Objective
To characterize the presence of bland (nontumor) thrombus in advanced renal cell carcinoma
and assess the impact of this finding on cancer-specific survival.
Methods
A multi-institutional database of patients treated with nephrectomy with caval thrombectomy
for locally-advanced renal tumors was assembled from 5 tertiary care medical centers.
Using clinicopathologic variables including patient age, body mass index, Eastern
Cooperative Oncology Group performance status, tumor stage, grade, nodal status and
histology, and nearest-neighbor and multiple-matching propensity score matched cohorts
of bland thrombus vs nonbland thrombus patients were assessed. Multivariable analysis
for predictors of cancer-specific survival was performed.
Results
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 < .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 vs 156.8 months, and 28.1 months vs 76.7 months,
P < .001 for both). The presence of bland thrombus remained independently associated
with an increased risk of cancer-specific mortality on multivariable analysis (hazard
ratio 4.33, 95% confidence interval 2.79-6.73, P < .001).
Conclusion
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.
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Article info
Publication history
Published online: February 27, 2018
Accepted:
February 14,
2018
Received:
December 18,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
