Outcome of surgery for patients with renal cell carcinoma and tumour thrombus in the era of modern targeted therapy

Abstract

Objective: This study evaluated the clinical outcome of patients with renal cell carcinoma (RCC) with tumour thrombus (TT) after surgical management.

Materials and methods: In total, 142 consecutive RCC patients with TT who were operated on in Helsinki University Hospital between 2006 and 2014 were analysed. Eighty-eight (62%) of these patients had been operated on with radical intention and 54 (38%) with cytoreductive intention. A total of 73 patients (51%) received postoperative targeted therapy. The primary endpoint was cancer-specific survival (CSS).

Results: The 5 year CSS for level of involvement of TT in the renal vein, subdiaphragmatic vena cava and supradiaphragmatic vena cava was 60% (81 patients), 43% (52 patients) and 51% (nine patients), respectively (p = .42). The median CSS for lymph-node involvement was 63 months for patients with no lymph-node involvement but 10 months for patients with lymph-node involvement (p < .01). The median CSS for metastasis status was 63 months for patients with no metastases compared with 18 months for patients with metastases (p < .01). Among several factors examined, WHO performance status (p = .04), tumour necrosis (p = .05), presence of distant metastases (p = .04) and tumour histology (p = .05) were associated with CSS in the multivariate analysis.

Conclusions: Operative treatment for RCC with TT is associated with good prognosis when there is no lymph-node involvement or distant metastases.

Keywords:

• Complications
• prognostic factors
• surgery
• renal cell carcinoma
• tumour thrombus

Acknowledgement

The authors would like to thank Professor Harri Sintonen for his assistance with the statistical analyses.

Disclosure statement

The authors have no conflicts of interest to declare.

Järvinen R, Kilpeläinen, Kantonen, Simpanen, Nisen and Visapää have no conflict of interest to declare. Bono reports outside of this submitted work honoraria from Pfizer, MSD, Novartis, Orion Pharma, BMS. Järvinen P declares reimbursement from Lilly, Novartis, Sobi for attending scientific meetings. Tornberg declares reimbursement from Astellas for attending a scientific meeting and unrestricted financial grants from Finnish Urological Association. Taari declares consultation fees from Abbvie, lecturer fees from GSK, reimbursements from Orion and Astellas for attending a scientific meeting and other from Medivation, outside the submitted work.

Funding information

This study was financially supported by the Competitive State Research Financing of the Expert Responsibility area of Helsinki University Hospital and also the Hospital District of Helsinki and Uusimaa, 10.13039/100008376.