Urothelial carcinoma of the renal pelvis with renal vein and inferior vena cava tumor thrombus: case series and literature review

Abstract

Background: Urothelial carcinoma (UC) of the renal pelvis with renal vein and inferior vena cava (IVC) tumor thrombus (TT) was extremely rare. We aimed to explore the clinical and pathological characteristics, diagnosis and treatment of renal pelvis UC with renal vein and IVC TT. Methods: From March 2016 to January 2019, eight patients of renal pelvis UC with renal vein and IVC TT were diagnosed and underwent operation in our hospital. Clinical features, operative details, pathological outcomes, and prognosis data were reviewed and collected. Results: There were five males and three females (52-84 years old). Their main symptoms were flank pain and hematuria. According to the Mayo classification, the TT was 4 level-0 (1 left and 3 right), 2 level-I (right), and 2 level-II (right). Half the patients underwent retroperitoneal laparoscopic radical nephroureterectomy with thrombectomy, and the other underwent open procedures. The mean operative time was 298.9 minutes. Pathological outcomes revealed high-grade UC, with positive lymph nodes in 6 cases. Four patients received adjuvant chemotherapy, one target therapy and one adjuvant chemotherapy combined with immunotherapy after surgery. The mean follow-up time was 11.1 months. Three patients are alive, and two of them developed recurrence and lung metastasis.Conclusions: Preoperative differentiation between renal pelvis UC and renal cell carcinoma with venous TT was very important for the management. Radical nephroureterectomy with thrombectomy might be a reasonable method for renal pelvis UC with venous TT. The prognosis of such cases was poor even if adjuvant therapy was scheduled.

Surgical Management of Upper Urinary Tract Urothelial Cell Carcinoma with Venous Tumor Thrombus: A Liver Transplant-Based Approach

“…Huber et al reported a median survival of 8.9 months for five patients having renal TCC and venous TT; all five of these patients died of their disease [4]. Thus, in spite of our being able to perform a radical nephroureterectomy with minimal complications observed in all patients, our observed median patient survival of 12 months (range: 10 days-24 months) did not appear to differ from these other reports of UTUC with TT [2,4,29,30].…”

“…Despite aggressive surgical treatment, the prognosis of these patients is very grim, with reported survival being between 6 months and 14 months [2,29]. Huber et al reported a median survival of 8.9 months for five patients having renal TCC and venous TT; all five of these patients died of their disease [4].…”

“…Renal cell carcinoma (RCC) is the most common malignancy that results in venous tumor thrombus (TT) and is associated with vascular extension into the inferior vena cava (IVC) in 4-10% of cases [1]. Upper urinary tract urothelial cell carcinoma (UTUC) is a rare urological malignancy with aggressive behavior, and its extension into the renal vein (RV) and IVC is an even rarer occurrence, with a total of only 49 such patients previously being reported in the literature [2]. In a large study of 2380 patients (from 101 centers in 29 countries) with UTUC, 1430 (60.1%) underwent radical nephroureterectomy, and none had TT venous extension [3].…”