MP59-20 THE EFFECT OF AGGRESSIVE HISTOLOGIC VARIANTS ON NEPHRECTOMY AND IVC THROMBECTOMY FOR RENAL CELL CARCINOMA

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (MP59)1 Sep 2021MP59-20 THE EFFECT OF AGGRESSIVE HISTOLOGIC VARIANTS ON NEPHRECTOMY AND IVC THROMBECTOMY FOR RENAL CELL CARCINOMA Molly DeWitt-Foy, Mohamed Eltemamy, Scott Lundy, and Venkatesh Krishnamurthi Molly DeWitt-FoyMolly DeWitt-Foy More articles by this author , Mohamed EltemamyMohamed Eltemamy More articles by this author , Scott LundyScott Lundy More articles by this author , and Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002094.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Though the presence of rhabdoid and/or sarcomatoid differentiation on final pathology has been identified as a poor prognostic indicator for patients with renal cell carcinoma (RCC), the impact of these features on RCC with inferior vena cava (IVC) thrombus has not yet been described. These aggressive histologic variants (AHV) are thought to cause a desmoplastic reaction which may complicate resection and carry worse longterm prognosis. We aim to describe the effect of AHV on the operative management and overall outcome of patients with RCC and IVC thrombus. METHODS: Retrospective chart review was performed for 383 patients with RCC who underwent nephrectomy and IVC thrombectomy at a single institution between 1990 and 2018. Baseline demographics, pre-, intra-, and postoperative details, radiology and pathology reports were reviewed. Data analysis was conducted using Fisher's exact and chi-square tests, Kaplan-Meier curves, and Wilcoxon tests as appropriate. RESULTS: AHV was demonstrated on final pathology in 78(20.37%) patients. There was no statistically significant difference between thrombus level, tumor size, operative time, or blood loss between those with and without AHV. As compared to RCC without sarcomatoid or rhabdoid differentiation, patients with AHV were more likely to require partial or total caval resection at the time of IVC thrombectomy (25.32% v 14.48%, P=0.0196) and to have pathologic node positive disease (41.07% v 23.35%, p=0.0061), metastatic disease (31.82% v 16.80%, P=0.0068), and sinus fat invasion (91.89% v 78.23%, p=0.0074). Rates of perioperative death and postoperative complications did not differ between groups. Though the difference in median survival time was not statistically significant between AHV+RCC group and RCC group (16.8 v 26.9 months, p=0.0648), subgroup analysis for RCC with sarcomatoid differentiation alone conveyed worse prognosis than RCC without AHV (12.25 v 25.7 months, p=0.0142). CONCLUSIONS: In this large single center series of RCCs with associated IVC thrombi, tumors with rhabdoid and/or sarcomatoid differentiation were more likely to metastasize and invade locally on the kidney and IVC level. The presence of AHV appears to result in a more adherent tumor thrombus, as evidenced by the higher rate of partial or total IVC resection in this group. In our experience these aggressive tumors do not necessarily portend worse operative risk, as demonstrated by equivalent operative time, blood loss, and intraoperative complications. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1038-e1039 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Molly DeWitt-Foy More articles by this author Mohamed Eltemamy More articles by this author Scott Lundy More articles by this author Venkatesh Krishnamurthi More articles by this author Expand All Advertisement Loading ...