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目的分析肾癌伴下腔静脉瘤栓患者的手术治疗策略及长期预后。方法行肾癌根治性切除及腔静脉瘤栓取出术患者107例,采用美国梅约医学中心的静脉瘤栓分级方法:Ⅰ级55例、Ⅱ级26例、Ⅲ级16例、Ⅳ级10例。采用Kaplan-Meier法进行生存分析,Log-rank检验法比较不同级别瘤栓生存时间差异,采用Cox比例风险模型分析影响肾癌伴腔静脉瘤栓患者生存预后的危险因素。结果88例患者得到完整随访资料,中位随访时间59.8个月(3~143个月),中位生存期为50.1个月。Ⅰ~Ⅳ级瘤栓患者中位生存期分别为56.8、48.1、41.9及23.3个月,5年总体生存率及肿瘤特异性生存率分别为41.9%及47.7%,低级别瘤栓(Ⅰ~Ⅱ级瘤栓)患者5年肿瘤特异性生存时间明显长于高级别(Ⅲ~Ⅳ级瘤栓患者),P<0.05。在多因素回归分析中,瘤栓级别和Fuhrman分级是独立预后因素。结论对于无远处转移的患者,肾癌根治性切除及腔静脉瘤栓取出术是治疗肾癌伴腔静脉瘤栓的有效方法。瘤栓级别和Fuhrman分级是影响患者预后的独立因素。
Objective To analyze the surgical treatment strategies and long-term prognosis of patients with renal cell carcinoma and inferior vena cava thrombus. Methods A total of 107 patients with radical nephrectomy and caval aneurysm thrombectomy were enrolled in this study. Fifty-five patients with grade I, 26 with grade II, 16 with grade III and 10 with grade IV . Survival analysis was performed by Kaplan-Meier method. Log-rank test was used to compare the survival time of different tumor types. Cox proportional hazard model was used to analyze the risk factors of survival in patients with renal cell carcinoma complicated with venous thrombus. Results 88 patients were followed up for a median of 59.8 months (range 3 to 143 months) with a median follow-up of 50.1 months. The median survival time was 56.8, 48.1, 41.9 and 23.3 months for patients with grade Ⅰ ~ Ⅳ tumor embolus. The 5-year overall survival rate and tumor-specific survival rate were 41.9% and 47.7% respectively. Low-grade tumor suppositories (Ⅰ ~ Ⅱ Grade tumor suppository) patients 5-year tumor-specific survival was significantly longer than the high-grade (grade Ⅲ ~ Ⅳ tumor thrombus patients), P <0.05. In multivariate regression analysis, tumor size and Fuhrman grade were independent prognostic factors. Conclusion For patients without distant metastasis, radical resection of renal cell carcinoma and removal of cavopulmonary aneurysm embolization is an effective method for the treatment of renal cell carcinoma with venous thrombosis. Tumor grade and Fuhrman grade are independent prognostic factors.