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.
Conclusion: 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.
目的: 回顾性分析2016年1月至2022年12月于北京大学第三医院因肾肿瘤伴瘤栓行手术治疗的患者(年龄≤40岁)临床资料，评估手术效果，探讨其临床病理特征与预后之间的关系。
方法: 回顾17例青年肾肿瘤伴瘤栓患者的临床资料，总结其临床病理特征和预后情况。按照有无症状、2017年美国癌症联合委员会(American Joint Committee on Cancer, AJCC)的临床分期、术后有无联合辅助治疗进行分组，采用Kaplan-Meier方法描绘生存曲线，并采用Log-rank检验比较不同组间患者术后生存时间、无进展生存时间的差异，分析临床病理特征和预后的关系。
结果: 17例患者均接受静脉瘤栓取出术，其中，肾根治性切除术16例(94.1%)，保留肾单位术1例(5.9%)；术前有症状者12例(70.6%)，无症状者5例(29.4%)；良性肾肿瘤2例(11.8%)，恶性肾肿瘤15例(88.2%)，包括肾透明细胞癌1例(6.7%)，非透明细胞癌14例(93.3%)。15例恶性肾肿瘤中，AJCC临床Ⅲ期8例(53.3%)，Ⅳ期7例(46.7%)。术后联合多种辅助治疗者6例(40%)，未联合多种辅助治疗者9例(60%)。随访时间2~78个月，中位随访时间41个月，随访中死亡3例(20%)。患者术后中位生存时间39.0 (2.3，77.8)个月，无进展生存时间16.4 (2.3，77.8)个月。根据术前有无症状(P=0.307，P=0.302)、AJCC临床分期(P=0.340，P=0.492)、术后有无联合辅助治疗(P=0.459，P=0.253)分组，青年肾肿瘤伴瘤栓患者的术后生存时间、无进展生存时间差异无统计学意义。
结论: 青年肾肿瘤伴瘤栓患者多出现症状，病理类型更复杂多样，恶性肿瘤合并瘤栓中非透明细胞癌的比例更高，有症状及非透明细胞癌与不良预后可能存在一定潜在相关性，外科手术联合辅助治疗是青年肾肿瘤伴瘤栓患者相对安全、有效的治疗方式。
Keywords: Clinicopathologic features; Kidney neoplasms; Prognosis; Tumor thrombus; Young adult.