Surgical Management of Renal Cell Carcinoma Extending Into Venous System: A 20-Year Experience

Xiao, Xia; Zhang, L; X, Chen; Cui, Ligang; Zhu, Haibo; Pang, Dong; Yang, Yu Shih; Wang, Q; Wang, M; Gao, Chao

doi:10.1177/1457496917738922

Cited by 12 publications

(11 citation statements)

References 29 publications

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“…Metastasis at surgery was generally reported as a poor prognostic indicator in patients with RCC with VTT [ 17 , 27 ], with a median survival expectation of less than 1 year. However, some studies found inconsistent outcomes [ 14 , 28 ], even some patients with metastatic diseases have prolonged survival due to unknown reasons [ 6 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

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

Chen

Yang

et al. 2021

BMC Cancer

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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.

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Section: Discussionmentioning

confidence: 99%

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

Chen

Yang

et al. 2021

BMC Cancer

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“…Some believed the presence of IVC tumor thrombus affected the prognosis with poor prognosis, [15] while others believed that tumor thrombus had little effect on prognosis. [16,17]…”

Section: Discussionmentioning

confidence: 99%

Surgical complexity and prognostic outcome of small volume renal cell carcinoma with high-level venous tumor thrombus and large volume renal cell carcinoma with low-level thrombus

Liu

Zhang

et al. 2019

Chinese Medical Journal

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Background:Radical nephrectomy with thrombectomy is one of the most difficult and complicated urological operations. But the roles of renal tumor volume and thrombus level in surgical complexity and prognostic outcome are not clear. This study aimed to evaluate the surgical complexity and prognostic outcome between the volume of renal cell carcinoma (RCC) and the level of venous tumor thrombus.Methods:The clinical data of 67 RCC cases with renal vein or inferior vena cava (IVC) tumor thrombus from January 2015 to May 2018 were retrospectively analyzed. Among these 67 cases, 21 (31.3%) were small tumors with high-level thrombus (tumor ≤7 cm in diameter and thrombus Neves Level II–IV), while 46 (68.7%) were large tumors with low-level thrombus group (tumor >7 cm in diameter and thrombus Level 0–I). Clinical features, operation details, and pathology data were collected. Univariable and multivariable logistic regression analyses were applied to evaluate the risk factors for small tumor with high-level thrombus.Results:Patients with small tumors and high-level thrombus were more likely to have longer operative time (421.9 ± 135.1 min vs. 282.2 ± 101.9 min, t = 4.685, P < 0.001), more surgical bleeding volume (1200 [325, 2900] mL vs. 500 [180, 1000] mL, U = 270.000, P = 0.004), more surgical blood transfusion volume (800 [0, 1400] mL vs. 0 [0, 800] mL, U = 287.500, P = 0.004), more plasma transfusion volume (0 [0, 800] mL vs. 0 [0, 0] mL, U = 319.000, P = 0.004), higher percentage of open operative approach (76.2% vs. 32.6%, χ2 = 11.015, P = 0.001), higher percentage of IVC resection (33.3% vs. 0%, χ2 = 17.122, P < 0.001), and higher percentage of post-operative complications (52.4% vs. 19.6%, χ2 = 7.415, P = 0.010) than patients with large tumors and low-level thrombus. In multivariate analysis, decreased hemoglobin (Hb) (odds ratio [OR]: 0.956, 95% confidence interval [CI]: 0.926–0.986, P = 0.005) and non-sarcomatoid differentiation (OR: 0.050, 95% CI: 0.004–0.664, P = 0.023) were more likely to form small tumors with high-level tumor thrombus rather than large tumor with small tumor thrombus. The estimated mean cancer-specific survival times of small tumor with high-level thrombus and large tumor with low-level thrombus were 31.6 ± 3.8 months and 32.5 ± 2.9 months, without statistical significance (P = 0.955). After univariate and multivariate Cox proportional hazard survival regression analyses, only distant metastasis (hazard ratio [HR]: 3.839, P = 0.002), sarcomatoid differentiation (HR: 7.923, P < 0.001), alkaline phosphatase (HR: 2.661, P = 0.025), and severe post-operative complications (HR: 10.326, P = 0.001) were independent predictors of prognosis.Conclusions:The level of the tumor thrombus was more important than the diameter of the primary kidney tumor in affecting the complexity of surgery. In the same T3 stage, neither the renal tumor diameter nor the tumor thrombus level was an independent risk factor for prognosis.

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“…Although surgical techniques and perioperative management have been improved a lot over time, the overall survival of patients with RCC and VTT remains poor, with 5-year OS varied from 37-71% [8,[12][13][14][15][16]. This wide variation may result from varied sample size, VTT level, surgical era, tumor pathological classi cation, comorbidities of patient population and improvements in adjuvant therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Metastasis at surgery was generally reported as a poor prognostic indicator in patients with RCC with VTT [16,24], with a median survival expectation of less than 1 year. However, some studies found inconsistent outcomes [13,27], even some patients with metastatic diseases have prolonged survival due to unknown reasons [6,28].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Renal Cell Carcinoma with Associated Venous Tumor Thrombus: Experience from a Large Cohort and Short Time Span in a Single Center

Chen

Yang

et al. 2020

Preprint

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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 the chi-square and Fisher’s exact tests. Over-all survival (OS) was estimated using the Kaplan-Meier method. Univariable and multivariable survival analyses were performed using COX.Results: 121 patients (91 men & 30 women) were identified with a mean age of (59.3±10.8) years. VTT level was 0 in 25 patients, I in 20, II in 50, III in 12 and IV in 14. The mean follow-up time was (25.7±14.6) months. During the follow-up period, 50 (41.3%) patients died and 69 (57.0%) patients experienced recurrence or metastasis. The 3-year and 5-year OS rate were 57.8% and 38.9%. Among the several factors examined, positive lymph node (P=0.008), tumor necrosis (P =0.022), sarcomatoid differentiation (P <0.001) and perinephric fat invasion (P =0.041) were demonstrated as independent significant risk factors on multivariate analysis. Conclusion: The OS was poor for patients with RCC with VTT. Rather than VTT level, positive lymph node, tumor necrosis, sarcomatoid differentiation and perinephric fat invasion were independent prognostic predictors.

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Surgical Management of Renal Cell Carcinoma Extending Into Venous System: A 20-Year Experience

Cited by 12 publications

References 29 publications

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

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

Surgical complexity and prognostic outcome of small volume renal cell carcinoma with high-level venous tumor thrombus and large volume renal cell carcinoma with low-level thrombus

Outcomes of Renal Cell Carcinoma with Associated Venous Tumor Thrombus: Experience from a Large Cohort and Short Time Span in a Single Center

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