PURPOSE: Supra-hepatic IVC tumor thrombus in RCC has historically portended a poor prognosis.
With advances in perioperative management of patients with high level thrombi, contemporary outcomes are hypothesized to be improved. We evaluated long-term oncologic outcomes of contemporary surgical management of RCC patients with level III-IV IVC thrombi treated at high volume centers.
MATERIALS AND METHODS: Clinical and pathologic data of RCC patients with level III-IV thrombus who had surgery from January 2000-June 2013 at 4 tertiary referral centers was examined. Survival outcomes and associated prognostic variables were assessed with Kaplan-Meier and multivariable Cox-regression analyses.
RESULTS: 166 patients were identified (69 with level III, and 97 with level IV thrombus). Median post-operative follow-up was 27.8 months. Patients with no evidence of nodal or distant metastases (pN0/X,M0) had 5-yr CSS and OS of 49.0% and 42.2% respectively. There were no differences in survival based on the level of tumor thrombus or pathologic tumor stage. Variables associated with increased risk of death from kidney cancer on multivariable analysis were: regional nodal metastases (HR 3.94,p< 0.0001), systemic metastases (HR 2.39,p=0.01), tumor grade 4 (HR 2.25,p=0.02), histologic tissue necrosis (HR 3.11,p=0.004), and elevated pre-operative serum alkaline phosphatase level (HR 2.30, p=0.006).
CONCLUSIONS: Contemporary surgical management achieves nearly 50% 5-year survival in non-metastatic patients with RCC tumor thrombus above the hepatic veins. Factors associated with increased mortality included nodal/distant metastases, advanced grade, histologic necrosis and elevated pre-operative serum alkaline phosphatase. These findings support an aggressive surgical approach to the management of RCC patients with advanced tumor thrombi.
Written by:
Haddad AQ, Wood CG, Abel EJ, Krabbe LM, Darwish OM, Thompson RH, Heckman JE, Merril MM, Gayed BA, Sagalowsky AI, Boorjian SA, Margulis V, Leibovich BC. Are you the author?
Department of Urology, The University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI; University of Muenster Medical Center, Muenster, Germany; Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN.
Reference: J Urol. 2014 Apr 2. pii: S0022-5347(14)03310-2.
doi: 10.1016/j.juro.2014.03.111
PubMed Abstract
PMID: 24704115
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