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

Zhigang Chen,Xiaojun Tian,Cheng Liu,Lulin Ma,Zhuo Liu,Liyuan Ge,Shudong Zhang,Min Qiu,Feilong Yang

doi:10.1186/s12885-021-08508-x

Zhigang Chen, Xiaojun Tian + Show 7 more

Open Access

https://doi.org/10.1186/s12885-021-08508-x

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Journal: BMC Cancer	Publication Date: Jul 2, 2021
Citations: 15	License type: open-access

Affiliation: Peking University Third Hospital, Peking University

Abstract

BackgroundThe 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.MethodsPatients 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.Results121 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.ConclusionThe 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.

Highlights

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)
It has been observed that VTT occurs approximately in 4 to 10% patients with RCC [1, 2], including thrombus extending to the renal vein or extending to the inferior vena cava (IVC)
A total of 185 patients who received RNTE in less than 4 years were identified in our center

Summary

Introduction

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). Kaplan et al [7] reviewed their experience from 11 patients with RCC with IVC involvement in 8 years, Wu et al [8] evaluated the clinical and oncological outcomes in 86 patients with RCC and VTT in 10 years, while Nooromid et al [9] showed their 15year experience with RCC with VTT in 37 patients Though these studies provide a good reference for the treatment of RCC with VTT, two issues have been identified, which regard a limited sample size and an extensive time span. The emerging of targeted therapy offers more choices for RCC with VTT and has been shown to improve survival of RCC with

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