Abstract
ObjectiveTo define preoperative clinical and radiographic risk factors for the need of inferior vena cava (IVC) resection in patients with renal cell carcinoma (RCC) and IVC tumor thrombus.MethodsWe reviewed data of 121 patients with renal cell carcinoma and venous tumor thrombus receiving radical nephrectomy and thrombectomy at our institution between 2015 and 2017, and 86 patients with Mayo I–IV level tumor thrombus were included in the final analysis. Clinical features, operation details, and pathology data were collected. Preoperative images were reviewed separately by two radiologists. Univariable and multivariable logistic regression analyses were applied to evaluate clinical and radiographic risk factors of IVC resection.ResultsOf the 86 patients, 44 (51.2%) received IVC resection during thrombectomy. In univariate analysis, we found that body mass index (BMI) (odds ratio [OR] = 1.22, P = 0.003), primary tumor diameter (OR = 0.84, P = 0.022), tumor thrombus width (OR = 1.08, P = 0.037), tumor thrombus level (OR = 1.57, P = 0.030), and IVC occlusion (OR = 2.67, P = 0.038) were associated with the need for resection of the IVC. After adjusting for the other factors, BMI (OR = 1.18, P = 0.019) was the only significant risk factor for IVC resection. Multivariable analysis in Mayo II–IV subgroups confirmed BMI as an independent risk factor (OR = 1.26, P = 0.024). A correlation between BMI and the width (Pearson’s correlation coefficient [PCC] = 0.27, P = 0.014) and length (PCC = 0.23, P = 0.037) of the tumor thrombus was noticed.ConclusionWe identified BMI as an independent risk factor for IVC resection during thrombectomy of RCC with tumor thrombus in a Chinese population. More careful preoperative preparation for the IVC resection and/or reconstruction is warranted in patients with higher BMI.
Highlights
Renal cell carcinoma (RCC) represents 2–3% of all cancers [1]
Univariate analysis confirmed that the aforementioned factors were significantly associated with the resection of inferior vena cava (IVC)
In multivariate analysis, body mass index (BMI) was the only factor associated with IVC resection (OR = 1.18, P = 0.019)
Summary
Renal cell carcinoma (RCC) represents 2–3% of all cancers [1]. In the USA, RCC represents 5% of annual new cancer cases and is the third most common cancer in the urinary system [2]. In China, the incidence rate of RCC is approximately 2% of adult malignant tumors, ranking second in urological malignancies, and the incidence rate keeps rising each year [3]. Studies have reported that RCC with VTT leads to a 1-year disease-specific survival of 29% among untreated patients. The 5-year survival rate can increase to 40–65% [5]. Radical nephrectomy combined with thrombectomy is the only current potential curative method [6]. The survival rate of patients with tumor thrombus was better in those receiving both
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