Abstract
This study aimed to define patients with renal cell cancer and coexisting tumor thrombus in order to address concerns regarding survival and prognostic factors after radical surgery. Several prognostic factors for overall survival (OS) were assessed in patients treated surgically at five institutions from 2012 to 2018. Univariate and multivariate analyses were used to determine the independent risk factors of OS. A total of 142 patients were eligible for further analysis (mean age of 64.75 years, 56% males). Most patients presented with clear cell carcinoma (95%). The Mayo stage was predominantly 0–1 (88%). Distant visceral metastases at the time of diagnosis were present in 36 patients (25%), whereas nodal metastases were present in 24 patients (16.9%). During the follow-up period (mean of 32.5 months), the 3-year OS rate reached 68.2%. The majority of patients received no adjuvant treatment (n = 107). In a multivariable model predicting OS, regional lymph node status (p < 0.001), distant metastases (p = 0.009), tumor grade (p = 0.002), duration of hospitalization (p = 0.016), and Clavien–Dindo grade (p = 0.047) were identified as independent prognostic factors. A subgroup of patients with specific clinicopathological factors may benefit most from the radical surgery, including patients without regional lymph node or distant metastases and with low tumor grades, whereas short hospitalization and low Clavien–Dindo grades represent additional independent prognostic factors.
Highlights
The authors emphasize the existence of two major subtypes: with invasion restricted to the renal vein, or with distal propagation to the inferior vena cava and right atrium [1]
The following data were collected: (a) demographic: age, gender; (b) clinical: length of hospitalization, American Society of Anesthesiologists scale (ASA), blood transfusions, staging based on CT or MRI scans of chest, abdomen, and pelvis according to 2017 TNM classification system [10], staging according to the classification of tumor thrombus level according to the Mayo staging system, as described before [11,12], adjuvant systemic treatment; and (c) pathological: histological diagnosis including grade, presence of necrosis within the tumor, as well as the dates of diagnosis and death, and the last follow-up
The majority of patients presented with clear cell carcinoma (95%)
Summary
The currently available data on renal cell carcinoma (RCC) with tumor thrombus are inconclusive in terms of the optimal management of such cases [1]. The treatment of patients with no distant metastases comprises a complicated surgical procedure of radical nephrectomy combined with cavotomy and thrombectomy, with early complications present in 58% of cases, out of which 30% are severe, including death [2]. RCC presents with tumor thrombus in up to 10% of cases [3]. The cases with tumor thrombus confined to the renal vein are frequently treated in non-tertiary referral centers and may encompass up to 78% of T3 disease [4]. The management of such cases includes a simple thrombectomy without caval reconstruction [5], and surgery does not require cardiac arrest with extracorporeal circulation [1]. Patient selection seems to be of crucial importance and should be based on a variety of prognostic factors
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