Resection of the inferior vena cava in patients with renal cell carcinoma with bulky tumor venous thrombosis

Давыдов, М. И.; Матвеев, В. Б.; Волкова, М. И.; Фигурин, К. М.; Черняев, А.В.; Климов, А. Е.; Бегалиев, А. К.; Феоктистов, П. И.; Кузнецов, К. П.; Нехаев, И. В.; Жужгинова, О. В.; Огородникова, Е. В.; Мхитарян, С. М.

doi:10.17650/1726-9776-2018-14-2-15-25

Cited by 6 publications

(4 citation statements)

References 18 publications

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“…5. Общая выживаемость оперированных больных почечно-клеточным раком с опухолевым венозным тромбозом в зависимости от количества факторов риска (степени анаплазии опухоли G [3][4] , экспрессии VEGFR-1 в клетках первичной опухоли ≥95 HS, экспрессии VEGFR-2 ≥40 HS и VEGF-A <15 HS в клетках опухолевого тромба). Здесь и на рис.…”

Section: Discussionunclassified

“…По данным разных авторов, частота венозной инвазии достигает 4-10 %, при этом от 2 до 16 % опухолевых тромбов достигает правого предсердия [1,2]. Светлоклеточный вариант ПКР ассоциирован с наиболее высоким риском опухолевой венозной инвазии, реже тромбозы наблюдаются при хромофобном и папиллярном раке почки [3]. Опухолевые тромбы чаще всего являются флотирующими и фиксированы к стенке НПВ только в области устья почечной вены [4,5].…”

Section: Introductionunclassified

“…Опухолевые тромбы чаще всего являются флотирующими и фиксированы к стенке НПВ только в области устья почечной вены [4,5]. Однако у 14 % пациентов имеется истинное врастание опухоли в стенку НПВ [3]. Несмотря на огромное количество исследований, посвященных широкому спектру вопросов диагностики и лечения рака почки с опухолевым венозным тромбозом, в доступной нам литературе мы не обнаружили работ, посвященных экспрессии проангиогенных факторов, регулируемых гипоксия-индуцированным фактором (HIF), в клетках опухолевого тромба.…”

Section: Introductionunclassified

“…Overall survival of renal cell carcinoma patients with tumor venous thrombosis depending on VEGFR-2 expression in tumor thrombus cells Общая выживаемость / Overall survival Общая выживаемость / Overall survival Общая выживаемость / Overall survival р мес / Life expectancy, months Экспрессии VEGFR-2 в клетках первичной опухоли / VEGFR-2 expression in primary tumor cells ˂95 ≥95 Цензурированные / Censore Экспрессии VEGFR-2 в клетках опухолевого тромба / VEGFR-2 expression in tumor thrombus cells ˂40 ≥40 Цензурированные / Censore Экспрессии VEGF-A в клетках опухолевого тромба / VEGF-A expression in tumor thrombus cells ≥15 ˂15 Цензурированные / Censore р = 0,093Проведен многофакторный анализ ОВ, в который в качестве потенциальных факторов риска включены количество признаков (от 0 до 4) и комбинации количества признаков (0 или 1-4, 0-1 или 2-4, 0-2 или 3-4, 0-3 или 4), оказывавших негативное влияние на ОВ, по данным однофакторного анализа (экспрессия VEGFR-2 в клетках первичной опухоли ≥95 HS, экспрессия VEGFR-2 ≥40 HS и VEGF-A <15 HS в клетках опухолевого тромба, степень дифференцировки G[3][4] ). Независимым негативным прогностическим влиянием на ОВ обладало наличие ≥3 перечисленных выше факторов риска (отношение рисков 1,8; 95 % доверительный интервал 1,1-3,1; р = 0,026).…”

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Expression of growth factors and tyrosine kinase receptors in the primary tumor and tumor thrombus cells in patients with renal cell carcinoma

et al. 2020

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Objective: to assess the expression and prognostic value of vascular endothelial growth factor A (VEGF-A), fibroblast growth factor 2 (FGF-2) and their receptors VEGFR-1, -2; FGFR-1, -2, as well as platelet-derived growth factor receptors (PDGFR-α, PDGFR-β) in paired samples of primary tumors and tumor thrombi in renal cell carcinoma (RCC).Materials and methods. Expression of VEGF-A, FGF-2, VEGFR-1, -2; FGFR-1, -2; PDGFR-α, -β was studied in paired surgical samples of primary tumors and tumor thrombi in 25 patients with clear cell RCC pT3a–T4N0–1M0–1 and tumor venous thrombosis by immunohistochemical assay using the appropriate Abcam/Santa Cruz Biotech antibodies from the immunohistochemical staining kit Invitrogen. Expression levels were evaluated by a semi-quantitative method (H-score). The analysis of the correlation between expression levels of VEGF-A, FGF-2, VEGFR-1, -2; FGFR-1, -2; PDGFR-α, -β and RCC characteristics, as well as evaluation of their influence on the outcome of RCC were performed.Results. VEGF-A, FGF-2, as well as VEGFR-1, -2; FGFR-1, -2; PDGFR-α, -β were expressed in the cytoplasm and on the membrane of the primary tumor and tumor thrombus cells in RCC patients. Tumor thrombus cells were characterized by lower expression of VEGFR-1, VEGFR-2, PDGFR-α (p <0.05 for all) and tendency to lower expression of VEGF-A (p = 0.060), FGF-2 (p = 0.046), FGFR-1 (p = 0.077) and FGFR-2 (p = 0.090) compared with primary tumor cells. RCC Furman grade correlated with the expression levels of VEGFR-1 (p = 0.035) and FGFR-1 (p = 0.022) in the primary tumor cells, tumor invasion into venous wall correlated with the expression levels of VEGFR-1 (p = 0.023) and FGFR-2 (p = 0.005) on the thrombus cells. VEGFR-2 overexpression in the primary tumor cells was associated with significant decrease of overall survival (OS) rate (p = 0.011). There was a tendency to OS deterioration in cases with overexpression of VEGFR-2 (p = 0.093) and VEGF-A (p = 0.095) in the tumor thrombus cells. One-year OS in patients with ³2 identified risk factors was 27.3 %, <2 risk factors – 87.5 % (p = 0.004).Conclusion. Tumor thrombus cells in RCC patients expressed VEGF-A, FGF-2, VEGFR-1, -2; FGFR-1, -2; PDGFR-α, -β less active than the cells of the primary tumor. Overexpression of growth factors and tyrosine kinases correlated with RCC Furman grade and tumor venous wall invasion. Overexpression of VEGFR-2 in both primary tumor and thrombus cells in combination with hypoexpression of VEGF-A in the thrombus negatively influenced on OS.

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Expression of growth factors and tyrosine kinase receptors in the primary tumor and tumor thrombus cells in patients with renal cell carcinoma

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Reconstruction of renal vessels during extracorporeal partial nephrectomy of a single kidney

Зотиков¹,

Грицкевич²,

Adyrkhaev³

et al. 2022

Kardiol. serdechno-sosud. khir.

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Surgical treatment of patients with renal cell cancer complicated by specific (tumor) and non-specific thrombosis of the inferior Vena cava

Воробьев¹,

Ашырова²,

Головащенко³

et al. 2020

Issled. prakt. med. (Print)

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Among malignant neoplasms, kidney cancer occupies one of the first places in terms of the growth rate of incidence in Russia. Despite the possibilities of modern diagnostic research methods, the number of patients with common forms of the disease does not decrease. In 5–10% of cases, renal cell carcinoma is complicated by the formation of a tumor clot in the inferior Vena cava (VCI), which requires volume surgery — nephrectomy with thrombectomy, which is the only effective treatment option for this group of patients. Previously, the results of treatment of locally advanced kidney cancer were unsatisfactory due to the high incidence of complications and mortality after extended surgical interventions. However, improving the operation technique requires a re-evaluation of previous representations. Performing a nephrectomy with a VCI thrombectomy is not an easy task and is often associated not only with technical difficulties due to the need for mobilization, control and resection of the inferior Vena cava, but also with the risk of intra — and postoperative complications. The most difficult task is the choice of surgical tactics for descending non-tumor hemorrhagic thrombosis. As a result of long-term tumor obstruction, organized blood clots that are soldered to the intima of the vessel often spread to the common iliac veins and, as a rule, are technically impossible to remove. If the VCI is preserved, a residual hemorrhagic blood clot in the area of its confluence is a potential source of pulmonary embolism (PE), for the prevention of which mechanical plication is used. This maneuver does not lead to the development of clinically significant chronic venous insufficiency of the lower extremities (CVI NC), postoperative VCI or PE thrombosis. Despite the technical complexity of the operation and the difficult course of the postoperative period, surgical treatment of renal cell cancer complicated by tumor thrombosis is certainly justified. This article presents a clinical case of surgical treatment of a patient with renal cell cancer complicated by massive specific (tumor) and non-specific thrombosis in the presence of reduced parenchymalexcretory function of the contralateral kidney and severe cardiac pathology. Goal: to share experience and demonstrate the results of successful surgical treatment of renal cell carcinoma.

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Resection of the inferior vena cava in patients with renal cell carcinoma with bulky tumor venous thrombosis

Cited by 6 publications

References 18 publications

Expression of growth factors and tyrosine kinase receptors in the primary tumor and tumor thrombus cells in patients with renal cell carcinoma

Expression of growth factors and tyrosine kinase receptors in the primary tumor and tumor thrombus cells in patients with renal cell carcinoma

Reconstruction of renal vessels during extracorporeal partial nephrectomy of a single kidney

Surgical treatment of patients with renal cell cancer complicated by specific (tumor) and non-specific thrombosis of the inferior Vena cava

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