Prognostic Factors and Cancer-Specific Survival of Surgically Managed Renal Cell Carcinoma With Venous Thrombus: A 30-Year Experience at a Tertiary Referral Center

Abstract

Purpose This study investigated the prognostic factors and cancer-specific survival (CSS) of patients who had renal cell carcinoma (RCC) with venous thrombus and underwent radical nephrectomy with thrombectomy (RNTx). Materials and Methods From January 1990 to December 2022, we retrospectively reviewed the medical records of patients diagnosed with RCC with venous thrombus who underwent RNTx at a single tertiary medical center. Univariate and multivariable Cox proportional hazard regression analyses were conducted to identify significant prognostic factors affecting CSS. A Kaplan-Meier model was used to calculate CSS rates at 1, 3, and 5 years after RNTx. Results We included 262 patients in the final analysis (median age, 59 years) with a median follow-up of 28 months. The 1-, 3-, and 5-year CSS rates were 84.1%, 62.5%, and 46.4%, respectively. Multivariable analysis revealed that pathologic T4 stage (hazard ratio [HR], 3.711; 95% confidence interval [CI], 1.599–8.611, p=0.002), pathologic N1 stage (HR, 2.371; 95% CI, 1.231–4.567; p=0.01), sarcomatoid differentiation (HR, 1.89; 95% CI, 1.027–3.477; p=0.041), and tumor necrosis (HR, 2.993; 95% CI, 1.132–7.914; p=0.027) were associated with CSS. Conclusions Approximately one-third of all RCC patients with venous thrombus remained disease-free, and half survived 5 years after RNTx. Sarcomatoid differentiation and the presence of tumor necrosis in pathology predicted poorer CSS outcomes in our study. Further retrospective studies are required to validate these findings.

Keywords

• renal cell carcinoma
• tumor thrombus
• thrombectomy
• survival analysis