Beijing Da Xue Xue Bao Yi Xue Ban. 2026 Aug 18;58(4):692-699.
ABSTRACT
OBJECTIVE: To characterize the clinicopathological features of long-term survivors among patients with clear cell renal cell carcinoma (ccRCC) and venous tumor thrombus (VTT) who underwent surgical treatment, and to explore potential prognostic factors beyond tumor-related variables, with particular emphasis on host-related inflammatory and nutritional indicators.
METHODS: The patients with ccRCC and VTT who underwent radical nephrectomy combined with tumor thrombectomy at Peking University Third Hospital between 2014 and 2019 were retrospectively analyzed. The patients were stratified into a long-term survival group (overall survival ≥60 months) and a non-long-term survival group (overall survival < 60 months). The following parameters were compared between the two groups: clinical characteristics (age, sex, body mass index, Mayo classification), pathological features (T stage, M stage, histological grade, sarcomatoid change, perirenal fat invasion), perioperative parameters (surgical approach, operative time, intraoperative blood loss, complications), and laboratory parameters (platelet count, albumin, neutrophil count, etc.). Optimal cutoff values for continuous variables, such as age, body mass index (BMI), platelet count and serum albumin level, were determined using X-tile software based on the minimum P-value principle. Subsequently, Kaplan-Meier survival analysis with Log-rank test was performed within the long-term survival cohort to evaluate the association of the above-mentioned factors with long-term survival.
RESULTS: Long-term survival was achieved in 13.9% of 397 patients with ccRCC and VTT. Significant differences were observed between the long-term survival group (n=55) and the non-long-term survival group (n=342) in baseline platelet count (P=0.040), pathological T stage (P=0.001), histological grade (P=0.006), surgical approach (P < 0.001), as well as receipt of systemic therapy (P=0.028), treatment timing (P=0.003), and treatment regimen (P < 0.001). Regarding T stage, the long-term survival group had a significantly higher proportion of pT3a tumors (63.6% vs. 42.4%) and a significantly lower proportion of pT4 tumors (10.9% vs. 33.0%) compared with the non-long-term survival group. The long-term survival group also had a higher proportion of low-grade tumors (G1/G2: 50.9% vs. 31.9%). Regarding surgical approach, laparoscopic surgery predominated in the long-term survival group (35/55, 63.6%), whereas the non-long-term survival group had a more balanced distribution, including open surgery (102/342, 29.8%), laparoscopic surgery (123/342, 36.0%), and robotic surgery (117/342, 34.2%). Regarding systemic therapy, in the long-term survival group, 26 patients (47.3%) received systemic therapy, all of whom (100.0%) received adjuvant therapy. In the non-long-term survival group, 215 patients (62.9%) received systemic therapy, of whom 160 (74.4%) received adjuvant therapy and 55 (25.6%) received neoadjuvant therapy. Regarding treatment regimen, the long-term survival group was predominantly treated with targeted monotherapy (25/26, 96.2%), whereas the non-long-term survival group had a higher proportion of targeted therapy plus immunotherapy combination (64/215, 29.8%). The median follow-up time for the long-term survival group was 81.7 months. Further subgroup analysis of this group showed that age < 70 years (P=0.038), BMI≥18.5 kg/m2 (P=0.032), platelet count 159×109/L-273×109/L (P=0.003), and albumin level >41.4 g/L (P=0.028) were significantly associated with better long-term survival, whereas Mayo classification of tumor thrombus showed no significant association with long-term survival (P=0.250).
CONCLUSION: A subset of patients with ccRCC and VTT can achieve long-term survival. Beyond pathological tumor stage and grade, patient-related inflammatory and nutritional status may be associated with long-term survival. Exploring prognostic factors related to long-term survival may help further optimize risk stratification and treatment strategies for high-risk patients.
PMID:42493434