Venous Tumor Thrombus Research Articles

Based on disulfidptosis, revealing the prognostic and immunological characteristics of renal cell carcinoma with tumor thrombus of vena cava and identifying potential therapeutic target AJAP1.

Patients with clear cell renal cell carcinoma (ccRCC) with venous tumor thrombus have a poor prognosis, high surgical risk, and lack of targeted therapeutic agents. Genes with consistent differential expression trends in tumor tissues and VTT groups were first screened, and then differential genes associated with disulfidptosis were found by correlation analysis. Subsequently, identifying ccRCC subtypes and constructing risk models to compare the differences in prognosis and the tumor microenvironment in different subgroups. Finally, constructing a nomogram to predict the prognosis of ccRCC and validate key gene expression levels in cells and tissues. We screened 35 differential genes related to disulfidptosis and identified 4 ccRCC subtypes. Risk models were constructed based on the 13 genes, and the high-risk group had a higher abundance of immune cell infiltration, tumor mutational load, and microsatellite instability scores, predicting high sensitivity to immunotherapy. The 1-year AUC = 0.869 for predicting OS by nomogram has a high application value. The expression level of the key gene AJAP1 was low in both tumor cell lines and cancer tissues. Our study not only constructed an accurate prognostic nomogram for ccRCC patients but also identified an AJAP1 biomarker as a potential biomarker for the disease.

Renal Cell Carcinoma with Venous Extension: Safety of Laparoscopic Surgery for Thrombus Levels I-IIIa.

Background: Novel studies are helping to consider minimally invasive surgery for treating patients with renal cell carcinoma and venous tumor thrombus. Evidence regarding its feasibility and safety is still sparse and does not include a subclassification for level III thrombi. We aim to compare the safety of laparoscopic vs open surgery in patients with levels I-IIIa thrombus. Materials and Methods: This is a cross-sectional comparative study using single-institutional data on adult patients treated surgically between June 2008 and June 2022. Participants were categorized into open and laparoscopic surgery groups. Primary outcome was difference in the incidence of 30-day major postoperative complications (Clavien-Dindo III-V) between groups. Secondary outcomes were differences in operative time, length of hospital stay, intraoperative blood transfusions, delta hemoglobin level, 30-day minor complications (Clavien-Dindo I-II), estimated overall survival, and progression-free survival between groups. A logistic regression model was performed including adjustment for confounding variables. Results: Overall, 15 patients in the laparoscopic group and 25 patients in the open group were included. Major complications occurred in 24.0% of patients within the open group and 6.7% of patients were treated laparoscopically (p = 0.120). Minor complications arose in 32.0% of patients treated with open surgery and in 13.3% of patients treated in the laparoscopic group (p = 0.162). Although not significant, there was a higher perioperative death rate within open surgery cases. The laparoscopic approach presented a crude odds ratio for major complications of 0.22 (95% confidence interval 0.02-2.1, p = 0.191) compared with open surgery. No differences were found between groups regarding oncologic outcomes. Conclusion: Laparoscopic approach for patients with venous thrombus levels I-IIIa seems to be as safe as open surgery.

Intravoxel Incoherent Motion Diffusion-Weighted MR Imaging and Venous Tumor Thrombus Consistency in Renal Cell Carcinoma.

Venous tumor thrombus (VTT) consistency of renal cell carcinoma (RCC) is an important consideration in nephrectomy plus thrombectomy. However, evaluation of VTT consistency through preoperative MR imaging is lacking. To evaluate VTT consistency of RCC through intravoxel incoherent motion-diffusion weighted imaging (IVIM-DWI) derived parameters (Dt , Dp , f, and ADC) and the apparent diffusion coefficient (ADC) value. Retrospective. One hundred and nineteen patients (aged 55.8 ± 11.5 years, 85 male) with histologically-proven RCC and VTT who underwent radical resection. 3.0-T; two-dimensional single-shot diffusion-weighted echo planar imaging sequence at 9 b-values (0-800 s/mm2 ). IVIM parameters and ADC values of the primary tumor and the VTT were calculated. The VTT consistency (friable vs. solid) was determined through intraoperative findings of two urologists. The accuracy of VTT consistency classification based on the individual IVIM parameters of primary tumors and of VTT, and based on models combining parameters, was assessed. Type of operation, intra-operative blood loss, and operation length were recorded. Shapiro-Wilk test; Mann-Whitney U test; Student's t-test; Chi-square test; Receiver operating characteristic (ROC) analysis. Statistical significance level was P < 0.05. Of the enrolled 119 patients, 33 patients (27.7%) had friable VTT. Patients with friable VTT were significantly more likely to experience open surgery, have significantly more intraoperative blood loss, and significantly longer operative duration. The area under the ROC curve (AUC) values of Dt of the primary tumor and VTT in classifying VTT consistency were 0.758 (95% CI 0.671-0.832) and 0.712 (95% CI 0.622-0.792), respectively. The AUC value of the model combining Dp and Dt of VTT was 0.800 (95% CI 0.717-0.868). Furthermore, the AUC of the model combining Dp and Dt of VTT and Dt of the primary tumor was 0.886 (95% CI 0.814-0.937). IVIM-derived parameters had the potential to predict VTT consistency of RCC. 3 Technical Efficacy: Stage 2.

L1CAM deployed perivascular tumor niche promotes vessel wall invasion of tumor thrombus and metastasis of renal cell carcinoma

The survival of tumor cells in the bloodstream, and vasculature adhesion at metastatic sites are crucial for tumor metastasis. Perivascular invasion aids tumor cell self-renewal, survival, and formation of metastases by facilitating readily available oxygen, nutrients, and endothelial-derived paracrine factors. Renal cell carcinoma (RCC) is among the most prevalent tumors of the urinary system, and the formation of venous tumor thrombus (VTT) is a characteristic feature of RCC. We observed high expression of L1CAM in the VTT with vessel wall invasion. L1CAM promotes the adhesion, migration, and invasion ability of RCC and enhances metastasis by interacting with ITGA5, which elicits activation of signaling downstream of integrin α5β1. L1CAM promotes ADAM17 transcription to facilitate transmembrane ectodomain cleavage and release of soluble L1CAM. In response to soluble L1CAM, vascular endothelial cells release several cytokines and chemokines. Endothelial-derived CXCL5 and its receptor CXCR2 promote the migration and intravasation of RCC toward endothelial cells suggesting that crosstalk between endothelial cells and tumor cells has a direct guiding role in driving the metastatic spread of RCC. LICAM plays a crucial role in the invasive ability of RCC, and regulation of L1CAM expression may contribute therapeutically to preventing RCC progression.

PD08-09 INTERIM ANALYSIS OF A NATIONAL RETROSPECTIVE STUDY OF cT3b+ RENAL CELL CARCINOMA PATIENTS’ PULMONARY EMBOLISM RISK AND THROMBOPROPHYLAXIS MANAGEMENT

You have accessJournal of UrologyCME1 Apr 2023PD08-09 INTERIM ANALYSIS OF A NATIONAL RETROSPECTIVE STUDY OF cT3b+ RENAL CELL CARCINOMA PATIENTS’ PULMONARY EMBOLISM RISK AND THROMBOPROPHYLAXIS MANAGEMENT Osman El-Koubani, James Blackmur, Flora Rodgers, Gianluca Maresca, Lucy Drummond, Caroline Bradley, Siobhan Duffy, Satchi Swami, Khalid Janjua, Steve Leung, Ross Clark, Gavin Lamb, Alex Chapman, James Donaldson, Grenville Oades, and Alexander Laird Osman El-KoubaniOsman El-Koubani More articles by this author , James BlackmurJames Blackmur More articles by this author , Flora RodgersFlora Rodgers More articles by this author , Gianluca MarescaGianluca Maresca More articles by this author , Lucy DrummondLucy Drummond More articles by this author , Caroline BradleyCaroline Bradley More articles by this author , Siobhan DuffySiobhan Duffy More articles by this author , Satchi SwamiSatchi Swami More articles by this author , Khalid JanjuaKhalid Janjua More articles by this author , Steve LeungSteve Leung More articles by this author , Ross ClarkRoss Clark More articles by this author , Gavin LambGavin Lamb More articles by this author , Alex ChapmanAlex Chapman More articles by this author , James DonaldsonJames Donaldson More articles by this author , Grenville OadesGrenville Oades More articles by this author , and Alexander LairdAlexander Laird More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003239.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Up to 10% of patients with renal cell carcinoma (RCC) have venous tumour thrombus at diagnosis. The incidence of PE in patients with RCC invading the venous system is unknown. The role of anticoagulation to prevent PE in such patients is also unknown and there is currently no guidance on whether patients should receive anticoagulation at diagnosis. We aimed to determine the incidence of PE is patients with RCC invading the inferior vena cava, understand the pattern of prophylactic anticoagulation prescribing in such patients and assess the effect of anticoagulation of PE risk. METHODS: We performed a retrospective review of records for all consecutive patients with cT3b, cT3c or cT4 with associated IVC thrombus (T3b+) RCC from 9 centres across a nation between Jan 2017 and Dec 2020. Patient demographics, comorbidities, anticoagulation prescription and outcomes were recorded. RESULTS: Data from 6 of 9 units was available for analysis, including 162 patients with RCC and IVC thrombus. 94(58%) patients were male and the median age was 68yrs (range: 31-93yrs). 112 (69.1%) patients died during follow-up.42(25.9%) patients developed a PE during the study period. PE was more common with larger venous tumour thrombus (10/64 patients [15.5%] level 1, 32/98 patients [32.7%] level 2+; p=0.17). 27(16.7%) patients had a PE at initial RCC diagnosis while 15 (11.1%) of the remaining 135 patients subsequently developed a PE during their management. Of the 135 patients, 11 (8.1%) patients, 27(20%) patients, and 97(71.9%) patients were commenced on prophylactic dose, treatment dose or no anticoagulation respectively. While not significant, there was a trend for higher rate of PE in the non-anticoagulated group, compared with those receiving prophylactic anticoagulation and treatment dose anticoagulation after diagnosis of T3b+ RCC (13[13.4%], 1[9.0%] and 1[3.7%] respectively, p=0.357). There was a higher rate of post-diagnosis haematuria in the anticoagulated group compared to the non-anticoagulated group (15.4% and 7.7%, p=0.122). CONCLUSIONS: In this interim analysis, we demonstrate a significant risk of concurrent or subsequent diagnosis of PE in those patients with cT3b+ RCC, which is related to venous tumour thrombus level. There is heterogeneity in the approach to prescribing anticoagulant prophylaxis in these patients. However, there is a trend for a reduction in the diagnosis of PE in those patients who receive anticoagulation following diagnosis of cT3b+ RCC, although this may result in higher rates of haematuria. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e236 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Osman El-Koubani More articles by this author James Blackmur More articles by this author Flora Rodgers More articles by this author Gianluca Maresca More articles by this author Lucy Drummond More articles by this author Caroline Bradley More articles by this author Siobhan Duffy More articles by this author Satchi Swami More articles by this author Khalid Janjua More articles by this author Steve Leung More articles by this author Ross Clark More articles by this author Gavin Lamb More articles by this author Alex Chapman More articles by this author James Donaldson More articles by this author Grenville Oades More articles by this author Alexander Laird More articles by this author Expand All Advertisement PDF downloadLoading ...

MP28-20 ROBOT-ASSISTED RADICAL NEPHRECTOMY AND INFERIOR VENA CAVA LEVEL I-III THROMBECTOMY: PERIOPERATIVE AND MID-TERM ONCOLOGIC OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP28-20 ROBOT-ASSISTED RADICAL NEPHRECTOMY AND INFERIOR VENA CAVA LEVEL I-III THROMBECTOMY: PERIOPERATIVE AND MID-TERM ONCOLOGIC OUTCOMES Umberto Anceschi, Aldo Brassetti, Alfredo Maria Bove, Gabriele Tuderti, Mariaconsiglia Ferriero, Leonardo Misuraca, Riccardo Mastroianni, Manuela Costantini, Salvatore Guaglianone, Giovanni Cacciamani, Mihir Desai, Monish Aron, Inderbir Singh Gill, and Giuseppe Simone Umberto AnceschiUmberto Anceschi More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Alfredo Maria BoveAlfredo Maria Bove More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Leonardo MisuracaLeonardo Misuraca More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Manuela CostantiniManuela Costantini More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , Mihir DesaiMihir Desai More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir Singh GillInderbir Singh Gill More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003256.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Few series of robot-assisted radical nephrectomy (RARN) with inferior vena cava tumor thrombectomy (IVCT) for renal cell carcinoma (RCC) with venous tumor thrombus (VTT) are available in literature, all with short-term oncologic outcomes. The aim of this study is to describe perioperative and long-term oncologic outcomes of RARN and IVCT performed at a single, high-volume centre. METHODS: Between January 2014 and October 2022, 37 consecutive patients underwent RARN-IVCT for RCC and VTT at a single tertiary-care center. Baseline, demographic and perioperative data were collected. A descriptive statistical analysis was performed. Frequencies and proportions were reported for categorical variables while medians and interquartile ranges (IQRs) were reported for continuously coded variables. Overall survival (OS), disease-free survival (DFS) and metastasis-free (MFS) were computed with the Kaplan-Meier method. RESULTS: Overall 37 consecutive patients were included in the analysis, 8 with VTT Mayo level I (21.6%), 11 with level II (29.7%), and 18 with level III (48.7%), respectively. All cases were successfully completed without conversion to open surgery. Median operative time was 360 minutes (IQR 232.5-382.5). Median estimated blood loss was 550 ml (IQR 275-1500). Median hospital stay was 7 days (IQR 4-12.2). Overall, 19 patients (51.3%) had perioperative complications, 15 Clavien grade 2 (40.5%, all blood transfusions) and 4 grade 3-5 (10.8%), respectively. At a median follow-up of 32 months (IQR 17.2-62.5), MFS, DFS and OS probabilities were 37.8%, 59.4%, and 59.4%, respectively. The small series, the high rate of adjuvant targeted therapies (32.4%) as the extreme surgical complexity may affect reproducibility of outcomes. CONCLUSIONS: RARN-IVCT represents a feasible and safe surgical option in tertiary referral centers; mid-term oncologic results seem to be comparable to those reported in open surgery literature. Our results support RARN-IVCT as a feasible and safe surgical option in tertiary referral centers even in the most advanced setting. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e379 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Umberto Anceschi More articles by this author Aldo Brassetti More articles by this author Alfredo Maria Bove More articles by this author Gabriele Tuderti More articles by this author Mariaconsiglia Ferriero More articles by this author Leonardo Misuraca More articles by this author Riccardo Mastroianni More articles by this author Manuela Costantini More articles by this author Salvatore Guaglianone More articles by this author Giovanni Cacciamani More articles by this author Mihir Desai More articles by this author Monish Aron More articles by this author Inderbir Singh Gill More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...

MP58-12 VENOUS TUMOUR THROMBUS IN RENAL CELL CARCINOMA: LOCALLY ADVANCED OR METASTATIC DISEASE?

MP58-12 VENOUS TUMOUR THROMBUS IN RENAL CELL CARCINOMA: LOCALLY ADVANCED OR METASTATIC DISEASE?

Integrative analysis of transcriptomic landscape and urinary signature reveals prognostic biomarkers for clear cell renal cell carcinoma.

Clear cell renal cell carcinoma (ccRCC) patients with venous tumor thrombus (VTT) have poor prognosis. We aimed to reveal features of ccRCC with VTT and develop a urine-based prognostic classifier to predict ccRCC prognosis through integrative analyses of transcriptomic landscape and urinary signature. RNA sequencing was performed in five patients with ccRCC thrombus-tumor-normal tissue triples, while mass spectrometry was performed for urine samples from 12 ccRCC and 11 healthy controls. A urine-based classifier consisting of three proteins was developed to predict patients' survival and validated in an independent cohort. Transcriptomic analysis identified 856 invasion-associated differentially expressed genes (DEGs). Furthermore, proteomic analysis showed 133 differentially expressed proteins (DEPs). Integration of transcriptomic landscape and urinary signature reveals 6 urinary detectable proteins (VSIG4, C3, GAL3ST1, TGFBI, AKR1C3, P4HB) displaying abundance changes consistent with corresponding genes in transcriptomic profiling. According to TCGA database, VSIG4, TGFBI, and P4HB were significantly overexpressed in patients with shorter survival and might be independent prognostic factors for ccRCC (all p<0.05). A prognostic classifier consisting of the three DEPs highly associated with survival performed satisfactorily in predicting overall survival (HR=2.0, p<0.01) and disease-free survival (HR=1.6, p<0.001) of ccRCC patients. The ELISA analysis of urine samples from an independent cohort confirmed the satisfied predictive power of the classifier for pathological grade (AUC=0.795, p<0.001) and stage (AUC=0.894, p<0.001). Based on integrative analyses of transcriptomic landscape and urinary signature, the urine-based prognostic classifier consisting of VSIG4, TGFBI, and P4HB has satisfied predictive power of ccRCC prognosis and may facilitate ccRCC molecular subtyping and treatment.

The surgical evolution of radical nephrectomy and tumor thrombectomy: a narrative review.

Renal cell carcinoma (RCC) accounts for 2-3% of all malignant disease in adults. RCC propagates into the renal vein and inferior vena cava (IVC) in up to 25% of patients with RCC. Despite advances in medical management such as immunotherapy, surgical resection remains the gold standard treatment of RCC with venous tumor thrombus (TT) extension. Surgical innovation has revolutionized the management of RCC with TT, reducing morbidity and mortality through advanced surgical techniques and minimally invasive approaches. The aim of this review is to summarize the evolving developments in the surgical treatment of RCC with venous TT. We performed an advanced search on PubMed between the inception of the database and April 2022 to summarize the evolution of the surgical management of RCC with venous TT, focusing on the reports of key historical, current, and recent studies. Implementation of entirely intraabdominal liver transplant-based approaches have allowed for successful surgical excision of higher-level tumor thrombi, obviating the need for sternotomy or cardiopulmonary bypass (CPB). Recent advances in robotic surgery provide a promising approach for minimally invasive management of RCC with venous TT extension. Surgical innovation has revolutionized the management of RCC with TT, reducing morbidity and mortality through minimally invasive techniques with preserved oncologic effectiveness.

Hepatoid adenocarcinoma of the stomach: CT findings.

To analyze the CT findings of hepatoid adenocarcinoma of the stomach (HAS) and improve the diagnosis accuracy of this condition. The CT images of 22 pathologically confirmed HAS patients were analyzed retrospectively. We investigated the location of lesions, morphology, enhancement features, area of invasion into surrounding organs, lymph node metastasis, and venous tumor thrombus. Among the 22 patients (17 men and 5 women, the mean age was 61.41 ± 9.83 years ranging from 36 to 80 years) with HAS; the morphology of tumors included mass (n = 5), focal ulcer (n = 7), and infiltrating ulcer (n = 10). Extraserous fat was invaded in 12 cases. Enhancement scans showed continuous enhancement in all cases. The CT values of unenhanced scan, the arterial phase, and the portal venous phase are 30.36 ± 6.46, 60.91 ± 17.80, and 75.64 ± 22.09 (HounsfieldUnit, HU), respectively. In six cases, the tumor infiltrated the surrounding organs: liver (n = 1), pancreas (n = 2), and both liver and pancreas (n = 3). In 16 out of 22 patients (72.3%), suspicious lymph node metastasis at CT imaging has then been confirmed by pathological specimens. Intrahepatic metastasis was found in 14 cases. Seven patients had venous tumor thrombus: three patients developed tumor thrombus in the main trunk and intrahepatic branches of the portal vein and two patients in the portal vein, splenic vein, and superior mesenteric vein simultaneously. The CT scans of HAS often show a thickened gastric wall and infiltrating ulceration. Infiltration into extraserosal fat is often seen. Enhancement scans show a continuous and progressive enhancement of lesions. Lymph node metastasis, intrahepatic metastasis, and portal vein tumor thrombus are common in HAS patients.

Prognostic Factors of Adrenocortical Carcinoma: Experience from a Regional Medical Center in Eastern China.

This study aimed to summarize and analyze the clinical and pathological features and prognostic risk factors of adrenocortical carcinoma (ACC). We retrospectively analyzed clinical and pathological data and the prognoses of 39 adult ACC patients confirmed by pathologic diagnosis at the Affiliated Hospital of Qingdao University between August 2009 and October 2021. Kaplan-Meier curves and univariate and multivariate Cox regression models were used to analyze correlations between clinical and pathological parameters and prognosis. A nomogram prediction model was constructed for overall survival (OS) based on the independent prognostic factors and externally validated it with The Cancer Genome Atlas (TCGA) dataset. The mean age of the patient cohort was 53.87 ± 11.1 years (range: 29-80 years), which included 17 men and 22 women. The 1-, 2-, and 5-year OS rates were 83.7%, 64.4%, and 59.8%, respectively; the recurrence-free survival (RFS) rates at the same time points were 76.1%, 45.8%, and 23.5%, respectively. Kaplan-Meier curves showed that patients with poor OS were associated with M1 stage (P = 0.008), late ENSAT stage (P = 0.017), presence of venous tumor thrombus (P = 0.015), Ki67 >20% (P = 0.006), R1/R2 status (P = 0.018), and poorly differentiated tumors (P = 0.047). Patients with late ENSAT stage (P = 0.017), combined with venous tumor thrombus (P = 0.008), Ki67 >20% (P = 0.022) were more likely to have tumor recurrence. However, age, gender, BMI, tumor diameter, clinical symptoms and postoperative treatment were not correlated with OS or RFS (P > 0.05). Univariate and multivariate COX analyses showed that Ki67 >20% (P = 0.013) and R1/2 status (P = 0.040) were independent risk factors for OS, while only Ki67 >20% (P = 0.032) was an independent risk factor for RFS. A nomogram for predicting OS was constructed based on the above factors, and the area under the receiver characteristic curve (ROC)-1, 3, and 5-year survival were 0.8, 0.825 and 0.902, respectively. The C-index of the predicted nomogram was 0.813 and a high C-index value of 0.846 could still be achieved in the external validation of TCGA. ACC is a rare and deadly endocrine malignancy with a high rate of recurrence. High Ki67 index (>20%) and R1/R2 resection status were independent risk factors for poor prognosis in ACC patients. A novel nomogram with a relatively good accuracy was established to assist clinicians in assessing the risk of OS in patients with ACC.

Venous tumour thrombus in renal cell carcinoma: Locally advanced or metastatic disease?

Venous tumour thrombus in renal cell carcinoma: Locally advanced or metastatic disease?

Prognostic value of systemic immune-inflammation index in non-metastatic clear cell renal cell carcinoma with tumor thrombus.

This study aims to determine the prognostic value of SII for non-metastatic clear cell renal cell carcinoma (ccRCC) patients with venous tumor thrombus (VTT). We retrospectively collected and analyzed 328 non-metastatic ccRCC patients with VTT who underwent radical nephrectomy and thrombectomy from 3 tertiary centers in China between 2011 to 2021. Kaplan-Meier analyses and Cox proportional hazard analyses were used to determine its prognostic value for overall survival (OS) and disease free survival (DFS). The Harrell concordance index (C-index), receiver operating characteristic curve (ROC) analysis, and decision curve analysis (DCA) were used to evaluate its role in the improvement of prognostic accuracy of the existing models. Nomogram models containing the SII were then developed and evaluated by R. Patients were divided into low-SII and high-SII groups based on the SII optimal cut-off value 912 calculated by the Youden index in all patients. Higher SII was correlated with more symptoms, longer surgical time, higher WHO/ISUP grade, and longer tumor diameter. Kaplan-Meier analyses revealed significant differences in OS and DFS between two groups. Multivariate analyses revealed that SII was an independent prognostic factor for OS (HR:2.220, p=0.002) and DFS (HR:1.846, p=0.002). Compared with other indicators, SII had a superior accuracy (c-index=0.630 for OS and 0.595 for DFS). It also improved the performance of models for predicting OS and DFS (all p <0.01). Based on the results of LASSO Cox regression analysis, we constructed a nomogram to predict OS and it performed well on both the training cohort (AUC=0.805) and the validation cohort (AUC=0.795). Risk stratification based on nomogram can distinguish patients with different risks (all p <0.001). Preoperative SII is an independent predictive factor for OS and DFS of non-metastatic ccRCC patients with VTT. It can be used to improve the performance of current risk models.

68Ga]Ga-PSMA-11 and [18F]FDG uptake of venous tumor thrombus in inferior vena cava and left common iliac vein from prostate cancer on positron emission tomography.

68Ga]Ga-PSMA-11 and [18F]FDG uptake of venous tumor thrombus in inferior vena cava and left common iliac vein from prostate cancer on positron emission tomography.

Хирургия опухолевых тромбов нижней полой вены.

Introduction. Venous invasion and tumor thrombus formation are rare, but life-threatening complications of renal cell carcinoma (RCC), especially in combination with metastases, are considered significant adverse prognostic factors. Aim. To systematize the existing knowledge and summarize the clinical experience of surgical treatment (open and robot-assisted surgery) of RCC with inferior vena cava (IVC) tumor thrombus. Materials and methods. A literature search in the period 2000-2022 was performed in core databases MEDLINE, Scopus, Clinicaltrials.gov, Google Scholar and Web of Science. The PICO framework (Population-Intervention-Comparison-Outcome) was used to develop a literature search strategy. The following keywords were used to search databases: «renal cell carcinoma», «venous invasion», «inferior vena cava tumor thrombus», «surgical treatment», «robot-assisted», «clinical outcomes». Results. A total of 65 publications were identified. Various classifications of tumor thrombus level are considered, their inferiority and superiority in terms of selecting optimal surgical treatment, both open or robot-assisted surgeries, are discussed. Independent predictors of severe perioperative complications are determined. Optimal surgical treatment of RCC with tumor thrombus is highlighted. Functional and oncological outcomes of patients with RCC with IVC tumor thrombus, who underwent open surgical intervention and robot-assisted ones, are presented. Conclusion. Open surgery in patients with RCC and IVC tumor thrombus above the hepatic veins is associated with prolonged surgery duration, higher intraoperative blood loss, and prolonged in-hospital stay. Prolonged in-hospital stay, the need for blood transfusion, metastasis, sarcomatoid differentiation, and Clavien-Dindo grade 3-5 postoperative complications are predictors of poor outcomes.

Diagnostic performance and prognostic value of preoperative 18F-FDG PET/CT in renal cell carcinoma patients with venous tumor thrombus

BackgroundTo observe the diagnostic efficacy of preoperative fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) upon venous tumor thrombus (VTT) in patients with renal cell carcinoma (RCC), and investigate the prognostic value of imaging parameters integrated with clinicopathological characteristics in patients with VTT after nephrectomy with tumor thrombectomy.MethodsPatients with newly diagnosed RCC who underwent 18F-FDG PET/CT were reviewed retrospectively. The diagnostic efficacy of 18F-FDG PET/CT in VTT was analyzed. Logistic regression analysis was carried out to identify the clinical variables and PET/CT variables (including maximum standardized uptake value (SUVmax) of primary tumor, VTT SUVmax and primary tumor size) for differentiating early VTT (Mayo 0-II) from advanced VTT (Mayo III-IV). Cox proportional hazard analyses were used to evaluate clinicopathological factors and PET/CT factors (including distant metastasis, primary tumor SUVmax, VTT SUVmax and primary tumor size) for disease-free survival (DFS) in patients with VTT after operation.ResultsA total of 174 eligible patients were included in this study, including 114 men (65.5%) and 60 women (34.5%), with a median age of 58 years (range, 16–81 years). The distribution of pathological tumor stage (T stage) was 56 (T1), 17 (T2), 95 (T3), and 6 cases (T4), respectively. According to WHO/ISUP grade, except for 4 cases of chromophobe cell RCC, there were 14 patients (8.0%) of grade 1, 59 patients (33.9%) of grade 2, 74 patients (42.5%) of grade 3 and 23 patients (13.2%) of grade 4. The median maximum diameter of the primary tumor on PET/CT was 7.3 cm (5.0–9.5 cm). The distal metastasis was observed in 46 patients (26.4%). Sixty-one cases (35.1%) were confirmed with VTT by pathology. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 18F-FDG PET/CT imaging were 96.7, 99.1, 98.3, 98.3, and 98.2%, in detecting VTT, respectively, and 70.0, 100.0, 94.9, 100.0, and 94.2%, in evaluating the level of VTT, respectively. Elevated VTT SUVmax (≥5.20) could significantly distinguish the early VTT group and advanced VTT group (P = 0.010). In the prognosis analysis, elevated VTT SUVmax (≥4.30) (P = 0.018, HR 3.123, 95% CI 1.212–8.044) and distant metastasis (P = 0.013, HR 3.344, 95% CI 1.293–8.649) were significantly independent predictors for DFS.ConclusionPreoperative 18F-FDG PET/CT has a high diagnostic efficacy in detecting VTT and evaluating its level in RCC patients. Those patients with elevated VTT SUVmax should be carefully monitored to detect the possibility of disease progression after operation.

Management of Locally Advanced Renal Cell Carcinoma

Renal cell carcinoma (RCC) has a natural tendency to invade the venous system with formation of a venous tumor thrombus in the renal vein, which can extend proximally into the inferior vena cava (IVC) and in some cases into the right atrium. The presence of venous involvement significantly worsens prognosis. Despite recent advances in systemic therapies, surgery remains the most effective method of treatment and in the case of complete removal of all tumor, it provides satisfactory long-term survival and must be attempted whenever possible. Several surgical techniques have been proposed, but all are associated with a high rate of perioperative complications and mortality. Minimally invasive approaches are mainly applicable for less extended IVC thrombi, while open surgery remains the gold standard for this category of patients. Most IVC thrombi can be managed without use of circulatory support by using different methods of IVC control depending on the thrombus level. However, use of cardiac bypass with or without deep hypothermic cardiac arrest is indicated in some patients with bulky intraatrial tumor thombi. In select patients presenting with IVC tumor thrombus and synchronous distant metastases, cytoreductive nephrectomy with IVC tumor thrombectomy may be considered with or without neoadjuvant systemic therapy. Surgery for RCC with venous thrombus is complex and requires experienced multidisciplinary surgical, anesthesia, and critical care teams at high-volume centers to achieve the best outcomes.

What's New in Musculoskeletal Tumor Surgery.

What's New in Musculoskeletal Tumor Surgery.

Prevalence, Treatment, and Prognosis of Tumor Thrombi in Renal Cell Carcinoma

BackgroundRenal cell carcinoma (RCC) can be complicated by a venous tumor thrombus (TT), of which the optimal management is unknown. ObjectivesThis study sought to assess the prevalence of TT in RCC, its current management, and its association with venous thromboembolism (VTE), arterial thromboembolism (ATE), major bleeding (MB), and mortality. MethodsPatients diagnosed with RCC between 2010 and 2019 in our hospital were included and followed from RCC diagnosis until 2 years after, or until an outcome of interest (VTE, ATE, and MB) or death occurred, depending on the analysis. Cumulative incidences were estimated with death as a competing risk. Cause-specific hazard models were used to identify predictors and the prognostic impact. ResultsOf the 647 patients, 86 had a TT (prevalence 13.3%) at RCC diagnosis, of which 34 were limited to the renal vein, 37 were limited to the inferior vena cava below the diaphragm, and 15 extended above the diaphragm; 20 patients started therapeutic anticoagulation and 45 underwent thrombectomy with/without anticoagulation. During follow-up (median 24.0 [IQR: 7.0-24.0] months), 17 TT patients developed a VTE, 0 developed an ATE, and 11 developed MB. TT patients were more often diagnosed with VTE (adjusted HR: 6.61; 95% CI: 3.18-13.73) than non-TT patients, with increasing VTE risks in more proximal TT levels. TT patients receiving anticoagulation still developed VTE (HR: 0.56; 95% CI: 0.13-2.48), at the cost of more MB events (HR: 3.44; 95% CI: 0.95-12.42) compared with those without anticoagulation. ConclusionsPatients with RCC-associated TT were at high risk of developing VTE. Future studies should establish which of these patients benefit from anticoagulation therapy.

Analysis of surgical outcomes in 102 patients with renal cell carcinoma with venous tumor thrombus: A retrospective observational single-center study.

The aim of the study was to assess short- and long-term results following radical nephrectomy with renal vein and inferior vena cava thrombectomy in patients with renal cell cancer with venous thrombus and to investigate impact of various demographical, clinical and histological factors on overall survival (OS). The medical records of 102 adult patients with renal cell cancer with venous thrombus admitted for surgery in Department of General, Vascular and Transplant Surgery from 2012 to 2019 were retrospectively analyzed. The tumor was more frequently located on the right side compared to the left one (55 vs. 47). According to Neves Zincke classification, the levels of venous thrombus were as follows: 1 to 48 (47%), 2 to 47 (46%), 3 to 6 (6%), and 4 to 1 (1%). Postoperative complications were noted in 16 (15.7%) patients. One (3%) patient (Neves Zincke 2) died of intraoperative pulmonary embolism during hospitalization. Clear cell carcinoma was the most common pathological type reported in 92 (90.2%) patients. Thirty nine (38.2%) patients were alive at the time of last follow-up. The median OS was 21.50 (0–101.17) months. The 1-year OS was 75.5%. Significantly better OS (median 38.03 months) was noted in patients with RCC Neves Zincke 1 compared to OS (median 14.79 months) in patients with Neves Zincke 2-4 VT (P = .008). Higher tumor staging (T3 vs. T4) (P = .038), nodal staging (N0 vs. N1) (P = .0008), Fuhrman histological grading (G1-2 vs. G3-4) (P = .033) were associated with a shorter OS. Patients with renal cell cancer with venous thrombus, with an acceptable perioperative risk, should be treated surgically, because radical nephrectomy with thrombectomy performed in a high volume surgical center is a safe procedure. Neves Zincke 2-4 venous thrombus, higher tumor and nodal staging, as well higher Fuhrman histological grading are associated with a shorter OS.