Renal cell carcinoma with inferior vena cava thrombus: Survival and prognostic factors in surgically treated patients

• Published in: Urology annals Vol. 16; no. 4; pp. 277 - 283
• Main Authors: Miranda, Miguel, Polido, Joana, Fernandes, Miguel, Lopes, Filipe, Oliveira, Tiago, Lopes, Tomé, Costa, Luís, Nobre, Ângelo, Leitão, Tito Palmela, Pedro, Luís Mendes, Reis, José Palma dos
• Format: Journal Article
• Language: English
• Published: Mumbai Medknow Publications & Media Pvt. Ltd 01.10.2024; Wolters Kluwer Medknow Publications
• Subjects: Blood clots; inferior vena cava; Kidney cancer; Medical prognosis; prognostic factor; renal cell carcinoma; tumor thrombus
• ISSN: 0974-7796; 0974-7834
• DOI: 10.4103/ua.ua_113_23

Introduction: Renal cell carcinoma (RCC) often develops a tumor thrombus extending into the inferior vena cava (IVC). Radical nephrectomy with IVC thrombectomy is the standard treatment, although prognostic factors are yet to be properly established. Objectives: The objectives of this study were to review the clinicopathological features of surgically treated patients with RCC and IVC thrombus and to investigate potential prognostic factors. Materials and Methods: This retrospective analysis covered patients with RCC and IVC thrombus who underwent surgical treatment at a tertiary center over 12 years. Results: Of the 32 patients included, 56% and 41% had nodal (N1) and metastatic (M1) diseases, respectively. Thrombus level was 1 in 25% and 4 in 21.9% of cases, according to the Mayo classification. The median follow-up was 17.0 months. The median overall survival (OS) was 20.0 months, with a median OS of 36.0 months in M0 patients and 10.0 months in M1 patients (log-rank P = 0.029). Stage IV disease (T4 and/or M1 status) (hazard ratio [HR]: 2.85, P = 0.021), fat invasion (HR: 2.52, P = 0.044), positive margins (HR: 2.54, P = 0.037), American Society of Anesthesiologists score (HR: 2.59, P = 0.033), tumor size >100 mm (HR: 2.538, P = 0.033), and higher neutrophil-to-lymphocyte ratio ( r 2 = 0.304, P = 0.001) were significantly associated with worse OS in univariate analysis. Thrombus level did not impact prognosis. Conclusions: Certain clinicopathological factors, but not thrombus level, appear to influence prognosis. Prospective multicentric randomized studies are needed to better stratify patient risk, improve prognostic prediction, and evaluate systemic therapy responses.