Cytoreductive nephrectomy in patients with metastatic renal cell carcinoma and venous thrombus-Trends and effect on overall survival.

Journal Article (Journal Article)

PURPOSE:Patients with metastatic renal cell carcinoma (mRCC) commonly present with tumor thrombi in the renal vein and inferior vena cava (IVC). The benefit of cytoreductive nephrectomy (CN) in this population is unclear and the effect on overall survival (OS) has been incompletely evaluated. MATERIALS AND METHODS:We queried the National Cancer Database from 2010 to 2013 for patients diagnosed with mRCC and tumor thrombi, which was defined as renal vein, infradiaphragmatic IVC, or supradiaphragmatic IVC. Descriptive statistics were performed and associations between clinicopathologic variables and utilization of CN were analyzed. Patients were matched on the receipt of CN and Kaplan-Meier analyses and multivariable Cox proportional hazards models were used to estimate survival. RESULTS:In total, 8,629 patients were found to have mRCC during the study period. Approximately 27% (n = 2,376) had tumor thrombus. Tumor thrombus was associated with increased rates of CN utilization, however rates decreased as thrombus level increased. In a matched Kaplan-Meier analysis, CN was associated with improved OS in patients without thrombus, and with renal vein or infradiaphragmatic thrombus (all P < 0.01). Patients with supradiaphragmatic thrombus did not benefit from CN (P = 0.46). This effect was confirmed in a Cox proportional hazards model. CONCLUSIONS:Tumor thrombus is common in patients with mRCC. OS is poor, and patient and tumor specific factors influence the use of CN. Despite discrepancies in utilization, CN is associated with improved OS, although this effect appears to be limited to those with mRCC and tumor thrombus limited to the renal vein and infradiaphragmatic IVC.

Full Text

Duke Authors

Cited Authors

  • Lenis, AT; Burton, CS; Golla, V; Pooli, A; Faiena, I; Johnson, DC; Salmasi, A; Drakaki, A; Gollapudi, K; Blumberg, J; Pantuck, AJ; Chamie, K

Published Date

  • September 2019

Published In

Volume / Issue

  • 37 / 9

Start / End Page

  • 577.e9 - 577.e16

PubMed ID

  • 30930099

Pubmed Central ID

  • PMC6698401

Electronic International Standard Serial Number (EISSN)

  • 1873-2496

International Standard Serial Number (ISSN)

  • 1078-1439

Digital Object Identifier (DOI)

  • 10.1016/j.urolonc.2019.03.009

Language

  • eng