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

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.

T.H.R.O.B.V.S. Score – A Comprehensive Model to Predict the Surgical Complexity of Renal Cell Carcinoma With Tumor Thrombus

“…It results in a long operation time, more blood loss, and a higher probability of postoperative complications. Similarly, the properties of the VTT (H score) also play a role in surgical complexity ( 10 ).…”

“…Predicting the complexity of operations conveniently and accurately before surgery has always been of great significance in clinical research. However, there is no quantitative tool to help surgeons make a proper determination with patients in advanced RCC with VTT ( 10 ). Most surgical decisions currently rely on qualitative indicators ( 11 – 13 ), which are far from standardized.…”

Surgical treatment of inferior vena cava tumor thrombus.

“…В исследовании Z. Chen и соавт. в состав междисциплинарной команды в обязательном порядке входили уролог, анестезиолог, кардиохирург, абдоминальный хирург, реаниматолог и рентгенолог, что позволило составить комплексный периоперационный план лечения и ведения пациентов в послеоперационном периоде [27]. В общей сложности в исследование был включен 121 пациент, из них 91 мужчина и 30 женщин (медиана возраста составила 60 (53-67) лет.…”

“…Выбор хирургического доступа зависит от уровня опухолевого тромба и характеристик первичной почечной опухоли (размер, локализация, регионарная лимфаденопатия и аберрантная сосудистая анатомия). В настоящее время данные о хирургическом лечении и исходах больных ПКР с опухолевыми тромбами в НПВ ограничены, а факторы, оказывающие значимое влияние на выбор хирургической техники лечения и обладающие высоким прогностическим потенциалом, требуют уточнения [27].…”

Efficacy and safety analysis of TACE + sunitinib vs. sunitinib in the treatment of unresectable advanced renal cell carcinoma: a retrospective study

“…Meanwhile, 20-40% of patients with localized RCC will develop distant metastasis after surgery [9]. The biological behavior of RCC is also complex and diverse, and invasion of the venous system is one of its unique biological behaviors [10], and the incidence of venous tumor thrombus accounts for 5-15% of RCC, with renal venous tumor thrombus being the most common, accounting for 60-78% of venous tumor thrombus [11]. Renal vein tumor thrombus can further progress to the vein or even the right atrium.…”