Tumor thrombus (TT) is a complication of renal cell carcinoma (RCC) for which favorable medical management remains undefined. While radical nephrectomy has been shown to increase overall survival in RCC patients, surgical interventions such as cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) utilized to perform TT resection carry high mortality rates. While it has been documented that RCC with TT is associated with venous thromboembolism (VTE) development, anticoagulation use in these patients remains controversial in clinical practice. Whether anticoagulation is associated with improved survival outcomes remains unclear. Furthermore, if anticoagulation is initiated, there is limited evidence for whether direct oral anticoagulants (DOACs), heparin, or warfarin serve as the most advantageous choice. While the combination of immunotherapy and tyrosine kinase inhibitors (TKIs) has been shown to improve the outcomes of RCC, the clinical benefits of this combination are not well studied prospectively in cases with TT. In this literature review, we explore the challenges of treating RCC-associated TT with special attention to anticoagulation. We provide a comprehensive overview of current surgical and medical approaches and summarize recent studies investigating anticoagulation in RCC patients undergoing surgery, targeted therapy, and/or immunotherapy. Our goal is to provide clinicians with updated clinical insight into anticoagulation for RCC-associated TT patients.
肿瘤血栓是肾细胞癌的一种并发症，目前尚未确立理想的药物治疗方案。虽然根治性肾切除术已被证实可提高肾细胞癌患者的总生存率，但用于切除肿瘤血栓的手术干预措施（如体外循环和深低温停循环）具有较高的死亡率。尽管已有文献记载，伴有肿瘤血栓的肾细胞癌与静脉血栓栓塞的发生相关，但在临床实践中，对这些患者使用抗凝治疗仍存在争议。抗凝治疗是否与改善生存结局相关尚不明确。此外，如果启动抗凝治疗，关于直接口服抗凝药、肝素或华法林是否为最优选择，目前证据有限。虽然免疫治疗与酪氨酸激酶抑制剂的联合应用已被证明可改善肾细胞癌的预后，但这种联合治疗在伴有肿瘤血栓的病例中的临床获益尚未得到充分的前瞻性研究。在本篇文献综述中，我们探讨了治疗肾细胞癌相关肿瘤血栓的挑战，特别关注抗凝治疗。我们全面概述了当前的手术和药物治疗方法，并总结了近期针对接受手术、靶向治疗和/或免疫治疗的肾细胞癌患者进行抗凝治疗的研究。我们的目标是为临床医生提供关于肾细胞癌相关肿瘤血栓患者抗凝治疗的最新临床见解。
肿瘤(癌症)患者之家