Few studies of renal cell cancer with tumor thrombus have evaluated the risk of recurrence after attempted curative surgery. The objective of this study was to determine predictors of postsurgical recurrence for non-metastatic patients with RCC and venous thrombus.
Records from consecutive non-metastatic RCC patients with tumor thrombus treated surgically from 2000 to 2012 at three centers were reviewed. Univariable and multivariable analysis was used to evaluate the association of risk factors for post-surgical recurrence.
A total of 465 non-metastatic patients were identified including patients with thrombus present in: renal vein 257 (55.3%), infrahepatic IVC 144 (31.0%), and suprahepatic IVC 64 (13.8%). Median follow-up was 28.3 months (IQR 12.2-56.4) with metastatic RCC developing in 188 (40.5%) patients. Independent predictors of recurrence included: BMI ≤20 (HR 2.66; 95% CI 1.29-5.49), low pre-operative hemoglobin (HR 1.54; 95% CI 1.07-2.20), perinephric fat invasion (HR 1.51; 95% CI 1.09-2.10), IVC thrombus height (HR 2.64; 95% CI 1.47-4.74), tumor diameter (HR 1.04 95% CI 1.00-1.09), nuclear grade (HR 1.56 95% CI 1.12-2.15), and non-clear cell histology (2.13; 1.30-3.50). Independently predictive variables were used to create a recurrence model for 3 risk groups based on 0, 1-2, or >2 risk factors respectively. Five-year RFS was significantly different in favorable risk (79.1%) compared to intermediate risk (55.1%) or high risk (22.1%) patients, p<0.0001.
Seven risk factors for recurrence are identified for patients with non-metastatic RCC with thrombus, which can be used to select patients who may benefit from increased surveillance or adjuvant therapy clinical trials.
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BJU international 2015 Aug 25 [Epub ahead of print]
E Jason Abel, Vitaly Margulis, Tyler M Bauman, Jose A Karam, William P Christensen, Laura-Maria Krabbe, Ahmed Haddad, Vishnukamal Golla, Christopher G Wood
Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI , Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX , Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI , 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 , Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX , Department of Urology, 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, The University of Texas M D Anderson Cancer Center, Houston, Texas