Abstract
BackgroundThe aim of the study is to evaluate the role of cytoreductive nephrectomy (CN) with thrombectomy before targeted molecular therapy (TMT) on survival in metastatic renal cell carcinoma (mRCC) with venous tumor thrombus.MethodsWe performed a retrospective analysis of 47 patients treated in our center from April 2008 to October 2014. In the study, 20 patients underwent CN with thrombectomy followed by targeted therapy (group 1); 15 patients received targeted therapy alone (group 2); and 12 patients underwent CN with thrombectomy alone (group 3). The overall survival (OS) and cancer-specific survival (CSS) were calculated according to the Kaplan-Meier survival curve method, and prognostic variables were assessed by Cox regression analyses.ResultsThe median follow-up times of group 1, group 2, and group 3 were 24.5, 12, and 6.5 months, respectively. During follow-up, in both group 1 and group 3, 12 patients died. In group 2, 14 patients died. The median OS of group 1, group 2, and group 3 was 22, 12, and 6 months, respectively (P < 0.001). Compared with surgery alone and targeted therapy alone, patients with cytoreductive surgery before targeted therapy had statistically better survival benefits (P < 0.001, P = 0.009, respectively). On univariate analysis, the number of metastatic sites (P = 0.004) was a statistically significant prognostic factor influencing OS.ConclusionsOur single-center experience showed that CN with thrombectomy before targeted therapy improved the survival of patients with mRCC with venous tumor thrombus. The number of metastatic sites was an independent prognostic factor influencing OS.
Highlights
The aim of the study is to evaluate the role of cytoreductive nephrectomy (CN) with thrombectomy before targeted molecular therapy (TMT) on survival in metastatic renal cell carcinoma with venous tumor thrombus
We reviewed the medical records of all patients who presented to our center from April 2008 to October 2014 for evaluation of or treatment for concomitant metastatic renal cell carcinoma (mRCC) with Venous tumor thrombus (VTT)
20 patients underwent CN with thrombectomy followed by TMT; 15 patients received TMT alone; 12 patients underwent CN with thrombectomy alone; and 2 refused any therapy
Summary
The aim of the study is to evaluate the role of cytoreductive nephrectomy (CN) with thrombectomy before targeted molecular therapy (TMT) on survival in metastatic renal cell carcinoma (mRCC) with venous tumor thrombus. Venous tumor thrombus (VTT) occurs in approximately 5–10% of patients undergoing nephrectomy for renal cell carcinoma (RCC) [1]. Before the era of targeted therapy, two prospective randomized controlled trials had demonstrated the overall benefit of cytoreductive nephrectomy (CN) in metastatic RCC [4, 5]. Differential expression of prognostic proteomic markers, such as VEGFR1, was found in primary tumor, VTT, and metastatic renal cell cancer tissue [9], suggesting that TKI alone may help improve the survival of mRCC with VTT
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