Outcomes of cytoreductive nephrectomy with tumor thrombectomy are poorly characterized in the literature. The objective of this study was to report survival in patients with metastatic renal cell carcinoma with tumor thrombus who underwent cytoreductive nephrectomy with tumor thrombectomy.
This was a retrospective, multi-institutional study. To be included, patients required an imaging confirmed diagnosis of metastatic renal cell carcinoma with a tumor thrombus on either computerized tomography and/or magnetic resonance imaging and underwent cytoreductive nephrectomy with tumor thrombectomy. Tumor thrombus was graded using the Mayo Clinic classification system. Overall survival, cancer-specific survival, and progression-free survival were evaluated. Cox proportional hazards regression and competing risks regression was used to assess the significance of demographic variables, treatment characteristics, and location of metastases on survival time-to-event measures within five years of surgery.
Overall, 131 patients were included. Median number of metastatic sites at the time of cytoreductive nephrectomy was one. Fifty-six (44%) patients had a level I thrombus, 31 (24%) had a level II, 20 (16%) had a level III, and 20 (16%) had a level IV thrombus. Median overall survival was 1.7 years, cancer-specific survival was 2.2 years, and progression-free survival was 1.1 years. Systemic symptoms at diagnosis, larger preoperative tumor size, and adrenal metastases conferred a greater hazard of death (P<0.05). Brain metastasis conferred a greater hazard of cancer-specific death (P<0.05).
Identification of patients most likely to benefit from cytoreductive nephrectomy with tumor thrombectomy remains elusive. Multiple patient specific factors could aid in prediction of survival postoperatively.
Minerva urology and nephrology. 2026 May 20 [Epub ahead of print]
Maxwell Sandberg, Gregory Russell, Phillip Krol, Mitchell Hayes, Seok-Soon Byun, Oscar Rodriguez Faba, Patricio Garcia Marchinena, Alberto Jurado, Gaetano Ciancio, Charles C Peyton, Philippe E Spiess, Reza Mehrazin, Soroush Rais-Bahrami, Diego Abreu, Stenio DE Cassio Zequi, Alejandro R Rodriguez
Department of Urology, Wake Forest University School of Medicine, Winston Salem, NC, USA - ., Department of Biostatistics, Wake Forest University School of Medicine, Winston Salem, NC, USA., Department of Urology, Wake Forest University School of Medicine, Winston Salem, NC, USA., Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa Bay, FL, USA., Department of Urology, Seoul National University Bundang Medical Center, Seoul, South Korea., Department of Urology, Puigvert Foundation, Barcelona, Spain., Department of Urology, Hospital Italiano, Buenos Aires, Argentina., Department of Urology and Transplant Surgery, University of Miami Miller School of Medicine, Miami, FL, USA., Department of Urology, University of Alabama Birmingham Medical Center, Birmingham, AL, USA., Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Department of Urology, Hospital Pasteur, Montevideo, Uruguay., Department of Urology, AC Camargo Cancer Institute, Sao Paulo, Brazil.