Risk factors for recurrence after surgery in non-metastatic RCC with thrombus: a contemporary multicentre analysis.

Journal Article (Multicenter Study;Journal Article)

Objective

To determine the predictors of post-surgical recurrence for patients with non-metastatic renal cell carcinoma (RCC) and venous thrombus.

Methods

Records from consecutive patients with non-metastatic RCC with tumour thrombus, treated surgically between 2000 and 2012 at one of three centres, were reviewed. Univariable and multivariable analysis were used to evaluate the association of risk factors for post-surgical recurrence.

Results

A total of 465 patients with non-metastatic RCC were identified, including patients with thrombus present in the renal vein (257 patients, 55.3%), infrahepatic inferior vena cava (IVC; 144 patients, 31.0%) and suprahepatic IVC (64 patients, 13.8%). The median (interquartile range) follow-up was 28.3 (12.2-56.4) months, with metastatic RCC developing in 188 patients (40.5%). Independent predictors of recurrence included: body mass index ≤20 kg/m(2) (hazard ratio [HR] 2.66; 95% confidence interval [CI] 1.29-5.49), low preoperative haemoglobin (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), tumour 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 (HR 2.13; 95% CI 1.30-3.50). Independently predictive variables were used to create a recurrence model for three risk groups based on 0, 1-2, or >2 risk factors, respectively. The 5-year recurrence-free survival rate was significantly different in patients with favourable-risk (79.1%) compared with intermediate- (55.1%) or high-risk (22.1%) disease (P < 0.001).

Conclusions

Seven risk factors for recurrence were 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.

Full Text

Duke Authors

Cited Authors

  • Abel, EJ; Margulis, V; Bauman, TM; Karam, JA; Christensen, WP; Krabbe, L-M; Haddad, A; Golla, V; Wood, CG

Published Date

  • June 2016

Published In

Volume / Issue

  • 117 / 6B

Start / End Page

  • E87 - E94

PubMed ID

  • 26305276

Electronic International Standard Serial Number (EISSN)

  • 1464-410X

International Standard Serial Number (ISSN)

  • 1464-4096

Digital Object Identifier (DOI)

  • 10.1111/bju.13268

Language

  • eng