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

Published:February 27, 2018DOI:https://doi.org/10.1016/j.urology.2018.02.019

      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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      References

        • Psutka S.P.
        • Leibovich B.C.
        Management of inferior vena cava tumor thrombus in locally advanced renal cell carcinoma.
        Ther Adv Urol. 2015; 7: 216-229
        • Skinner D.G.
        • Pritchett T.R.
        • Lieskovsky G.
        • Boyd S.D.
        • Stiles Q.R.
        Vena caval involvement by renal cell carcinoma. Surgical resection provides meaningful long-term survival.
        Ann Surg. 1989; 210 (discussion 392-384): 387-392
        • Smith S.A.
        • Travers R.J.
        • Morrissey J.H.
        How it all starts: initiation of the clotting cascade.
        Crit Rev Biochem Mol Biol. 2015; 50: 326-336
        • Blute M.L.
        • Boorjian S.A.
        • Leibovich B.C.
        • Lohse C.M.
        • Frank I.
        • Karnes R.J.
        Results of inferior vena caval interruption by greenfield filter, ligation or resection during radical nephrectomy and tumor thrombectomy.
        J Urol. 2007; 178 (discussion 444): 440-445
        • Shirodkar S.P.
        • Ciancio G.
        • Soloway M.S.
        Vascular stapling of the inferior vena cava: further refinement of techniques for the excision of extensive renal cell carcinoma with unresectable vena-caval involvement.
        Urology. 2009; 74: 846-850
        • Hu K.
        • Lou L.
        • Ye J.
        • Zhang S.
        Prognostic role of the neutrophil-lymphocyte ratio in renal cell carcinoma: a meta-analysis.
        BMJ Open. 2015; 5: e006404
        • Hu Q.
        • Gou Y.
        • Sun C.
        • et al.
        The prognostic value of C-reactive protein in renal cell carcinoma: a systematic review and meta-analysis.
        Urol Oncol. 2014; 32 (e51-58): 50
        • Motzer R.J.
        • Hutson T.E.
        • Tomczak P.
        • et al.
        Sunitinib versus interferon alfa in metastatic renal-cell carcinoma.
        N Engl J Med. 2007; 356: 115-124
        • Motzer R.J.
        • Escudier B.
        • McDermott D.F.
        • et al.
        Nivolumab versus everolimus in advanced renal-cell carcinoma.
        N Engl J Med. 2015; 373: 1803-1813
        • Chen G.
        • Hutchinson R.
        • Houston Thompson R.
        • et al.
        Presence of Bland Thrombus is a Negative Indicator for Cancer Specific Survival in Patients Undergoing Nephrectomy for Kidney Tumors with Venous Tumor Thombus.
        University of Texas Southwestern Medical Center, 2016 (AUA Annual Meeting 2016)
        • Ayyathurai R.
        • Garcia-Roig M.
        • Gorin M.A.
        • et al.
        Bland thrombus association with tumour thrombus in renal cell carcinoma: analysis of surgical significance and role of inferior vena caval interruption.
        BJU Int. 2012; 110: E449-E455
        • Martinez-Salamanca J.I.
        • Huang W.C.
        • Millan I.
        • et al.
        Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension.
        Eur Urol. 2011; 59: 120-127
        • Wagner B.
        • Patard J.J.
        • Mejean A.
        • et al.
        Prognostic value of renal vein and inferior vena cava involvement in renal cell carcinoma.
        Eur Urol. 2009; 55: 452-459
        • Zargar-Shoshtari K.
        • Sharma P.
        • Espiritu P.
        • et al.
        Caval tumor thrombus volume influences outcomes in renal cell carcinoma with venous extension.
        Urol Oncol. 2015; 33 (e123-119): 112
        • Weiss V.L.
        • Braun M.
        • Perner S.
        • et al.
        Prognostic significance of venous tumour thrombus consistency in patients with renal cell carcinoma (RCC).
        BJU Int. 2014; 113: 209-217
        • Haddad A.Q.
        • Leibovich B.C.
        • Abel E.J.
        • et al.
        Preoperative multivariable prognostic models for prediction of survival and major complications following surgical resection of renal cell carcinoma with suprahepatic caval tumor thrombus.
        Urol Oncol. 2015; 33 (e381-389): 388
        • Lawindy S.M.
        • Kurian T.
        • Kim T.
        • et al.
        Important surgical considerations in the management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumour thrombus.
        BJU Int. 2012; 110: 926-939
        • Sonavane S.N.
        • Malhotra G.
        • Asopa R.
        • Upadhye T.
        Role of fluorine-18 fluorodeoxyglucose positron emission tomography in a case of renal cell carcinoma to differentiate tumor thrombus from bland thrombus.
        Indian J Nucl Med. 2015; 30: 355-357
        • Hu S.
        • Zhang J.
        • Cheng C.
        • Liu Q.
        • Sun G.
        • Zuo C.
        The role of 18F-FDG PET/CT in differentiating malignant from benign portal vein thrombosis.
        Abdom Imaging. 2014; 39: 1221-1227
        • Hallscheidt P.J.
        • Fink C.
        • Haferkamp A.
        • et al.
        Preoperative staging of renal cell carcinoma with inferior vena cava thrombus using multidetector CT and MRI: prospective study with histopathological correlation.
        J Comput Assist Tomogr. 2005; 29: 64-68
        • Psutka S.P.
        • Boorjian S.A.
        • Thompson R.H.
        • et al.
        Clinical and radiographic predictors of the need for inferior vena cava resection during nephrectomy for patients with renal cell carcinoma and caval tumour thrombus.
        BJU Int. 2015; 116: 388-396
        • Neves R.J.
        • Zincke H.
        Surgical treatment of renal cancer with vena cava extension.
        Br J Urol. 1987; 59: 390-395