 0.734-0.948), a sensitivity of 0.783, and a specificity of 0.812. Among the 3 models, the ET model had the best diagnostic effect, with a good balance of sensitivity and specificity. And the higher the tumor thrombus grade, the better the diagnostic efficacy of the ET model. In inferior vena cava tumor thrombus, the sensitivity, specificity, accuracy, and AUC of ET model can be improved to 0.889, 0.800, 0.857, 0.878 (95% CI, 0.745-1.000). CONCLUSION Machine learning combined with radiomics method can effectively identify whether venous wall was invaded by tumor thrombus and has high diagnostic efficacy with an AUC of 0.853 (95% CI, 0.734-0.948).
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Affiliation(s)
- Xun Zhao
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, People’s Republic of China
| | - Ye Yan
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, People’s Republic of China
| | - Wanfang Xie
- School of Engineering Medicine, Beihang University, Beijing, People’s Republic of China
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, People’s Republic of China
| | - Litao Zhao
- School of Engineering Medicine, Beihang University, Beijing, People’s Republic of China
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, People’s Republic of China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, People’s Republic of China
| | - Jiangang Liu
- School of Engineering Medicine, Beihang University, Beijing, People’s Republic of China
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the People’s Republic of China, Beijing, People’s Republic of China
- Beijing Engineering Research Center of Cardiovascular Wisdom Diagnosis and Treatment, Beijing, People’s Republic of China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, People’s Republic of China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, People’s Republic of China
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Chen J, Liu Z, Zhang H, Wang G, Tian X, Zhao X, Ge L, Tian Y, Zhang Q, Hong P, Li Y, Chen K, Gao Q, Liu X, Liu C, Ma L, Zhang S. Pure Retroperitoneal Laparoscopic Peritoneum Incision Technique in Right Nephrectomy and Inferior Vena Cava Tumor Thrombectomy: A Novel Surgical Technique and Long-Term Outcomes from a Large Chinese Center. J Endourol 2023; 37:986-994. [PMID: 37254522 DOI: 10.1089/end.2023.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Purpose: To explore the safety and effectiveness of the Pure Retroperitoneal Laparoscopic Peritoneum Incision Technique (PREP-IT) in laparoscopic radical nephrectomy (LRN) and inferior vena cave (IVC) tumor thrombectomy for right renal-cell carcinoma (RCC) with level Mayo I to III venous tumor thrombus (VTT). Patients and Methods: From May 2015 to September 2020, 92 patients with right RCC and Mayo I to III VTT were retrospectively reviewed, including 57 patients who underwent retroperitoneal LRN and IVC thrombectomy using PREP-IT, and 35 patients who underwent open surgery. PREP-IT refers to dissecting the retroperitoneum and temporarily placing the right kidney into the abdominal cavity to enlarge the retroperitoneal workspace for a safer and faster IVC operation. Results: Compared with the open surgery group, the PREP-IT group had a larger tumor diameter, while a larger proportion of Mayo I tumor thrombus and smaller maximum tumor thrombus width. Two patients (3.5%) in the PREP-IT group had a history of abdominal surgery. No conversion to open surgery or standard laparoscopic surgery occurred in PREP-IT group. Laparoscopic surgery with PREP-IT was characterized by shorter operative time, less surgical blood loss, shorter postoperative hospital stay, and lower postoperative complication rate. With a 33-month (ranges: 2-86) follow-up time period, the estimated mean overall survival time was 57.2 ± 5.3 and 58.1 ± 71.5 months in the PREP-IT group and open surgery group, respectively. Log-rank test indicated no significant difference between the two groups in terms of overall survival and cancer-specific survival. Conclusions: The PREP-IT is relatively safe and feasible for retroperitoneal LRN with right renal tumor and IVC tumor thrombus, allowing for a large workspace and wide exposure for IVC operations.
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Affiliation(s)
- Jiyuan Chen
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Xun Zhao
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Liyuan Ge
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Yu Tian
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Qiming Zhang
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Yuxuan Li
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Kewei Chen
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Qiyue Gao
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Xinchen Liu
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Haidian, Beijing, China
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Li KP, Chen SY, Wang CY, Li XR, Yang L. Perioperative and oncologic outcomes of minimally-invasive surgery for renal cell carcinoma with venous tumor thrombus: a systematic review and meta-analysis of comparative trials. Int J Surg 2023; 109:2762-2773. [PMID: 37526108 PMCID: PMC10498880 DOI: 10.1097/js9.0000000000000405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/06/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The present study aimed to conduct a pooled analysis to compare the perioperative and oncologic outcomes of minimally-invasive radical nephrectomy with tumor thrombus (MI-RNTT) with open radical nephrectomy with tumor thrombus (O-RNTT). METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Four electronic databases (PubMed, Embase, Web of Science, and the Cochrane Library database) were systematically searched to identify relevant studies published in English up to December 2022. The primary outcomes were perioperative results, complications, and oncologic outcomes. Review Manager 5.4 was used for this analysis. RESULTS In total, eight retrospective trials with a total of 563 patients were included. Compared to O-RNTT, MI-RNTT had shorter hospitalization time [weighted mean difference (WMD) -3.58 days, 95% CI: -4.56 to -2.59; P <0.00001), lower volumes of blood loss (WMD -663.32 ml, 95% CI: -822.22 to -504.42; P <0.00001), fewer transfusion rates (OR 0.18, 95% CI: 0.09-0.35; P <0.00001), fewer overall complications (OR 0.33, 95% CI: 0.22-0.49; P <0.00001), and fewer major complications s (OR 0.49, 95% CI: 0.24-1.00; P =0.05). However, operative time, intraoperative complications, mortality rate (intraoperative, within 30 days, and total mortality), overall survival, recurrence-free survival, and cancer-specific survival did not significantly differ between the two groups. CONCLUSIONS MI-RNTT possesses more benefits than O-RNTT in terms of length of hospital stay, blood loss, and complications and provides comparable mortality rates and oncologic outcomes. However, more comprehensive and rigorous research is warranted to further validate the outcomes, which should include a larger sample size and comprehensive data from high-volume medical centers.
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Affiliation(s)
| | | | | | - Xiao-ran Li
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, People’s Republic of China
| | - Li Yang
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, People’s Republic of China
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Elgendi K, Zarli M, Ahmed S, Szell N. Inferior Vena Cava Thrombus Associated With Renal Cell Carcinoma With an Atypical Radiological Presentation: A Case Report. Cureus 2023; 15:e45193. [PMID: 37842479 PMCID: PMC10576161 DOI: 10.7759/cureus.45193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Renal cell carcinoma (RCC) is characterized by the development of kidney masses, which can lead to various long-term complications. Among the extrarenal manifestations associated with RCC, the formation of a thrombus within the inferior vena cava (IVC) is particularly prevalent due to the substantial tumor burden imposed by the kidneys. In this report, we present an exceptional case involving an 80-year-old male patient who presented with an intravascular thrombus within the inferior vena cava (IVC), which originated from RCC. The diagnosis of RCC was conclusively established through core needle biopsy and subsequent tumor marker staining. Remarkably, despite the confirmation of RCC within the IVC thrombus through biopsy and tumor marker analysis, radiological assessments failed to reveal any discernible renal cell masses within the kidneys. The patient subsequently received treatment for RCC with a combination regimen of cabozantinib and nivolumab, which resulted in a noteworthy improvement in his clinical condition. The presentation of RCC in this report is notably atypical, given that the biopsy of the thrombus yielded definitive evidence of RCC while radiological investigations did not yield any indications of renal masses or a tumor burden within the kidneys that would typically be associated with RCC.
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Affiliation(s)
- Kareem Elgendi
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Mohamadhusni Zarli
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Sohaib Ahmed
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Nicole Szell
- Urology, Advanced Urology Institute, Clearwater, USA
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Qu L, Chen H, Chen Q, Ge S, Jiang A, Yu N, Zhou Y, Kunc M, Zhou Y, Feng X, Zhai W, Wu Z, He M, Li Y, Chen R, Han B, Zeng X, Fu Y, Ji C, Fan X, Zhang G, Zhao C, Jing T, Feng C, Zhao H, Sun D, Wang L, Tai S, Zhang C, Chen S, Liu Y, Wang H, Gao J, Gu Y, Miao H, Zhao T, Yi X, Tang C, Fu D, He H, Rao Q, Zhou W, Xu N, Wang G, Liang C, Liu Z, Xia D, Zu X, Chen M, Guo H, Qin W, Wang Z, Xue W, Shi B, Wang S, Zheng J, Chen C, Zapała Ł, Ge J, Wang L. Development and validation of a prognostic model incorporating tumor thrombus grading for nonmetastatic clear cell renal cell carcinoma with tumor thrombus: A multicohort study. MedComm (Beijing) 2023; 4:e300. [PMID: 37484972 PMCID: PMC10357251 DOI: 10.1002/mco2.300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 07/25/2023] Open
Abstract
There is significant variability with respect to the prognosis of nonmetastatic clear cell renal cell carcinoma (ccRCC) patients with venous tumor thrombus (VTT). By applying multiregion whole-exome sequencing on normal-tumor-thrombus-metastasis quadruples from 33 ccRCC patients, we showed that metastases were mainly seeded by VTT (81.8%) rather than primary tumors (PTs). A total of 706 nonmetastatic ccRCC patients with VTT from three independent cohorts were included in this study. C-index analysis revealed that pathological grading of VTT outperformed other indicators in risk assessment (OS: 0.663 versus 0.501-0.610, 0.667 versus 0.544-0.651, and 0.719 versus 0.511-0.700 for Training, China-Validation, and Poland-Validation cohorts, respectively). We constructed a risk predicting model, TT-GPS score, based on four independent variables: VTT height, VTT grading, perinephric fat invasion, and sarcomatoid differentiation in PT. The TT-GPS score displayed better discriminatory ability (OS, c-index: 0.706-0.840, AUC: 0.788-0.874; DFS, c-index: 0.691-0.717, AUC: 0.771-0.789) than previously reported models in risk assessment. In conclusion, we identified for the first-time pathological grading of VTT as an unheeded prognostic factor. By incorporating VTT grading, the TT-GPS score is a promising prognostic tool in predicting the survival of nonmetastatic ccRCC patients with VTT.
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Jia JH, Li XZ, Wang F, Zhang M, Meng QS, Ma ZY, Wang X. [Application of Intraoperative Transesophageal Echocardiography in the Treatment of Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2023; 45:28-32. [PMID: 36861151 DOI: 10.3881/j.issn.1000-503x.15060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Objective To investigate the value of intraoperative transesophageal echocardiography (TEE) in the diagnosis and treatment of renal cell carcinoma with inferior vena cava tumor thrombus. Methods Ten patients of renal cell carcinoma with inferior vena cava tumor thrombus treated in the Second Hospital of Hebei Medical University from January 2017 to January 2021 were selected.TEE was employed to locate the position of the tumor thrombus,determine the occlusion point of the inferior vena cava,count the intraoperative tumor thrombus shedding rate,examine the tumor thrombus resection integrity,and measure blood loss and other indicators,on the basis of which the application value of TEE in the operation of renal cell carcinoma with inferior vena cava tumor thrombus was evaluated. Results All the 10 patients had completed the operations successfully,including 8 patients of open operation and 2 patients of laparoscopic operation.TEE showed tumor thrombi clearly,and all the tumor thrombi were completely removed.There was no tumor thrombus shedding during the operation.The blood loss varied within the range of 300-800 ml,with the mean of (520.0±193.2) ml.The grade III tumor thrombi in 2 patients and the grade I tumor thrombus in 1 patient diagnosed before operation were reduced to grade Ⅱ and upgraded to grade Ⅱ,respectively,by TEE.One patient had no floating tumor thrombus at the end of tumor thrombus before operation,and the blocking position was adjusted in time with the assistance of TEE to avoid the shedding of the floating tumor thrombus. Conclusion TEE can accurately determine and dynamically monitor the location and shape of inferior vena cava tumor thrombus,which provides an important reference and has a significant clinical value in the operation of renal cell carcinoma with inferior vena cava tumor thrombus.
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Affiliation(s)
- Jiang-Hua Jia
- Department of Urology, the Second Hospital of Hebei Medical University,Shijiazhuang 050031,China
| | - Xu-Ze Li
- Department of Anesthesiology, the Second Hospital of Hebei Medical University,Shijiazhuang 050031,China
| | - Feng Wang
- Department of Cardiac Ultrasound, the Second Hospital of Hebei Medical University,Shijiazhuang 050031,China
| | - Ming Zhang
- Department of Urology, the Second Hospital of Hebei Medical University,Shijiazhuang 050031,China
| | - Qing-Song Meng
- Department of Urology, the Second Hospital of Hebei Medical University,Shijiazhuang 050031,China
| | - Zi-Yue Ma
- Department of Urology, the Second Hospital of Hebei Medical University,Shijiazhuang 050031,China
| | - Xin Wang
- Department of Urology, the Second Hospital of Hebei Medical University,Shijiazhuang 050031,China
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Zhang W, Liu W, Yang Y, Xiao C, Xiao Y, Tan X, Pang Q, Wu H, Hua M, Shi X. Integrative analysis of transcriptomic landscape and urinary signature reveals prognostic biomarkers for clear cell renal cell carcinoma. Front Oncol 2023; 13:1102623. [PMID: 37035174 PMCID: PMC10079990 DOI: 10.3389/fonc.2023.1102623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/14/2023] [Indexed: 04/11/2023] Open
Abstract
Background Clear cell renal cell carcinoma (ccRCC) patients with venous tumor thrombus (VTT) have poor prognosis. We aimed to reveal features of ccRCC with VTT and develop a urine-based prognostic classifier to predict ccRCC prognosis through integrative analyses of transcriptomic landscape and urinary signature. Methods RNA sequencing was performed in five patients with ccRCC thrombus-tumor-normal tissue triples, while mass spectrometry was performed for urine samples from 12 ccRCC and 11 healthy controls. A urine-based classifier consisting of three proteins was developed to predict patients' survival and validated in an independent cohort. Results Transcriptomic analysis identified 856 invasion-associated differentially expressed genes (DEGs). Furthermore, proteomic analysis showed 133 differentially expressed proteins (DEPs). Integration of transcriptomic landscape and urinary signature reveals 6 urinary detectable proteins (VSIG4, C3, GAL3ST1, TGFBI, AKR1C3, P4HB) displaying abundance changes consistent with corresponding genes in transcriptomic profiling. According to TCGA database, VSIG4, TGFBI, and P4HB were significantly overexpressed in patients with shorter survival and might be independent prognostic factors for ccRCC (all p<0.05). A prognostic classifier consisting of the three DEPs highly associated with survival performed satisfactorily in predicting overall survival (HR=2.0, p<0.01) and disease-free survival (HR=1.6, p<0.001) of ccRCC patients. The ELISA analysis of urine samples from an independent cohort confirmed the satisfied predictive power of the classifier for pathological grade (AUC=0.795, p<0.001) and stage (AUC=0.894, p<0.001). Conclusion Based on integrative analyses of transcriptomic landscape and urinary signature, the urine-based prognostic classifier consisting of VSIG4, TGFBI, and P4HB has satisfied predictive power of ccRCC prognosis and may facilitate ccRCC molecular subtyping and treatment.
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Affiliation(s)
- Wei Zhang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wenqiang Liu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yiren Yang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Chengwu Xiao
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yutian Xiao
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xiaojie Tan
- Department of Epidemiology, Naval Medical University, Shanghai, China
| | - Qingyang Pang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Han Wu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Meimian Hua
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Xiaolei Shi, ; Meimian Hua,
| | - Xiaolei Shi
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
- *Correspondence: Xiaolei Shi, ; Meimian Hua,
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Zhao X, Yan Y, Dong JH, Liu Z, Zhang HX, Liu C, Ma LL. Influence of Deep Invasive Tumor Thrombus on the Surgical Complexity and Prognosis of Patients With Non-Metastatic Renal Cell Carcinoma Combined With Venous Tumor Thrombus. Front Oncol 2022; 12:833780. [PMID: 35223514 PMCID: PMC8865079 DOI: 10.3389/fonc.2022.833780] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/03/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND To evaluate the impact of deep invasive tumor thrombus (DITT) on the surgical complexity and prognosis of patients with renal cell carcinoma with venous tumor thrombus. METHODS We retrospectively reviewed clinical data of 138 patients with non-metastatic renal cell carcinoma combined with venous tumor thrombus, who underwent surgical treatment in Peking University Third Hospital from January 2015 to June 2020. Patients were divided into the DITT group (84 patients) and non-invasive tumor thrombus (NITT) group (54 patients). Chi-square, t-test and Mann-Whitney U test were used for categorical and continuous variables, respectively. Kaplan-Meier plots were performed to evaluate the influence of DITT. Univariable and multivariable Cox regressions were conducted to determine independent prognostic factors and then assembled to make a nomogram to predict the survival. The performance of the nomogram was evaluated by Harrell's consistency index (C-index) and calibration plot. RESULTS Deep invasive tumor thrombus significantly increased the difficulty of surgery for patients with renal cell carcinoma with venous tumor thrombus, which is mainly reflected in longer operation time (p < 0.001), more surgical bleeding (p < 0.001), a higher proportion of perioperative blood transfusion (p = 0.006), a higher proportion of open surgery (p = 0.001), a longer postoperative hospital stay (p = 0.003), and a higher proportion of postoperative complications (p = 0.001). DITT (hazard ratio [HR] = 2.781, p = 0.040) was one of the independent risk factors for worse prognosis. Multivariate analysis showed that sarcoma-like differentiation (p = 0.040), tumor thrombus invasion (p = 0.040), low hemoglobin (p = 0.003), and pathological type (p < 0.001) were independent prognostic factors. The nomogram, combining all these predictors, showed powerful prognostic ability with a C-index of 78.8% (CI: 71.2%-86.4%). The predicted risk closely matches the observed recurrence probability. CONCLUSION Deep invasive tumor thrombus significantly increased the difficulty of surgeries for patients of renal cell carcinoma with venous tumor thrombus, and may lead to poor prognosis.
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Affiliation(s)
- Xun Zhao
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Ye Yan
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Jing-Han Dong
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Hong-Xian Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lu-Lin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
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Niu S, Liu K, Xu Y, Peng C, Yu Y, Huang Q, Wu S, Cui B, Huang Y, Ma X, Zhang X, Wang B. Genomic Landscape of Chinese Clear Cell Renal Cell Carcinoma Patients With Venous Tumor Thrombus Identifies Chromosome 9 and 14 Deletions and Related Immunosuppressive Microenvironment. Front Oncol 2021; 11:646338. [PMID: 34249685 PMCID: PMC8260842 DOI: 10.3389/fonc.2021.646338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/18/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Clear cell renal cell carcinoma (ccRCC) with venous tumor thrombus (VTT) is associated with a poor clinical outcome. Although several studies have examined the genomic features of ccRCC, the genetic profile of VTT along with its matched primary tumor has not been fully elucidated. MATERIALS AND METHODS Samples of VTT tissues and matched primary tumor tissues from ccRCC patients (n = 25), as well as primary tumor tissues from patients without VTT (n = 25) were collected and analyzed using whole-exome sequencing. Four additional ccRCC patients who were unfit for surgery were treated with an anti-programmed death receptor-1 (PD-1) monoclonal antibody (Toripalimab, 240 mg, Q3W, IV). RESULTS By comparing the primary kidney tumors from ccRCC patients with or without VTT, a relatively higher prevalence of BAP1 and KDM5C alterations were found in ccRCC patients with VTT, and these alterations were associated with worse overall survival in the kidney renal clear cell carcinoma (KIRC) database. Based on subclone analysis, VTT was predicted to primarily originate directly from the primary renal mass. A significantly higher prevalence of CELSR2 and TET2 alterations were identified in the VTTs compared with the matched primary tumors. An increased prevalence of DNA damage repair genes, especially those involved in homologous recombination repair and non-homologous end joining, was found in ccRCC patients with VTT. Notably, VTT was characterized by the increase incidence of copy number loss in the whole exome (p < 0.05), particularly in the chromosome 9 and 14 regions. Deletion of chromosome 9 and 14 was associated with worse survival, unfavorable clinical features, and the presence of an immunosuppressive microenvironment, which was characterized by higher infiltration of regulatory T cells, follicular helper T cells, and resting mast cells, but lower counts of resting CD4 memory T cells and CD8 positive T cells. A significantly lower count of CD4+ and CD8+ tumor-infiltrated lymphocytes was identified in the VTT samples comparing with matched primary tumor. Of note, three out of the four ccRCC patients with VTT in our cohort who were treated with the anti-PD-1 therapy exhibited remarkable remission in the renal mass but no notable shrinkage in the VTT mass. CONCLUSION Our study revealed the genetic profile of Chinese ccRCC patients with VTT, and identified multiple features associated with known poor outcomes, including gene alterations and copy number loss. The deletions in chromosomes 9 and 14, and the associated immunosuppressive microenvironment may indicate limited sensitivity to anti-PD-1/PD-L1 monotherapy in VTT.
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Affiliation(s)
- Shaoxi Niu
- Department of Urology, The Third Medical Centre, Chinese PLA (People’s Liberation Army) General Hospital, Beijing, China
| | - Kan Liu
- Department of Urology, The Third Medical Centre, Chinese PLA (People’s Liberation Army) General Hospital, Beijing, China
| | - Yong Xu
- Department of Urology, The Third Medical Centre, Chinese PLA (People’s Liberation Army) General Hospital, Beijing, China
| | - Cheng Peng
- Department of Urology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yao Yu
- Department of Urology, The Third Medical Centre, Chinese PLA (People’s Liberation Army) General Hospital, Beijing, China
| | - Qingbo Huang
- Department of Urology, The Third Medical Centre, Chinese PLA (People’s Liberation Army) General Hospital, Beijing, China
| | - Shengpan Wu
- Department of Urology, The Third Medical Centre, Chinese PLA (People’s Liberation Army) General Hospital, Beijing, China
| | - Bo Cui
- Department of Urology, The Third Medical Centre, Chinese PLA (People’s Liberation Army) General Hospital, Beijing, China
| | - Yan Huang
- Department of Urology, The Third Medical Centre, Chinese PLA (People’s Liberation Army) General Hospital, Beijing, China
| | - Xin Ma
- Department of Urology, The Third Medical Centre, Chinese PLA (People’s Liberation Army) General Hospital, Beijing, China
| | - Xu Zhang
- Department of Urology, The Third Medical Centre, Chinese PLA (People’s Liberation Army) General Hospital, Beijing, China
| | - Baojun Wang
- Department of Urology, The Third Medical Centre, Chinese PLA (People’s Liberation Army) General Hospital, Beijing, China
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Tian X, Hong P, Liu Z, Huang Y, Wang G, Hou X, Zhang S, Ma L. En bloc retroperitoneal laparoscopic radical nephrectomy with inferior vena cava thrombectomy for renal cell carcinoma with level 0 to II venous tumor thrombus: A single-center experience. Cancer 2020; 126 Suppl 9:2073-2078. [PMID: 32293727 DOI: 10.1002/cncr.32747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 01/14/2020] [Accepted: 01/14/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The surgical treatment of patients with renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is challenging. In the current study, the authors have reported their surgical outcomes and experience with en bloc retroperitoneal laparoscopic radical nephrectomy (LRN) with inferior vena cava (IVC) thrombectomy for patients with RCC with level 0 to II VTT. METHODS A retrospective review of the clinical records of 78 patients who underwent retroperitoneal LRN with IVC thrombectomy from March 2015 to September 2018 was performed. The surgical procedures included establishing the retroperitoneal space, ligating and severing the renal artery, clamping the renal vein and IVC, incising the IVC, and placing the renal and tumor thrombus en bloc into a retrieval bag. RESULTS According to the Mayo classification, the tumor thrombus was level 0, I, and II, respectively, in 28 patients, 27 patients, and 23 patients. The median operative time, estimated blood loss, and postoperative hospital stay were 256 minutes, 400 mL, and 8 days, respectively. A total of 67 patients were not converted to open surgery. No patient died during surgery, and no tumor embolization occurred. Thirteen patients experienced complications. The pathological reports indicated clear cell RCC in 70 patients and other RCC in 8 patients. The median follow-up was 14.5 months, and 61 patients were alive at the time of last follow-up. CONCLUSIONS En bloc retroperitoneal LRN with IVC thrombectomy is a challenging but feasible procedure for experienced surgeons in patients with RCC with level 0 to II VTT.
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Affiliation(s)
- Xiaojun Tian
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Yi Huang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Xiaofei Hou
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, China
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Miao C, Wang Y, Hou C, Chen W, Xu A, Wang Z. Comprehensive managements of metastatic renal tumor with Mayo III inferior vena cava tumor thrombus: a case report. Transl Androl Urol 2020; 9:812-818. [PMID: 32420189 PMCID: PMC7215005 DOI: 10.21037/tau.2019.12.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Renal tumor with inferior vena cava (IVC) tumor thrombus still remains one of the most medical challenges in urological oncology. Despite numerous researches reporting the surgical experiences and survivals of this kind of patients, there is still lacking a standard recommended therapy right now. We reported a case of metastatic renal cell carcinoma with Mayo III IVC tumor thrombus who underwent robotic-assisted complete removal of the intracaval thrombus and radical left nephrectomy followed by renal arterial chemoembolization and pazopanib administration. It provides a new scheme and mode of diagnosis and treatment for this kind of patients. The patient was a 50-year-old man with left low-back pain for 20 days diagnosed with left renal tumor and Mayo III IVC tumor thrombus at the earliest. Initially, the patient underwent the renal arterial chemoembolization and targeted treatment to inhibit tumor's progression. After a two-year therapy period, the size of renal mass and lung nodules decreased than before, as well as the IVC tumor thrombus dropped to level II. Considering the efficacy of previous treatments, we performed robot-assisted IVC thrombectomy and radical left nephrectomy for this patient. The post-operative pathological examination confirmed the diagnosis of tumor thrombus as renal clear cell carcinoma. The patients recovered well after surgery and was followed-up for 36 months during the whole treatment course. This case with metastatic renal cell carcinoma (mRCC) and Mayo III IVC tumor thrombus received the interventional therapy, molecular targeted therapy and robot-assisted surgery successively, and acquired satisfying outcome. Patients with mRCC always suffer shorter overall survivals and aggressive progression compared with those localized tumors, therefore it is essential to formulate rational comprehensive treatment and carry out in time following-up.
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Affiliation(s)
- Chenkui Miao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yuhao Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Chao Hou
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Wen Chen
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Aiming Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zengjun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Ke XW, Zeng X, Wei X, Shen YQ, Gan JH, Tian JH, Hu ZQ. Robotic-assisted Laparoscopic Nephrectomy with Vein Thrombectomy: Initial Experience and Outcomes from a Single Surgeon. Curr Med Sci 2018; 38:834-9. [PMID: 30341517 DOI: 10.1007/s11596-018-1950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/21/2018] [Indexed: 10/28/2022]
Abstract
This study was designed to explore the safety and feasibility of robotic-assisted laparoscopic nephrectomy with vein thrombectomy (RAL-NVT) for the treatment of renal cell carcinoma (RCC) with venous tumor thrombus (VTT). Clinical data of 6 patients treated with RAL-NVT between July 2016 and November 2017 in our hospital were retrospectively collected and analyzed. There were 5 males and 1 female with their age ranging from 48 years to 68 years. Five renal tumors were right-sided and one left-sided. Three cases fell in level 0 VTT, one in level I and two in level II. Preoperative imaging revealed lymph node involvement in 1 case and distant metastasis in 2 cases. For RCC with level 0 VTT, the renal vein of the affected side was adequately and carefully dissected around the thrombus to the proximity of inferior vena cava (IVC) and was ligated with Hem-o-loks without cross-clamping the IVC. For level I and II VTT, the IVC was crossclamped cephalically and caudally around the tumor thrombus and all tributaries were sequentially blocked to ensure the safe retrieval of VTT. All operations were successfully completed without conversion to open operation. The mean operative time was 150 (115-230) min. Cross-clamping of the IVC happened in 3 cases, and the blocking time was 14, 19 and 20 min, respectively. The mean estimated blood loss during the operation was 400 (200-580) mL. The peritoneal drainage tube was removed 5 to 9 days after the operation, and all patients were postoperatively discharged at 6 to 11 days. Postoperative pathological analysis confirmed that the RCCs were comprised of 4 clear cell RCCs, 1 papillary cell RCC, and 1 medullary cell RCC; 2 cases were Fuhrman grade II, 3 cases grade III, and 1 case undefined grade. No recurrence or progression was observed during the follow-up of 4.2 (3-6) months. We concluded that RAL-NVT is highly challenging but safe and feasible for the treatment of RCC with VTT.
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Liang H, Guo W, Yang R, Tang X, Yan T, Ji T, Yang Y, Li D, Xie L, Xu J. Radiological characteristics and predisposing factors of venous tumor thrombus in pelvic osteosarcoma: A mono-institutional retrospective study of 115 cases. Cancer Med 2018; 7:4903-4913. [PMID: 30141256 PMCID: PMC6198205 DOI: 10.1002/cam4.1739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Venous tumor thrombus (VTT) in pelvic osteosarcoma has been regarded as a rare oncological condition and few literatures investigated this issue. METHODS We retrospectively reviewed 115 cases of pelvic osteosarcoma treated in our center from 2006 to 2016. Diagnosis of VTTs was made based on histo-pathological findings. We summarized the radiological manifestations of VTTs on CT, MRI, and PET/CT. We also compared the demographical, oncological, and radiological data between cases with or without VTTs to identify its predisposing factors. RESULTS Seventeen cases (14.8%) were diagnosed with VTT. Manifestations of VTTs on CT included increased caliber (64.7%), calcification (47.1%), low density on plain scan (100%), filling defect (100%), and streak-like enhancement (35.7%) on contrast enhancement. On MRI, the VTTs could be hypo- or iso-intense on T1WI (100%), hyperintense on T2WI (100%), and filling defect on contrast enhancement (100%). PET/CT showed high metabolic activity of the VTTs. The ranges of the VTTs included unilateral external iliac vein (EIV) (two cases), unilateral internal iliac vein (IIV) (one case), unilateral common iliac vein (CIV) and IIV (five cases), unilateral CIV + EIV (two cases), inferior vena cava (IVC) and unilateral CIV + EIV (one case), IVC and unilateral CIV + IIV (four cases), IVC and bilateral CIVs + IIVs (two cases). Multivariate analysis indicated that chondroblastic subtype and involvement of L5/S1 intervertebral foramen might predispose to VTTs. CONCLUSION The incidence of VTTs in pelvic osteosarcoma was 14.8%. Comprehensive radiological studies help preoperative diagnosis of VTTs. Predisposing factors included chondroblasic subtype and involvement of L5/S1 intervertebral foramen.
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Affiliation(s)
- Haijie Liang
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Wei Guo
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Rongli Yang
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Xiaodong Tang
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Taiqiang Yan
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Tao Ji
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Yi Yang
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Dasen Li
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Lu Xie
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Jie Xu
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
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Mager R, Daneshmand S, Evans CP, Palou J, Martínez-Salamanca JI, Master VA, McKiernan JM, Libertino JA, Haferkamp A, Haferkamp A, Capitanio U, Carballido JA, Chantada V, Chromecki T, Ciancio G, Daneshmand S, Evans CP, Gontero P, González J, Hohenfellner M, Huang WC, Koppie TM, Libertino JA, Espinós EL, Lorentz A, Martínez-Salamanca JI, Master VA, McKiernan JM, Montorsi F, Novara G, O'Malley P, Pahernik S, Palou J, Moreno JLP, Pruthi RS, Faba OR, Russo P, Scherr DS, Shariat SF, Spahn M, Terrone C, Tilki D, Vázquez-Martul D, Donoso CV, Vergho D, Wallen EM, Zigeuner R. Renal cell carcinoma with inferior vena cava involvement: Prognostic effect of tumor thrombus consistency on cancer specific survival. J Surg Oncol 2016; 114:764-768. [PMID: 27562252 DOI: 10.1002/jso.24395] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/18/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Renal cell carcinoma forming a venous tumor thrombus (VTT) in the inferior vena cava (IVC) has a poor prognosis. Recent investigations have been focused on prognostic markers of survival. Thrombus consistency (TC) has been proposed to be of significant value but yet there are conflicting data. The aim of this study is to test the effect of IVC VTT consistency on cancer specific survival (CSS) in a multi-institutional cohort. METHODS The records of 413 patients collected by the International Renal Cell Carcinoma-Venous Thrombus Consortium were retrospectively analyzed. All patients underwent radical nephrectomy and tumor thrombectomy. Kaplan-Meier estimate and Cox regression analyses investigated the impact of TC on CSS in addition to established clinicopathological predictors. RESULTS VTT was solid in 225 patients and friable in 188 patients. Median CSS was 50 months in solid and 45 months in friable VTT. TC showed no significant association with metastatic spread, pT stage, perinephric fat invasion, and higher Fuhrman grade. Survival analysis and Cox regression rejected TC as prognostic marker for CSS. CONCLUSIONS In the largest cohort published so far, TC seems not to be independently associated with survival in RCC patients and should therefore not be included in risk stratification models. J. Surg. Oncol. 2016;114:764-768. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Rene Mager
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany.
| | | | | | - Joan Palou
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | - Juan I Martínez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain
| | - Viraj A Master
- Department of Urology, Emory University, Atlanta, Georgia
| | - James M McKiernan
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | | | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center Mainz, Mainz, Germany
| | - Umberto Capitanio
- Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy
| | - Joaquín A Carballido
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - Venancio Chantada
- Department of Urology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain
| | - Thomas Chromecki
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Gaetano Ciancio
- Miami Transplant Institute, University of Miami, Miami, Florida
| | | | | | - Paolo Gontero
- Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy
| | - Javier González
- Department of Urology, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain
| | | | - William C Huang
- Department of Urology, New York University School of Medicine, New York, New York
| | - Theresa M Koppie
- Department of Urology, Oregon Health and Science University, Portland, Oregon
| | | | | | - Adam Lorentz
- Department of Urology, Emory University, Atlanta, Georgia
| | - Juan I Martínez-Salamanca
- Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain
| | - Viraj A Master
- Department of Urology, Emory University, Atlanta, Georgia
| | - James M McKiernan
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Francesco Montorsi
- Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy
| | - Giacomo Novara
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Padraic O'Malley
- Department of Urology, Weill Cornell Medical Center, New York, New York
| | - Sascha Pahernik
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | | | - Raj S Pruthi
- Department of Urology, UNC at Chapel Hill, Chapel Hill, North Carolina
| | | | - Paul Russo
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical Center, New York, New York
| | | | - Martin Spahn
- Department of Urology, University of Würzburg, Würzburg, Germany
| | - Carlo Terrone
- Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy
| | - Derya Tilki
- Department of Urology, UC Davis Medical Center, Sacramento, California
| | - Dario Vázquez-Martul
- Department of Urology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain
| | | | - Daniel Vergho
- Department of Urology, University of Würzburg, Würzburg, Germany
| | - Eric M Wallen
- Department of Urology, UNC at Chapel Hill, Chapel Hill, North Carolina
| | - Richard Zigeuner
- Department of Urology, Medical University of Graz, Graz, Austria
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Abstract
Objective To review retrospectively the clinical information of patients with renal cell carcinoma (RCC) and venous tumor thrombus, and to evaluate the changing from open to laparoscopic surgery and medium-term prognosis of these patients. Methods From Jan 2000 to Dec 2014, 276 patients were treated with renal cell carcinoma and venous tumor thrombus at our institute. It was analyzed for their clinical and perioperative data and follow-up information. Results There were 133 and 143 patients with renal vein (RV) and inferior vena cava (IVC) tumor thrombus respectively, which include 84 with IVC level I, 38 with IVC level II and 21 with IVC level III. There were several steps for the changing from open to laparoscopic surgery for RCC patients with venous tumor thrombus. (I) Traditional open surgery: before 2012, open surgery was routinely done for such kind of patients. For those with large tumor and advanced tumor thrombus, the renal artery may be embolized preoperatively, which could ease the renal dissection and the artery control during surgery. There were 52 patients with advanced tumor thrombus above the hepatic vein in our study, who underwent cardiopulmonary bypass (CPB) assisted surgery without major complication. (II) Retroperitoneal laparoscopic surgery first and then transperitoneal open surgery: from 2012, we introduced laparoscopic techniques into the operation for these patients. For those with IVC tumor thrombus, we could effectively combine the advantages of the retroperitoneal laparoscopic procedure in rapid renal pedicle control and the open transperitoneal procedure in IVC tumor thrombectomy. Compared with the traditional open surgery group, the combined surgery group showed shorter operation time (225 vs. 300 min), less blood loss (150 vs. 625 mL) and shorter hospitalization time (7 vs. 11 days) (all P<0.05). (III) Combined retroperitoneal and transperitoneal pure laparoscopic procedure: from 2013, we had completed six cases of pure laparoscopic surgery with this combined pathway for RCC patients with early IVC tumor thrombus (level I and level II, below hepatic vein), which could take advantages of both laparoscopic pathways and minimize the injury to patients. The median follow-up time was 52 months for all patients (range, 6-138 months) with a follow-up rate of 81.2% (224/276). The median survival time was 58 months and the 5-yr overall survival rate was 48.7% for all patients. There was no significant difference between the prognosis of patients with RV and IVC tumor thrombus (P=0.117), while patients with early tumor thrombus (below hepatic vein) showed significantly improved survival than those with advanced tumor thrombus (above hepatic vein) (P=0.011). Conclusions Because of the complexity and difficulty of these surgical procedures, we routinely did traditional open surgery for patients with RCC and venous tumor thrombus before 2012. With the development of laparoscopic techniques in recent years, the operation for these patients turned to be minimally invasive-pure laparoscoic for tumor thrombus below hepatic vein, with good tumor control and promising middle-term prognosis.
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Abstract
Objective Methods Results Conclusions
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