Pre-operative risk factors predicting missed diagnosis of renal vein tumor thrombus in renal cell carcinoma: a retrospective cohort study

Weixing Jiang,Chuanzhen Cao,Hongzhe Shi,Jianzhong Shou,Dong Wang,Li Wen,Changling Li,Jianhui Ma

doi:10.1080/21681805.2020.1727007

Abstract

Purpose: Previous reports showed that some patients with renal cell carcinoma (RCC) and renal vein tumor thrombus (RVTT) were misdiagnosed pre-operatively. To improve the accuracy of this diagnosis, the clinical characteristics of RCC with missed RVTT diagnosis were analyzed.Methods: We retrospectively reviewed RCC patients with RVTT between January 2000 and December 2015. The survival analysis was estimated using the Kaplan–Meier method. The Cox proportional hazard models were applied to identify risk factors.Results: The missed diagnosis rate of RVTT in RCC was 30.5%. In multivariate analysis, maximal tumor diameter, tumor located in the middle part, renal vein contrast agents filling insufficiently and tumor with collateral vessels (odds ratio = 1.22, 1.35, 1.25, 1.22; and p = .034, .003, .015 and .037, respectively) were independent predictors of missed RVTT diagnosis. A missed-diagnosis score was presented as area under curve of 0.852 (p < .001). Moreover, the missed diagnosis group had favorable prognosis, and tumor with collateral vessels was an independent prognostic indicator of poor overall survival time (hazard ratio = 1.15, p = .025).Conclusions: This was the first study exploring clinical features as predictors of missed RVTT diagnosis. The possibility of complicating tumor thrombus should be considered when there is pre-operative presence of tumor with large diameter, renal tumor in the middle part, renal tumor with collateral vessels and renal vein contrast agents filling insufficiently. Patients with three points in missed-diagnosis scoring suggested a high possibility of missed RVTT diagnosis, and tumor with collateral vessels indicated poor prognosis.

Highlights

Renal cell carcinoma (RCC) accounts for approximately 2–3% of all malignant diseases in adults and has an increasing trend in china [1,2]
It should be alert to the possibility of complicating tumor thrombus at once with preoperative presence of renal tumor located in the middle part, renal tumor with collateral vessels, renal vein contrast agents filling not well
39 patients (30.5%) with renal vein tumor thrombus (RVTT) misdiagnosed preoperatively by imaging were assigned to missed diagnosis group. 89 patients (69.5%) diagnosed as RVTT through preoperative imaging and confirmed by postoperative pathology were assigned to diagnosis group. 39 patients followed 1:1 statistical matching with missed diagnosis group were assigned to no tumor thrombus group

Summary

Introduction

Renal cell carcinoma (RCC) accounts for approximately 2–3% of all malignant diseases in adults and has an increasing trend in china [1,2]. RCC has the tendency of invading blood vessels and the incidence to form venous tumor thrombus (VTT) is about 10% [3]. With the development of imaging in recent decades, there has been an increase in the detection of RCC involving VTT. Radical nephrectomy combining thrombectomy is the only curable method [4]. Different from the localized RCC, the long-term survival for patients with RCC involving tumor thrombus is relatively poor [5]. Once the VTT falls off, it will cause life-threatening pulmonary embolism. It is important to diagnose VTT in clinical practice

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Discussion

Conclusion