AUA 2016: Identifying mRCC Patients with Venous Thrombus Who Are Likely to Benefit from Cytoreductive Surgery - Session Highlights

San Diego, CA USA ( In this session, Dr. Abel presented his work looking at the ability to predict poor overall survival in patients with metastatic renal cell carcinoma (mRCC) and tumor thrombus.  The objective of the study was to determine which patients would be least likely to benefit from cytoreductive nephrectomy (CN) due short post-operative survival.

This was a retrospective multi-institutional (4 centers) analysis of consecutive patients with mRCC and venous thrombus at presentation treated with upfront CN from 2000-2014. Prognostic systems from Memorial Sloan Kettering Cancer Center (MSKCC), international metastatic database consortium (IMDC), and MD Anderson Cancer Center (MDACC) were used to classify patients.  Kaplan Meier analysis was used to estimate overall survival (OS).  Univariate and multivariable Cox proportional hazard models were used to evaluate the association of individual variables with OS.

Overall survival for the entire cohort (n=293) was 17.2 (IQR 6.4-41) months.  Venous thrombus level as determined by the Neves system was 0, 1, 2, 3, and 4 for 77, 38, 104, 45, and 29 patients, respectively.  Median OS was worse for patients with IVC thrombus above the diaphragm compared to renal vein only thrombus or IVC thrombus below the diaphragm (6.8, IQR 2.2-19.1 months versus 18.8, IQR 8.1-37.8 months versus 18.9, IQR 6.7-44.5 months, respectively; p = 0.03).

Risk group 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 poor risk patients had median OS 12.5 (IQR 5-35) months, and MDACC unfavorable risk patients had median OS 6 (IQR 4-28.2) months.  Independent predictors of poor OS included tumor thrombus above the diaphragm (HR 5.2, 95%CI: 2.4-11.3), serum lactate dehydrogenase greater than upper limit of normal (HR 1.7, 95% CI: 1.1-2.6), and systemic symptoms (HR 2.2, 95% CI: 1.4-3.3).

Dr. Abel concluded that patients with mRCC and tumor thrombus classified as unfavorable risk using the MDACC criteria have poor OS and may not benefit from cytoreductive nephrectomy and thrombectomy.

Presented By: E. Jason Abel, MD

Reported By: Benjamin T. Ristau, MD, Fox Chase Cancer Center, Philadelphia, PA. at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California

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