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. 2022 Jun 23:12:900550.
doi: 10.3389/fonc.2022.900550. eCollection 2022.

T.H.R.O.B.V.S. Score - A Comprehensive Model to Predict the Surgical Complexity of Renal Cell Carcinoma With Tumor Thrombus

Kai Wang  1 , Zhuo Liu  1 , Peng Hong  1 , Yan-Chun Qin  1 , Xun Zhao  1 , Hong-Xian Zhang  1 , Cheng Liu  1 , Li-Yuan Ge  1 , Lu-Lin Ma  1
Affiliations

T.H.R.O.B.V.S. Score - A Comprehensive Model to Predict the Surgical Complexity of Renal Cell Carcinoma With Tumor Thrombus

Kai Wang et al. Front Oncol. .

Abstract

Background: To propose a quantitative model for predicting the surgical complexity of patients with renal cell carcinoma (RCC) and venous tumor thrombus (VTT).

Method: The clinical data of 226 cases of RCC with VTT in Peking University Third Hospital from January 2014 to August 2020 were retrospectively analyzed. Seven indicators were selected to establish the T.H.R.O.B.V.S. system, including alkaline phosphatase, tumor thrombus height, maximum tumor diameter, obesity, bland thrombus, vascular wall invasion, and side. Each indicator was assigned with 0, (1), and 2 points, and the total scores of 0~2, 3~5, and ≥6 were set as the low-, middle-, and high-risk groups, respectively. The surgical complexity was compared and validated among groups.

Results: As the risk increased, the proportion of open surgery significantly increased (P<0.001). The operation time (P<0.001), intraoperative blood loss (P<0.001), blood or plasma transfusion (P<0.001), and hospitalization (P<0.001) increased significantly. The postoperative complications (P<0.001), including notable complications (≥Clavein-Dindo II, P<0.001), were significantly different, and similar trends were shown in the validation group.

Conclusion: The T.H.R.O.B.V.S. scoring system is a quantifiable and satisfactory model to predict the surgical complexity and perioperative management of RCC with VTT.

Keywords: nephrectomy; prediction model; renal cell carcinoma; surgical complexity; thrombectomy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of study cohort selection and research strategy.
Figure 2
Figure 2
A 53-year-old man was admitted to the hospital with “painless gross hematuria for 3 months”. CTU examination revealed a tumor of the right kidney (maximum diameter 3 cm). The right RV, IVC (below the second hepatic portal) and part of the left RV were widened with uneven enhancement, TT considered. The boundary between TT and the venous wall was unclear, and vascular wall invasion was considered. Bland thrombus formed at the distal end of the IVC (green circle). T.H.R.O.B.V.S. score: 0 + 2+0+1+2+2+0 = 7 points, belonging to the high-risk group. AO, aorta; RK, right kidney; LK, left kidney; IVC, inferior vena cava; TT, tumor thrombus.
Figure 3
Figure 3
Bar charts of surgical complexity indicators and short-term postoperative recovery among T.H.R.O.B.V.S. risk stratifications. The grading system had a good effect on predicting (A) operation time, (B) intraoperative blood loss, (C) blood transfusion, (D) plasma transfusion, and (E) postoperative hospital stays. ns, no significant difference; *P < 0.05; **P < 0.01.
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References

    1. Ljungberg B, Campbell SC, Cho HY, Jacqmin D, Lee JE, Weikert S, et al. . The Epidemiology of Renal Cell Carcinoma. Eur Urol (2011) 60(4):615–21. doi: 10.1016/j.eururo.2011.06.049 - DOI - PubMed
    1. Scelo G, Larose TL. Epidemiology and Risk Factors for Kidney Cancer. J Clin Oncol (2018) 36(36):3574–81. doi: 10.1200/JCO.2018.79.1905 - DOI - PMC - PubMed
    1. Wang Z, Yin Y, Wang J, Zhu Y, Li X, Zeng X. Standardized Incidence Rate, Risk and Survival Outcomes of Second Primary Malignancy Among Renal Cell Carcinoma Survivors: A Nested Case-Control Study. Front Oncol (2021) 11:1–17. doi: 10.3389/fonc.2021.716741 - DOI - PMC - PubMed
    1. Leibovich BC, Lohse CM, Cheville JC, Zaid HB, Boorjian SA, Frank I, et al. . Predicting Oncologic Outcomes in Renal Cell Carcinoma After Surgery. Eur Urol (2018) 73(5):772–80. doi: 10.1016/j.eururo.2018.01.005 - DOI - PubMed
    1. Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. The Mayo-Clinic Experience With Surgical Management Complications and Outcome for Patients With Renal Cell Carcinoma and Venous Tumour Thrombus. BJU Int (2004) 94(1):33–41. doi: 10.1111/j.1464-410X.2004.04897.x - DOI - PubMed