The Adverse Survival Implications of Bland Thrombus in Renal Cell Carcinoma with Venous Tumor Thrombus

To characterize the presence of bland (non-tumor) thrombus in advanced renal cell carcinoma and assess the impact of this finding on cancer-specific survival.

A multi-institutional database of patients treated with nephrectomy with caval thrombectomy for locally-advanced renal tumors was assembled from five tertiary care medical centers. Using clinicopathologic variables including patient age, BMI, ECOG status, tumor stage, grade, nodal status and histology, nearest-neighbor and multiple propensity score matched cohorts of bland thrombus versus non-bland thrombus patients were assessed. Multivariable analysis for predictors of cancer-specific survival was performed.

From an initial cohort of 579 patients, 446 met inclusion criteria (174 with bland thrombus, 272 without). At baseline, patients with bland thrombus had significantly worse performance status, higher tumor stage, higher prevalence of regional nodal metastases and higher nuclear grade (p < 0.01 for all). In both nearest-neighbor and multiple-matching propensity score matched cohorts, the presence of bland thrombus presence was associated with inferior median cancer-specific survival (28.1 months versus 156.8 months, and 28.1 months versus 76.7 months, P < 0.001 for both). The presence of bland thrombus remained independently associated with an increased risk of cancer-specific mortality on multivariable analysis (HR 4.33, 95% CI 2.79-6.73, p <0.001).

Presence of bland thrombus is associated with adverse survival outcomes in patients treated surgically for renal tumors with venous tumor thrombus. These findings may have important implications in patient counseling, selection for surgery and inclusion in clinical trials.

Urology. 2018 Feb 27 [Epub ahead of print]

Ryan Hutchinson, Charles Rew, Gong Chen, Solomon Woldu, Laura-Maria Krabbe, Matthew Meissner, Kunj Sheth, Nirmish Singla, Nabeel Shakir, Viraj A Master, Jose A Karam, Surena F Matin, Leonardo D Borregales, Christopher Wood, Timothy Masterson, R Houston Thompson, Stephen A Boorjian, Bradley C Leibovich, E Jason Abel, Aditya Bagrodia, Vitaly Margulis

Department of Urology, The University of Texas Southwestern Medical Center., Department of Urology, The University of Texas MD Anderson Cancer Center., Department of Urology, Emory University., Department of Urology, Indiana University., Department of Urology, Mayo Clinic., Department of Urology, The University of Wisconsin., Department of Urology, The University of Texas Southwestern Medical Center. Electronic address: .