本文报道了一例肾细胞癌伴腔静脉癌栓、髂血管血栓的案例，患者因"腹痛腹胀1月余，晕厥、恶心2天"于广东省揭阳市人民医院泌尿外科就诊，PET-CT及增强CT提示右肾巨大肿瘤，下腔静脉及右肾静脉癌栓形成。右肾肿物穿刺活检病理考虑透明细胞性肾细胞癌。通过广东省医学会泌尿外科疑难病例多学科会诊，专家拟定了靶向联合免疫治疗的方案并定期评估疗效。现患者已行7疗程阿昔替尼联合替雷利珠单抗和7疗程甲磺酸伐仑替尼+特瑞普利单抗治疗，其间密切随访，虽然出现了皮肤瘙痒、血尿等轻度不良反应，但复查CT影像学提示腔静脉癌栓较前已有减小、髂血管血栓消失。后续将在国内大型医学中心评估风险后进行手术处理。目前由于缺乏高质量临床研究证据，针对肾癌合并癌栓的系统治疗尚存在争议，本案例提示了靶向联合免疫治疗在肾细胞癌伴腔静脉癌栓中对癌栓减小及改善患者生活质量方面的积极作用，其有效性、可行性和安全性值得进一步研究和探讨。

This article presents a case of renal cell carcinoma with inferior vena cava tumor thrombus and iliac vessel thrombosis (RCC-TT). The patient was admitted to the Urology Department of Jieyang People's Hospital in Guangdong Province. PET-CT and enhanced CT indicated a huge tumor in the right kidney, along with the formation of tumor thrombus in the inferior vena cava and right renal vein. Pathological examination of the right renal tumor biopsy suggested clear cell renal cell carcinoma. Through a multidisciplinary consultation on difficult cases in Guangdong Urological Association, we formulated a treatment plan combining targeted therapy with immunotherapy and regularly assessed its efficacy. The patient has completed seven courses of axitinib combined with tislelizumab and seven courses of lenvatinib mesylate combined with toripalimab treatment, with close follow-up during this period. Although mild adverse reactions such as skin itchiness and hematuria occurred, the follow-up CT imaging showed that the inferior vena cava tumor thrombus had decreased compared to before, and the iliac vessel tumor thrombus had disappeared. The subsequent surgical intervention will be performed after risk assessment at major domestic medical center. Currently, due to the lack of high-quality clinical research evidence, there is still controversy regarding the systemic treatment of renal cancer with tumor thrombus. This case affirms the positive role of targeted therapy combined with immunotherapy in reducing tumor thrombus and improving the quality of life in renal cell carcinoma with inferior vena cava tumor thrombus, which effectiveness, feasibility and safety are worth further research and exploration.