Presentation Authors: Benjamin Shiff*, Winnipeg, Canada, Rodney Breau, Ottawa, Canada, Alan So, Vancouver, Canada, Frederic Pouliot, Quebec City, Canada, Jun Kawakami, Calgary, Canada, Jean-Baptiste Lattouf, Montreal, Canada, Ricardo Rendon, Halifax, Canada, Simon Tanguay, Montreal, Canada, Ranjeeta Mallick, Ottawa, Canada, Rahul Bansal, Winnipeg, Canada
Introduction: Tumor extension into the venous circulation is a well-described feature of renal cell carcinoma (RCC), and aggressive surgical management has been shown to provide cure in a substantial proportion of patients. However, the factors that contribute to variability in outcomes are poorly understood. This study was conducted to examine factors associated with survival in patients who had undergone surgery for non-metastatic RCC with venous tumor thrombus.
Methods: The Canadian Kidney Cancer information system (CKCis) database was used to identify a historical cohort of patients who underwent radical nephrectomy and removal of renal vein or inferior vena cava tumor thrombus for non-metastatic pathological T3 RCC from 2011 to 2018. Association of level of tumor thrombus was examined with recurrence-free survival (RFS) and overall survival (OS). Univariate and multivariate analyses were performed.
Results: Of the 165 patients identified from the database who satisfied the study criteria, 100, 37, and 28 patients had level 0-1, 2, and 3-4 thrombus, respectively . Mean age was 65 (standard deviation [SD] 10.9) years and 73% of patients were male. Median Charlson Comorbidity Index score was 3 (interquartile range [IQR] 2-4). Fuhrman tumor grade 4 was associated with poor RFS on univariate analysis (Hazard Ratio [HR] 0.47; 95% confidence interval [CI] 0.24-0.94; p-value 0.032), though this association only trended towards significance on multivariate analysis when adjusted for tumor size, margin status, and level of tumor thrombus (HR 0.51; 95% CI 0.24-1.09; p-value 0.081). The level of venous tumor thrombus did not impact the RFS or OS. Predicted 5-year survival rates were 63.7%, 68.3%, and 60.8% for tumor thrombus level 0-1, 2, and 3-4, respectively, with no significant difference between them (log-rank test p-value 0.25). Main limitations are retrospective design, selection bias and possible reporting bias.
Conclusions: According to our data level of venous tumor thrombus is not associated with survival metrics in patients undergoing surgery for non-metastatic RCC with renal vein or inferior vena cava thrombus. Tumor grade may be associated with RFS in these patients.