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. 2019 Jan 15;17(1):17.
doi: 10.1186/s12957-019-1560-5.

Body mass index as an independent risk factor for inferior vena cava resection during thrombectomy for venous tumor thrombus of renal cell carcinoma

Bin-Shuai Wang  1 , Run-Zhuo Ma  1 , Yu-Qing Liu  1 , Zhuo Liu  1 , Li-Yuan Tao  2 , Min Lu  3 , Guo-Liang Wang  1 , Shu-Dong Zhang  1 , Jian Lu  4 , Lu-Lin Ma  5
Affiliations

Body mass index as an independent risk factor for inferior vena cava resection during thrombectomy for venous tumor thrombus of renal cell carcinoma

Bin-Shuai Wang et al. World J Surg Oncol. .

Abstract

Objective: To 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.

Methods: We 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.

Results: Of 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.

Conclusion: We 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.

Keywords: Renal cell carcinoma; Risk factor; Thrombectomy; Vascular resection; Venous tumor thrombus.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the ethics committees of Peking University Third Hospital. Informed consent was obtained from all individual participants included in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Summary of our study cohort and flow chart of exclusion criteria
Fig. 2
Fig. 2
Measurement of the length and width of IVC tumor thrombus. a The length is the sum of the tumor thrombus in the renal vein and in the IVC. b The maximum width of the tumor thrombus is measured in the coronary plane
Fig. 3
Fig. 3
ROC curve depicting the relationship between BMI and IVC resection. a ROC curve of the relationship between BMI and the IVC resection in Mayo level I–IV patients. AUC = 0.70. The best cutoff value was 22.2 kg/m2, which achieved a sensitivity of 77.3% and a specificity of 54.8%. b ROC curve of the relationship between BMI and the IVC resection in Mayo level II–IV patients. AUC = 0.71. The best cutoff value was 22.4 kg/m2, which achieved a sensitivity of 77.8% and a specificity of 54.2%
See this image and copyright information in PMC

References

    1. Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015;67:913–924. doi: 10.1016/j.eururo.2015.01.005. - DOI - PubMed
    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30. doi: 10.3322/caac.21442. - DOI - PubMed
    1. Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA Cancer J Clin. 2016;66:115–132. doi: 10.3322/caac.21338. - DOI - PubMed
    1. Benkirane A, Khodari M, Yakoubi R, Lambert M, Koussa M, Ghoneim T, et al. Polytetrafluoroethylene expanded prosthesis as replacement of the inferior vena cava in renal cell carcinoma with caval thrombus. Int J Urol. 2014;21:448–452. doi: 10.1111/iju.12339. - DOI - PubMed
    1. Lambert EH, Pierorazio PM, Shabsigh A, Olsson CA, Benson MC, McKiernan JM. Prognostic risk stratification and clinical outcomes in patients undergoing surgical treatment for renal cell carcinoma with vascular tumor thrombus. Urology. 2007;69:1054–1058. doi: 10.1016/j.urology.2007.02.052. - DOI - PubMed

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