PD04-10 IDENTIFYING MRCC PATIENTS WITH VENOUS THROMBUS WHO ARE LIKELY TO BENEFIT FROM CYTOREDUCTIVE SURGERY

Abstract

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) II1 Apr 2016PD04-10 IDENTIFYING MRCC PATIENTS WITH VENOUS THROMBUS WHO ARE LIKELY TO BENEFIT FROM CYTOREDUCTIVE SURGERY E. Jason Abel, Kamran Zargar, Vitaly Margulis, Michael A. Mann, Philippe E. Spiess, Kenan Ashouri, Leonardo Borregales, Ahmed Haddad, Charles Rew, Gong Chen, Fangfang Shi, Surena Matin, Christopher G. Wood, and Jose A. Karam E. Jason AbelE. Jason Abel More articles by this author , Kamran ZargarKamran Zargar More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , Michael A. MannMichael A. Mann More articles by this author , Philippe E. SpiessPhilippe E. Spiess More articles by this author , Kenan AshouriKenan Ashouri More articles by this author , Leonardo BorregalesLeonardo Borregales More articles by this author , Ahmed HaddadAhmed Haddad More articles by this author , Charles RewCharles Rew More articles by this author , Gong ChenGong Chen More articles by this author , Fangfang ShiFangfang Shi More articles by this author , Surena MatinSurena Matin More articles by this author , Christopher G. WoodChristopher G. Wood More articles by this author , and Jose A. KaramJose A. Karam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2415AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nephrectomy with tumor thrombectomy is associated with increased risk for morbidity especially when IVC thrombus extends above the hepatic veins. Some patients with metastatic RCC are less likely to benefit from cytoreductive surgery if their expected survival is short. The purpose of this study was to identify risk factors for poor overall survival in metastatic RCC patients with tumor thrombus. METHODS Data was collected from 4 centers for patients with mRCC and venous thrombus at presentation treated surgically from 2000-2014. MSKCC, IMDC, or MDACC (Cancer 2010) prognostic systems were used to classify patients and Kaplan Meier analysis was used to estimate OS. Univariate and multivariate Cox proportional hazard models were used to evaluate the association of individual variables with OS. RESULTS A total of 293 patients were evaluated and median OS (IQR) was 17.2 (6.4-41.0) months for the entire cohort. Venous thrombus level (Neves system) was 0,1,2,3, and 4 for 77, 38, 104, 45, and 29 patients. Median OS was worse (p=0.03) for patients with IVC thrombus above the diaphragm 6.8 (IQR 2.2-19.1) months compared to renal vein only thrombus 18.8(IQR 8.1-37.8) months or IVC thrombus below the diaphragm 18.9 (IQR 6.7-44.5) months (figure). Risk groups stratification was used to compare the ability of systems to predict short OS. MSKCC poor risk patients had median OS 13.4 (IQR 4.4-28.2) months, IMDC risk poor risk patients had median OS 12.5 (IQR 5.0-35) months and MDACC unfavorable risk patients had median OS 6 (IQR 4.4-28.2) months. Preoperative variables that were independent predictors of OS included: IVC thrombus above diaphragm HR 5.2 (95%CI 2.4-11.3); p<0.001, serum lactate dehydrogenase> ULN HR 1.7 (95%CI 1.1-2.6); p=0.01, and systemic symptoms (fatigue, weight loss, etc.) HR 2.2 (95%CI 1.4-3.3); p=0.0002. CONCLUSIONS Metastatic RCC patients with IVC thrombus above the diaphragm or patients classified as unfavorable using MDACC criteria have poor OS and may not benefit from cytoreductive nephrectomy with thrombectomy. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e123-e124 Advertisement Copyright & Permissions© 2016MetricsAuthor Information E. Jason Abel More articles by this author Kamran Zargar More articles by this author Vitaly Margulis More articles by this author Michael A. Mann More articles by this author Philippe E. Spiess More articles by this author Kenan Ashouri More articles by this author Leonardo Borregales More articles by this author Ahmed Haddad More articles by this author Charles Rew More articles by this author Gong Chen More articles by this author Fangfang Shi More articles by this author Surena Matin More articles by this author Christopher G. Wood More articles by this author Jose A. Karam More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...