Renal cell carcinoma with inferior vena cava involvement: Prognostic effect of tumor thrombus consistency on cancer specific survival

Abstract

Background Renal cell carcinoma forming a venous tumor thrombus (VTT) in the inferior vena cava (IVC) has a poor prognosis. Recent investigations have been focused on prognostic markers of survival. Thrombus consistency (TC) has been proposed to be of significant value but yet there are conflicting data. The aim of this study is to test the effect of IVC VTT consistency on cancer specific survival (CSS) in a multi-institutional cohort. Methods The records of 413 patients collected by the International Renal Cell Carcinoma-Venous Thrombus Consortium were retrospectively analyzed. All patients underwent radical nephrectomy and tumor thrombectomy. Kaplan-Meier estimates and Cox regression analyses investigated the impact of TC on CSS in addition to established clinicopathological predictors. Results VTT was solid in 225 patients and friable in 188 patients. Median CSS was 50 months in solid and 45 months in friable VTT. TC showed no significant association with metastatic spread, pT stage, perinephric fat invasion and higher Fuhrman grade. Survival analysis and Cox regression rejected thrombus consistency as prognostic marker for CSS. Conclusions In the largest cohort published so far, TC seems not to be independently associated with survival in RCC patients and should therefore not be included in risk stratification models.

Surgical treatment of renal cell carcinoma: Can morphological features of inferior vena cava tumor thrombus on computed tomography or magnetic resonance imaging be a prognostic factor?

“…The current study aimed to validate if thrombus consistency could serve as a prognostic factor for patients' survival . However, some studies argued that is no difference in survival between solid and friable thrombus consistency . In thrombus‐forming tumors, thrombi with relatively benign courses are more likely to be homogeneous and markedly hypoattenuating, whereas those with more malignant courses tend to be adherent to vessel walls, and collateral pathways are common .…”

“…10,20 However, some studies argued that is no difference in survival between solid and friable thrombus consistency. 20,21 In thrombus-forming tumors, thrombi with relatively benign courses are more likely to be homogeneous and markedly hypoattenuating, whereas those with more malignant courses tend to be adherent to vessel walls, and collateral pathways are common. 22 In addition, as shown in Figure 3a,b, pseudo-capsulation, as observed in RCC, occurs not only on solid masses, but also tumor thrombi, and, histologically, such pseudo-capsulation and margination of thrombi occur in the presence of abundant fibrotic tissue components.…”

Xeno‐pericardial patch repair of the inferior vena cava for radical resection of renal cell carcinoma with tumor thrombus

“…In-depth review of each cases, and/or meta-analysis would contribute to the care for this pathology. 21 In conclusion, radical resection and xeno-pericardial patch IVC repair was successfully performed without surgery-related mortalities or severe morbidities in the Novick II-IV tumor thrombus of the IVC complicated with kidney cancer. A clear exposure of the IVC by the surgical team was the key of success to remove the tumor en bloc with a tumor free margin in the IVC with minimum liver and kidney damages.…”

“…Considering the rarity and the advanced stage of this pathology, however, prospective study to compare the surgical approach may not be ethically permitted or effective. In‐depth review of each cases, and/or meta‐analysis would contribute to the care for this pathology …”

Sunitinib or Sorafenib as Neoadjuvant Therapy May not Improve the Survival Outcomes of Renal Cell Carcinoma with Tumor Thrombus

“…With the development of surgical techniques, radical nephrectomy combined with venous thrombectomy is the main treatment method for these patients. However, the 5-year survival rate was reported to be about 40-55% in different studies [3][4][5], and it was still not high for patients with renal vein or IVC tumor thrombus even after surgical treatment.…”