Characterizing Tumor Thrombus Arising from Non–Clear Cell Renal Cell Carcinoma

Esfandiary, Tina; Cheaib, Joseph G.; Patel, Sunil; Alam, Ridwan; Metcalf, Maynard M.; Enikeev, Dmitry; Pierorazio, Phillip M.; Ged, Yasser; Allaf, Mohamad E.; Singla, Nirmish

doi:10.1016/j.euros.2022.07.001

Cited by 7 publications

(6 citation statements)

References 34 publications

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“…It is worth noting that Rabinowitz’s study reported a median HLOS of 7 days for cases involving the IVC. However, comparing our results directly is challenging, as most of their cases were open procedures, not laparoscopic [ 8 ]. Additionally, their study only included those with IVC extension, whereas ours also encompassed cases with localized renal vein extension in addition to IVC.…”

Section: Discussionmentioning

confidence: 99%

“…Intriguingly, in our cohort, no significant association was observed between WHO/ISUP grading and the level of TT extension, suggesting the potential for other contributing factors in TT pathogenesis and progression (Table 6 ). It is worth noting that other RCC variants may also cause TT, and literature suggests that perioperative and oncologic outcomes of clear-cell and non-clear-cell TT are comparable [ 8 ]. However, this observation does not diminish the need for further research, especially in the Hispanic population, where an increased risk for obesity is associated with a worse disease-specific survival in RCC [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Renal Cell Carcinoma With Tumor Thrombus: A Case Series in Puerto Rico

Bernaschina-Rivera,

Alayón-Rosario,

Dieppa-Barnés

et al. 2024

Cureus

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Introduction: Renal cell carcinoma (RCC) is one of the most common types of kidney cancer. While RCC tends to present as a localized tumor, a notable proportion may present with distant metastasis. In some instances, RCC may also present with intravascular tumor extension, often called tumor thrombus (TT). Its presence confers a worse prognosis and has important implications for the tumor's staging and treatment. Despite extensive documentation of RCC TT in the US, limited data exists regarding its presentation, management, and outcomes in Puerto Rico (PR). This study aims to broaden the available information on RCC TT, emphasizing surgical management and outcomes. We also provide descriptive data on patient demographics and clinical presentation to improve decision-making among clinicians caring for Puerto Rican men and women. Methods: In this single-center, retrospective study, we evaluated patients who underwent partial or total nephrectomy at Saint Luke's Episcopal Medical Center between 2018 and 2022. Data was abstracted from electronic health records (EHR). Patients without documented evidence of TT during the peri-operative period were excluded from the study. A total of 220 patient records were evaluated, of which 12 met the inclusion criteria for the study. Cases were categorized using the latest RCC TT guidelines. Central tendency measurements were used to describe the sample distribution. The mean was considered to make assumptions regarding the prevalent observations, and the median was considered to rule out possible outliers. Categorical data were evaluated using proportion analyses, including TT extension level and BMI variables. Fisher’s exact test evaluated the association between the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade and TT extension level. Results: Most patients lacked TT-related symptoms. The most severe presenting symptom was a pulmonary embolism (8.3%). Hypertension (83.3%), BMI greater than 25 at the time of diagnosis (75%), and type 2 diabetes mellitus (66.7%) were the most common comorbid conditions within our cohort. Nearly 75% of patients underwent laparoscopic radical nephrectomy with TT resection. One left-sided level III case was managed by laparoscopic-assisted open radical nephrectomy with a right subcostal incision. There were zero intraoperative complications and two postoperative complications. The histopathological reports of all cases were consistent with clear cell carcinoma, and half of the cases (n=6) were WHO/ISUP G4. All patients are alive and free of disease. Conclusion: RCC is a common renal neoplasm in PR that can present with intravascular tumor extension. Our findings do not establish a definitive association between BMI, tumor size, WHO/ISUP grading, and TT extension level. Our study shows that laparoscopic removal of RCC TT is a safe and effective approach. However, the generalizability of our findings is limited by the study's design and sample size. Future research shoul...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Renal Cell Carcinoma With Tumor Thrombus: A Case Series in Puerto Rico

Bernaschina-Rivera,

Alayón-Rosario,

Dieppa-Barnés

et al. 2024

Cureus

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“…TT consistency was found to be an independent significant predictor of overall survival in RCC patients without distant or nodal metastases. Another study performed by Rabinowitz et al aimed to characterize clinicopathologic differences and survival outcomes among patients with IVC TT based on whether the TT exhibited clear cell or non-clear cell histology [8]. The study found no differences between groups when assessing cancer-specific survival, recurrence-free survival, and overall survival.…”

Section: Does Tumor Thrombus Burden Impact Survival?mentioning

confidence: 99%

“…An additional 1% of TT cases may extend into the right atrium [1,[4][5][6][7]. The majority of renal cancers associated with TT are of clear cell type [8].…”

Section: Introductionmentioning

confidence: 99%

The Role of Anticoagulation in Tumor Thrombus Associated with Renal Cell Carcinoma: A Literature Review

Williams,

Myint

2023

Cancers

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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.

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“…Это обусловлено тем, что на данный момент не разработаны клинические и рентгенологические признаки, которые позволили бы точно предсказать гистологию образования: дифференцировать ангиомиолипомы и онкоцитомы от ПКР, различать подтипы ПКР. Таким образом необходимо совершенствовать методы лучевой диагностики ПКР для получения высокой диагностической точности при подборе адекватного лечения и оценке прогноза ответа опухоли на терапию [5].…”

Section: Introductionunclassified

Use of artificial intelligence in the diagnosis, treatment and surveillance of patients with kidney cancer

Timofeeva,

Azilgareeva,

Morozov

et al. 2023

Vestn. Urol.

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Currently, artificial intelligence (AI) has developed greatly and has become the subject of active discussions. This is because artificial intelligence systems are constantly being improved by expanding their computing capabilities, as well as obtaining massive data. Due to this, AI can help to set a diagnosis and select the most effective treatment. The study aimed to analyse the possibilities of AI in the diagnosis, treatment and monitoring of patients with renal cell carcinoma (RCC). AI shows great prospects in the diagnosis urinary system lesions, in the ability to differentiate benign and malignant neoplasm (due to machine learning systems), as well as in predicting the histological subtype of the tumor. AI can be used at the intraoperative stage (thanks to the integration of virtual 3D models during surgical interventions), which reduces the frequency of thermal ischemia and damage to the kidney cavity system. AI finds its application in histopathological evaluation: the AI model reaches 100.0% sensitivity and 97.1% specificity in the differential diagnosis of normal tissue from RCC. AI model algorithms may be used to identify patients at high risk of relapse requiring long-term follow-up, as well as to develop individual treatment and follow-up strategies. All the above proves the possibility of using AI in all stages of the management of patients with RCC. The implementation of AI in medical practise opens new perspectives for the interpretation and understanding of complex data inaccessible to clinicians.

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Characterizing Tumor Thrombus Arising from Non–Clear Cell Renal Cell Carcinoma

Cited by 7 publications

References 34 publications

Renal Cell Carcinoma With Tumor Thrombus: A Case Series in Puerto Rico

Renal Cell Carcinoma With Tumor Thrombus: A Case Series in Puerto Rico

The Role of Anticoagulation in Tumor Thrombus Associated with Renal Cell Carcinoma: A Literature Review

Use of artificial intelligence in the diagnosis, treatment and surveillance of patients with kidney cancer

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