目的:回顾性分析北京大学第三医院2016年1月至2022年12月40岁以下肾肿瘤合并癌栓手术患者的临床资料。并评价其手术效果,探讨其临床病理特征与预后的关系。
方法:回顾性分析17例青年肾癌栓患者的临床资料,并对其临床病理特征及预后进行总结。根据有无症状对患者进行分组,2017年美国癌症联合委员会(AJCC)临床分期,术后联合辅助治疗。采用Kaplan-Meier法绘制存活曲线,采用Log-rank检验比较不同组间术后生存时间和无进展生存时间的差异。分析临床病理特征与预后的关系。
结果:17例患者均接受静脉肿瘤栓切除术,其中16例(94.1%)接受根治性肾切除术,1例(5.9%)接受部分肾切除术。12例(70.6%)患者术前出现症状,5例(29.4%)患者术前无症状。共观察到17个肾肿瘤,其中2例(11.8%)为良性,15例(88.2%)为恶性。在恶性肿瘤中,1例患者(6.7%)诊断为透明细胞癌,而其余14例患者(93.3%)被归类为非透明细胞癌。就肿瘤分期而言,8例(53.3%)按AJCC分级分为Ⅲ期,其中7例(46.7%)为Ⅳ期。此外,6例(40%)患者接受了多种辅助治疗,而9例患者(60%)未接受此类治疗。随访2~78个月,中位随访时间为41个月。在此期间,3例患者(20%)逝世亡。术后中位生存时间为39.0(2.3,77.8)个月,无进展生存期为16.4(2.3,77.8)个月。年轻肾肿瘤合并癌栓患者术后生存时间和无进展生存时间差异无统计学意义,根据手术前症状的存在(P=0.307,P=0.302),AJCC临床分期(P=0.340,P=0.492),术后辅助治疗组(P=0.459,P=0.253)。
结论:年轻肾肿瘤伴癌栓患者的病理类型因症状而更为复杂多样,非透明细胞癌在癌栓恶性肿瘤中的比例较高。有症状和非透明细胞癌可能与不良预后有关。手术联合辅助治疗是年轻肾肿瘤和癌栓患者相对安全有效的治疗方法。
OBJECTIVE: To retrospectively analyze clinical data of patients under 40 years old who underwent surgical treatment for renal tumors with tumor thrombus from January 2016 to December 2022 at Peking University Third Hospital, and to evaluate the surgical effect and investigate the relationship between clinicopathological characteristics and prognosis.
METHODS: The clinical data of 17 young patients with renal tumor thrombus were retrospectively analyzed, and the clinicopathological features and prognosis were summarized. The patients were grouped according to the presence or absence of symptoms, 2017 American Joint Committee on Cancer (AJCC) clinical stage, and postoperative combined adjuvant therapy. Kaplan-Meier method was used to plot the survival curve, and Log-rank test was used to compare the differences in postoperative survival time and progression-free survival time between the different groups. The relationship between clinicopathological features and prognosis was analyzed.
RESULTS: All the 17 patients received venous tumor thrombectomy, including 16 patients (94.1%) who underwent radical nephrectomy and 1 patient (5.9%) who underwent partial nephrectomy. Twelve patients (70.6%) had symptoms and 5 (29.4%) had no symptoms before operation. A total of 17 renal tumors were observed, with 2 patients (11.8%) identified as benign and 15 patients (88.2%) classified as malignant. Among the malignant tumors, 1 patient (6.7%) was diagnosed as clear cell carcinoma, while the remaining 14 patients (93.3%) were categorized as non-clear cell carcinoma. In terms of tumor stage, 8 patients (53.3%) were classified as stage Ⅲ according to the AJCC classification, while 7 patients (46.7%) were categorized as stage Ⅳ. Additionally, 6 patients (40%) received multiple adjuvant therapy, while 9 patients (60%) did not undergo such treatment. The follow-up period ranged from 2 to 78 months, with a median follow-up of 41 months. During this time, 3 patients (20%) died. The median survival time after surgery was 39.0 (2.3, 77.8) months, and the progression-free survival time was 16.4 (2.3, 77.8) months. There was no significant difference in postoperative survival time and progression-free survival time among young patients with renal tumor with tumor thrombus, based on the presence of symptoms before surgery (P=0.307, P=0.302), clinical stage of AJCC (P=0.340, P=0.492), and postoperative adjuvant therapy (P=0.459, P=0.253) group.
CONCLUSIONS: The pathological types of young patients with renal tumor with tumor thrombus are more complex and varied due to symptoms, and the proportion of non-clear cell carcinoma in malignant tumor with tumor thrombus is higher. Symptomatic and non-clear cell carcinoma may be potentially associated with poor prognosis. Surgical operation combined with adjuvant therapy is a relatively safe and effective treatment for young patients with renal tumor and tumor thrombus.