The influence of venous tumor thrombus combined with bland thrombus on the surgical treatment and prognosis of renal cell carcinoma patients

Abstract

Objective To describe the clinical characteristics of renal cell carcinoma (RCC) with venous tumor thrombus (VTT) and bland thrombus (BT), and to evaluate the influence of BT on surgical treatment and cancer‐specific survival (CSS) of RCC with VTT. Methods We retrospectively reviewed clinical data of 123 patients with RCC and VTT, who underwent surgical treatment in our center between February 2015 and May 2018. Patients were divided into the BT group (21 patients) and non‐BT group (102 patients). Chi‐square and Mann‐Whitney U test were used for categorical and continuous variables respectively. Univariable log‐rank tests and multivariable Cox regressions were conducted to evaluate the prognostic significance of each variable. Kaplan‐Meier plots were performed to evaluate the influence of BT. Results In the delayed phase of enhanced magnetic resonance imaging (MRI), BT and VTT had difference. Patients were divided according to the relative position of BT: proximal end BT (one patients), contralateral renal vein BT (two patients), distal end BT (12 patients), and multiple BT (six patients). The average length of BT was 8.4 ± 5.8 cm (range: 0.6‐20.0 cm). Patients with BT had longer operative time ( P = .001), more surgical blood loss ( P = .004), higher proportion of open surgery ( P = .006), more postoperative complications ( P = .011). BT (hazard ratio [HR] = 3.323, P = .007) were independent risk factors for poor prognosis. Conclusions In the delayed phase of enhanced MRI, BT showed no obvious enhancement, while VTT usually showed enhancement. This was an important basis for preoperative imaging diagnosis of BT. The presence of BT increases the difficulty of surgery, and is correlated with adverse survival outcomes in patients with RCC and VTT.

Renal cell carcinoma with tumor thrombus growing against the direction of venous return: an indicator of complicated surgery and poor prognosis

“…Therefore, the tumor thrombus extends to the branch vein or contralateral renal vein, showing an abnormal growth pattern against the direction of venous return. In previous studies, we found that tumor thrombus combined with bland thrombus was a risk factor for surgical complexity and poor prognosis [ 15 ], and bland thrombus was also a manifestation of obstructive tumor thrombus [ 22 ]. We believe that the obstruction of tumor thrombus caused the slow blood flow, and the platelets and red blood cells in the blood gathered at the distal end of the tumor thrombus, resulting in long-term thrombosis; on the other hand, the obstruction caused the space limitation and formed the tumor thrombus against the direction of venous return.…”

“…Tumor thrombus classification is divided into five categories according to the position of the proximal end of the tumor thrombus using Mayo classification [ 14 ]. Inferior vena cava MRI was used to determine whether the tumor thrombus was associated with bland thrombus (non-tumor thrombus), and the diagnostic criteria were based on our previous studies [ 15 ]. All patients were routinely performed preoperative abdominal B-ultrasound and abdominal enhanced CT to determine whether there were liver metastasis and adrenal metastasis, and lung CT plain scan was performed to determine whether there was lung metastasis.…”

PUTH Grading System for Urinary Tumor With Supradiaphragmatic Tumor Thrombus: Different Surgical Techniques for Different Tumor Characteristics

“…Enhanced computed tomography (CT) of urinary tract was used to confirm the clinical diagnosis of retroperitoneal tumors and to determine the presence of hilar lymph node metastasis and distant metastasis. Enhanced magnetic resonance imaging (MRI) was used to identify the characteristics of tumor thrombus in IVC and to assess the presence of accompanied blood thrombus (non-neoplastic thrombus) ( 13 ). The size of the tumor thrombus in the IVC were measured in the coronal view.…”

Clinical Experience and Management Strategy of Retroperitoneal Tumor With Venous Tumor Thrombus Involvement

“…The length and width of tumor thrombus in inferior vena cava were measured in coronal position. The presence or absence of thrombus (non-tumor emboli) was judged by the delayed period of MRI enhancement (14). According to the imaging characteristics, whether the tumor thrombus invaded the vessel wall was evaluated.…”