SIU 2017: Venous Tumor Thrombus in Patients with Renal Cell Carcinoma - Clinical and Oncological Outcome after Surgery

Lisbon, Portugal ( Renal cell carcinoma (RCC) is associated with intravascular tumor thrombus in 4%-10% of cases, of which nearly 1/3 of patients also have concurrent metastatic disease. The authors evaluated the clinical outcome and factors affecting survival in patients with RCC and venous tumor thrombus (VTT) in their center.

Between 2008-2016, 38 patients with VTT underwent radical nephrectomy and thrombectomy in a single institution. Patient data was reviewed retrospectively to evaluate the demographics, pathological features, clinical outcomes, and survival. Univariate analysis was used to determine the prognostic factors of overall survival (OS).

Thirty eight patients with a mean age of 63.2 years were analyzed. Thrombus level was in the renal vein in 14 patients (36.8%), at the entry of vena cava in 6 patients, infra-hepatic and supra-hepatic in 8 patients each, and intra-cardiac in 2 patients. The mean tumor size was 104.6 mm. Pathological examination revealed RCC of clear cell type in 34 patients, papillary in 2, chromophobe and collecting duct tumor in 1 patient each. Fourteen patients had distant metastases, and after a median follow up of 44.7 months, 21 patients died. 

Distant metastases (p=0.009), pathological T stage (p=0.003), surgical margins (p=0.026) and Fuhrman grade (p=0.004) were all found to significantly affect OS. However, the level of the tumor thrombus, lymph node involvement, thrombocytosis, hyperkalemia, and sarcomatoid component were not shown to affect OS.

The authors concluded that radical nephrectomy and thrombectomy is currently the most effective therapeutic option in patients with RCC and VTT. Despite the low number of patients treated in this study, the data are consistent with those reported in the literature with similar predictors of OS.

Presented by: Joana Alfarelos
Affiliation: Centro Hospitalar Lisboa Norte, Lisbon, Portugal

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal