Top

BMC Cancer

Published in:

Open Access 01-12-2021 | Kidney Cancer | Research article

Outcomes of renal cell carcinoma with associated venous tumor thrombus: experience from a large cohort and short time span in a single center

Authors: Zhigang Chen, Feilong Yang, Liyuan Ge, Min Qiu, Zhuo Liu, Cheng Liu, Xiaojun Tian, Shudong Zhang, Lulin Ma

Published in: BMC Cancer | Issue 1/2021

Abstract

Background

The surgical management and outcomes of renal cell carcinoma (RCC) with venous tumor thrombus (VTT) have been reported in limited sample size, and there remain discrepancies over the factors that influence oncologic outcomes after radical nephrectomy with thrombectomy (RNTE). The aim of the study was to analyze the outcomes of the patients with RCC with VTT in our institution and identify the independent prognostic factors.

Methods

Patients with RCC with VTT were enrolled for the study from February 2015 to December 2018. All patients underwent RNTE. Clinical data were compared using Mann-Whitney U test and the chi-square test for continuous and categorical variables respectively. Survival analysis was estimated using the Kaplan-Meier method. Univariable and multivariable survival analyses were performed using Cox regression model.

Results

121 patients (91 men & 30 women) were identified with a median age of 60 years. VTT level was 0 in 25 patients, I in 20, II in 50, III in 12 and IV in 14. The median follow-up time was 24 months. During the follow-up period, 51 (42%) patients died and 69 (57%) patients experienced recurrence or metastasis. The 3-year and 5-year over-all survival (OS) were 58 and 39%. Among the several factors examined, positive lymph node (P = 0.016), metastasis at surgery (P = 0.034), tumor necrosis (P = 0.023) and sarcomatoid differentiation (P < 0.001) were demonstrated as independent significant risk factors on multivariable analysis.

Conclusion

The OS was poor for patients with RCC with VTT. Rather than VTT level, positive lymph node, metastasis at surgery, tumor necrosis and sarcomatoid differentiation were independent prognostic predictors.

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. https://doi.org/10.1111/j.1464-410X.2004.04897.x.CrossRefPubMed

Al Otaibi M, Abou Youssif T, Alkhaldi A, et al. Renal cell carcinoma with inferior vena caval extension: impact of tumour extent on surgical outcome. BJU Int. 2009;104(10):1467–70. https://doi.org/10.1111/j.1464-410X.2009.08575.x.CrossRefPubMed

Martínez-Salamanca JI, Linares E, González J, et al. Lessons learned from the International Renal Cell Carcinoma-Venous Thrombus Consortium (IRCC-VTC). Curr Urol Rep. 2014;15:404.CrossRef

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(6):1054–8. https://doi.org/10.1016/j.urology.2007.02.052.CrossRefPubMed

Woodruff DY, Van Veldhuizen P, Muehlebach G, et al. The perioperative management of an inferior vena caval tumor thrombus in patients with renal cell carcinoma. Urol Oncol. 2013;31(5):517–21. https://doi.org/10.1016/j.urolonc.2011.03.006.CrossRefPubMed

Lardas M, Stewart F, Scrimgeour D, Hofmann F, Marconi L, Dabestani S, et al. Systematic review of surgical management of nonmetastatic renal cell carcinoma with vena caval thrombus. Eur Urol. 2016;70(2):265–80. https://doi.org/10.1016/j.eururo.2015.11.034.CrossRefPubMed

Kaplan S, Ekici S, Dogan R, et al. Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus. Am J Surg. 2002;183(3):292–9. https://doi.org/10.1016/S0002-9610(02)00782-1.CrossRefPubMed

Chen X, Li S, Xu Z, Wang K, Fu D, Liu Q, et al. Clinical and oncological outcomes in Chinese patients with renal cell carcinoma and venous tumor thrombus extension: single-center experience. World J Surg Oncol. 2015;13(1):14. https://doi.org/10.1186/s12957-015-0448-2.CrossRefPubMedPubMedCentral

Nooromid MJ, Ju MH, Havelka GE, Kozlowski JM, Kundu SD, Eskandari MK. Fifteen-year experience with renal cell carcinoma with associated venous tumor thrombus. Surgery. 2016;160(4):915–23. https://doi.org/10.1016/j.surg.2016.06.029.CrossRefPubMed

10.

Qi N, Wu P, Chen J, Li T, Ning X, Wang J, et al. Cytoreductive nephrectomy with thrombectomy before targeted therapy improves survival for metastatic renal cell carcinoma with venous tumor thrombus: a single-center experience. World J Surg Oncol. 2017;15(1):4. https://doi.org/10.1186/s12957-016-1066-3.CrossRefPubMedPubMedCentral

11.

Edge SB, Compton CC. The American joint committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4. https://doi.org/10.1245/s10434-010-0985-4.CrossRefPubMed

12.

Mitropoulos D, Artibani W, Graefen M, Remzi M, Rouprêt M, Truss M, et al. Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol. 2012;61(2):341–9. https://doi.org/10.1016/j.eururo.2011.10.033.CrossRefPubMed

13.

Master VA, Ethun CG, Kooby DA, Staley CA III, Maithel SK. The value of a cross-discipline team-based approach for resection of renal cell carcinoma with IVC tumor thrombus: a report of a large, contemporary, single-institution experience. J Surg Oncol. 2018;118(8):1219–26. https://doi.org/10.1002/jso.25271.CrossRefPubMed

14.

Sweeney P, Wood CG, Pisters LL, Slaton JW, Vaporciyan A, Munsell M, et al. Surgical management of renal cell carcinoma associated with complex inferior vena caval thrombi. Urol Oncol. 2003;21(5):327–33. https://doi.org/10.1016/S1078-1439(02)00280-6.CrossRefPubMed

15.

Kalkat MS, Abedin A, Rooney S, Doherty A, Faroqui M, Wallace M, et al. Renal tumours with cavo-atrial extension: surgical management and outcome. Interact Cardiovasc Thorac Surg. 2008;7(6):981–5. https://doi.org/10.1510/icvts.2008.180026.CrossRefPubMed

16.

Gu L, Wang Z, Chen L, Ma X, Li H, Nie W, et al. A proposal of post-operative nomogram for overall survival in patients with renal cell carcinoma and venous tumor thrombus. J Surg Oncol. 2017;115(7):905–12. https://doi.org/10.1002/jso.24575.CrossRefPubMed

17.

Xiao X, Zhang L, Chen X, Cui L, Zhu H, Pang D, et al. Surgical Management of Renal Cell Carcinoma Extending into Venous System: a 20-year experience. Scand J Surg. 2018;107(2):158–65. https://doi.org/10.1177/1457496917738922.CrossRefPubMed

18.

Hirono M, Kobayashi M, Tsushima T, et al. Impacts of clinicopathologic and operative factors on short-term and long-term survival in renal cell carcinoma with venous tumor thrombus extension: a multi-institutional retrospective study in Japan. BMC Cancer. 2013;13(1):447. https://doi.org/10.1186/1471-2407-13-447.CrossRefPubMedPubMedCentral

19.

Whitson JM, Reese AC, Meng MV. Population based analysis of survival in patients with renal cell carcinoma and venous tumor thrombus. Urol Oncol. 2013;31(2):259–63. https://doi.org/10.1016/j.urolonc.2010.11.017.CrossRefPubMed

20.

Staehler G, Brkovic D. The role of radical surgery for renal cell carcinoma with extension into the vena cava. J Urol. 2000;163(6):1671–5. https://doi.org/10.1016/S0022-5347(05)67517-9.CrossRefPubMed

21.

Spiess PE, Kurian T, Lin HY, et al. Preoperative metastatic status, level of thrombus and body mass index predict overall survival in patients undergoing nephrectomy and inferior vena cava thrombectomy. BJU Int. 2012;110(11 Pt B):E470–4.CrossRef

22.

Armstrong PA, Back MR, Shames ML, Bailey CJ, Kim T, Lawindy SM, et al. Outcomes after inferior vena cava thrombectomy and reconstruction for advanced renal cell carcinoma with tumor thrombus. J Vasc Surg Venous Lymphat Disord. 2014;2(4):368–76. https://doi.org/10.1016/j.jvsv.2014.05.002.CrossRefPubMed

23.

Sidana A, Goyal J, Aggarwal P, Verma P, Rodriguez R. Determinants of outcomes after resection of renal cell carcinoma with venous involvement. Int Urol Nephrol. 2012;44(6):1671–9. https://doi.org/10.1007/s11255-012-0314-x.CrossRefPubMed

24.

Tornberg SV, Nisen H, Visapää H, Kilpeläinen TP, Järvinen R, Mirtti T, et al. Outcome of surgery for patients with renal cell carcinoma and tumour thrombus in the era of modern targeted therapy. Scand J Urol. 2016;50(5):380–6. https://doi.org/10.1080/21681805.2016.1217558.CrossRefPubMed

25.

Martinez-Salamanca JI, Huang WC, Millan I, et al. Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension. Eur Urol. 2011;59(1):120–7. https://doi.org/10.1016/j.eururo.2010.10.001.CrossRefPubMed

26.

Wagner B, Patard JJ, Mejean A, et al. Prognostic value of renal vein and inferior vena cava involvement in renal cell carcinoma. Eur Urol. 2009;55(2):452–9. https://doi.org/10.1016/j.eururo.2008.07.053.CrossRefPubMed

27.

Tilki D, Nguyen HG, Dall’era MA, et al. Impact of histologic subtype on cancer-specific survival in patients with renal cell carcinoma and tumor thrombus. Eur Urol. 2014;66(3):577–83. https://doi.org/10.1016/j.eururo.2013.06.048.CrossRefPubMed

28.

Parekh DJ, Cookson MS, Chapman W, et al. Renal cell carcinoma with renal vein and inferior vena caval involvement: Clinicopathological features, surgical techniques and outcomes. J Urol. 2005;173(6):1897–902. https://doi.org/10.1097/01.ju.0000158459.42658.95.CrossRefPubMed

29.

Nesbitt JC, Soltero ER, Dinney CP, et al. Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus. Ann Thorac Surg. 1997;63(6):1592–600. https://doi.org/10.1016/S0003-4975(97)00329-9.CrossRefPubMed

Title: Outcomes of renal cell carcinoma with associated venous tumor thrombus: experience from a large cohort and short time span in a single center
Authors: Zhigang Chen
Feilong Yang
Liyuan Ge
Min Qiu
Zhuo Liu
Cheng Liu
Xiaojun Tian
Shudong Zhang
Lulin Ma
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Kidney Cancer
Metastasis
Kidney Cancer
Kidney Cancer
Thrombectomy
Published in: BMC Cancer / Issue 1/2021
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-021-08508-x

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Optimizing palliative chemotherapy for advanced invasive mucinous adenocarcinoma of the lung

Associations between I/D polymorphism in the ACE gene and lung cancer: an updated systematic review and a meta-analysis

Evaluation of body-surface-area adjusted dosing of high-dose methotrexate by population pharmacokinetics in a large cohort of cancer patients

The ideal approach for treatment of cT1N+ and cT2Nany esophageal cancer.: a NCDB analysis

EHHADH contributes to cisplatin resistance through regulation by tumor-suppressive microRNAs in bladder cancer

Association between oligo-residual disease and patterns of failure during EGFR-TKI treatment in EGFR-mutated non-small cell lung cancer: a retrospective study

Keynote webinar | Spotlight on antibody–drug conjugates in cancer