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?

Abstract

Objectives: To evaluate the impact of morphological features of inferior vena cava thrombus on the overall survival and cancer-specific survival (cancer-specific survival of patients with renal cell carcinoma). Methods: We retrospectively analyzed the records of 156 renal cell carcinoma patients with inferior vena cava thrombus who underwent radical nephrectomy and thrombectomy from 1998 to 2013 at five tertiary centers. Inferior vena cava thrombi were classified as spherical (type I) and spiculated (type II) according to morphological features on computed tomography or magnetic resonance imaging. Multivariate cox regression models were used to quantify the impact of prognostic factors on overall survival and cancer-specific survival. Results: Type I was found in 29 patients (18.6%), and type II in 127 patients (81.4%). Median follow up was 38.2 months (interquartile range 12-57). Demographic characteristics were not significantly different, except for the cranial thrombus height (P = 0.003). On multivariate analysis, Eastern Cooperative Oncology Group performance score, clinical tumor size, distant metastasis, histologic subtype, thrombus morphology and remnant venous thrombus significantly affected overall survival in pN any M any patients (all P < 0.05). Among the pN O / X M O patients, clinical tumor size, histologic subtype, thrombus morphology and remnant venous thrombus significantly affected overall survival (all P < 0.05). In terms of cancer-specific survival, Eastern Cooperative Oncology Group performance score, clinical tumor size, distant metastasis, histologic subtype and thrombus morphology significantly affected cancer-specific survival in pN any M any patients (all P < 0.05). In patients with pN O / X M O , body mass index, clinical tumor size, histological subtype, thrombus morphology and remnant venous thrombus significantly affected cancer-specific survival (all P < 0.05). Conclusion: Clinical tumor size, histological subtype, and thrombus morphology are independent predictors of overall survival and cancer-specific survival in renal cell carcinoma patients with inferior vena cava thrombus. These factors might be helpful for the surgeon's determination to improve therapeutic efficacy.

Editorial Comment to 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?

“…[6][7][8] In the study by Choi et al, 156 RCC patients with IVC thrombus were classified into two groups, type I and type II, on the basis of the preoperative morphological characteristics of IVC thrombus on imaging examination. 1 There was a statistically significant difference in thrombus height between the cases with type I thrombi and those with type II thrombi. Although the impact of the extension of IVC thrombus on the oncological outcome after surgical resection remains controversial, it is a very important point to discuss.…”

“…The article by Choi et al . addresses the impact of morphological characteristics of the inferior vena cava (IVC) tumor thrombus of renal cell carcinoma (RCC) on clinicopathological features including overall survival and cancer‐specific survival . We often experience cases of RCC patients with IVC thrombus whose indication of surgical treatment is controversial.…”

“…In the study by Choi et al ., 156 RCC patients with IVC thrombus were classified into two groups, type I and type II, on the basis of the preoperative morphological characteristics of IVC thrombus on imaging examination . There was a statistically significant difference in thrombus height between the cases with type I thrombi and those with type II thrombi.…”

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The article by Choi et al addresses the impact of morphological characteristics of the inferior vena cava (IVC) tumor thrombus of renal cell carcinoma (RCC) on clinicopathological features including overall survival and cancer-specific survival. 1 We often experience cases of RCC patients with IVC thrombus whose indication of surgical treatment is controversial. As the authors discussed, previous studies have reported several parameters, such as clinical tumor size, histological subtype, the status of distant metastasis, body mass index and performance status, for predicting the prognosis in RCC patients with IVC thrombus.

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A Predictive Model for Tumor Invasion of the Inferior Vena Cava Wall Using Multimodal Imaging in Patients with Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus

“…The current RCC with IVCTT classification systems, such as the Mayo Clinic [ 16 ], Novick, and Hinman systems, only take into account the TT's location, which may be insufficient to intraoperatively evaluate the probability of IVC invasion [ 17 ]. Moreover, there is still no standard for classifying IVCTT on imaging [ 18 ]. Thus, IVC thrombectomy caused by IVC invasion often requires comprehensive preoperative imaging evaluation.…”