Influence of Tumor Thrombus on Occurrence of Distant Venous Thromboembolism and Survival in Patients With Renal Cell Carcinoma After Surgery

Tumor thrombus is a unique characteristic of renal cell carcinoma (RCC). However, only a few studies have reported its clinical influence on the occurrence of venous thromboembolism (VTE). This study aimed to clarify the influence of tumor thrombus and other risk factors for VTE and to elucidate the impact of tumor thrombus on survival outcomes. We retrospectively reviewed data from patients with RCC who underwent radical or partial nephrectomy from September 1999 to August 2015 at Seoul National University Hospital. A total of 2762 patients were enrolled. The 1- and 5-year cumulative incidences of VTE were 0.5% ± 0.1% and 1.5% ± 0.3%, respectively. During a median follow-up of 39.0 months (95% confidence interval [CI], 37.1-41.0 months), deep vein thrombosis occurred in 13 patients and pulmonary embolism in 15 patients. Patients with tumor thrombus (diagnosed by surgical pathology findings) had a significantly higher incidence of VTE than those without thrombus (odds radio 8.160, 95% CI, 1.480-45.004). Older age (≥60 years) and higher preoperative C-reactive protein (>0.5 mg/dL) were also significant risk factors for VTE. Additionally, tumor thrombus was independently associated with worse progression-free survival (PFS) but not with overall survival (OS) in multivariable analysis (hazard ratio [HR] 1.916, 95% CI, 1.295-2.834 for PFS; HR 1.164, 95% CI, 0.755-1.793 for OS). In conclusion, the incidence of VTE was relatively low in patients who underwent surgery for RCC. Nevertheless, patients with tumor thrombus had an increased risk of VTE and should be closely monitored for VTE.

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Increased risk of preoperative venous thromboembolism in patients with renal cell carcinoma and tumor thrombus

Journal of Thrombosis and Haemostasis ◽

10.1111/jth.12459 ◽

2014 ◽

Vol 12 (2) ◽

pp. 169-171 ◽

Cited By ~ 9

Author(s):

D. W. Yokom ◽

R. Ihaddadene ◽

P. Moretto ◽

C. M. Canil ◽

N. Reaume ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Venous Thromboembolism ◽

Cell Carcinoma ◽

Renal Cell ◽

Tumor Thrombus ◽

Increased Risk

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Increased risk of preoperative venous thromboembolism in patients with renal cell carcinoma and tumor thrombus: reply

Journal of Thrombosis and Haemostasis ◽

10.1111/jth.12520 ◽

2014 ◽

Vol 12 (4) ◽

pp. 579-580

Author(s):

D. W. Yokom ◽

G. Le Gal ◽

M. Carrier

Keyword(s):

Renal Cell Carcinoma ◽

Venous Thromboembolism ◽

Cell Carcinoma ◽

Renal Cell ◽

Tumor Thrombus ◽

Increased Risk

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Increased risk of preoperative venous thromboembolism in patients with renal cell carcinoma and tumor thrombus: comment

Journal of Thrombosis and Haemostasis ◽

10.1111/jth.12517 ◽

2014 ◽

Vol 12 (4) ◽

pp. 577-578 ◽

Cited By ~ 1

Author(s):

J. González ◽

G. Ciancio

Keyword(s):

Renal Cell Carcinoma ◽

Venous Thromboembolism ◽

Cell Carcinoma ◽

Renal Cell ◽

Tumor Thrombus ◽

Increased Risk

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The impact of rhabdoid differentiation on prognosis in patients with grade 4 renal cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.494 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 494-494

Author(s):

Ben Yiming Zhang ◽

John C. Cheville ◽

Robert Houston Thompson ◽

Stephen A. Boorjian ◽

Christine M. Lohse ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Risk Of Death ◽

Pathologic Features ◽

Increased Risk ◽

Grade 3 ◽

Rhabdoid Differentiation ◽

The Impact ◽

Sarcomatoid Differentiation

494 Background: Renal cell carcinoma (RCC) with rhabdoid differentiation is thought to portend a poor prognosis, similar to RCC with sarcomatoid differentiation. Both rhabdoid and sarcomatoid differentiation are classified as grade 4 RCC based on the most recent International Society of Urological Pathology (ISUP) grading system. We sought to determine the prognostic value of rhabdoid differentiation in comparison to RCC with sarcomatoid differentiation, grade 4 RCC without rhabdoid or sarcomatoid differentiation, and grade 3 RCC. Methods: Using the Mayo Clinic Nephrectomy Registry, we identified 406 patients with ISUP grade 4 RCC and 1,758 patients with grade 3 RCC. A urologic pathologist reviewed all specimens to determine the presence of both rhabdoid and sarcomatoid differentiation. Associations of clinical and pathologic features with death from RCC were evaluated using Cox models. Results: Among the 406 grade 4 RCC tumors, 111 (27%) had rhabdoid differentiation and 189 (47%) had sarcomatoid differentiation, although only 28 (7%) demonstrated both rhabdoid and sarcomatoid differentiation. In multivariable analysis of grade 4 RCC tumors, the presence of rhabdoid differentiation was not associated with death from RCC (HR 0.95, p=0.75); in contrast, sarcomatoid differentiation was significantly associated with death from RCC (HR 1.63, p<0.001). Patients with RCC with rhabdoid differentiation were significantly more likely to die of RCC than patients with grade 3 RCC (HR 2.45, p<0.001) and grade 3 RCC with necrosis (HR 1.62; p<0.001). Conclusions: This study confirms that RCC with rhabdoid differentiation is appropriately classified as grade 4. However, unlike sarcomatoid differentiation, the presence of rhabdoid differentiation in grade 4 RCC is not associated with an increased risk of death from RCC. Therefore, rhabdoid and sarcomatoid differentiation should not be grouped together when assessing risk in a patient with grade 4 RCC.

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MP50-10 INCIDENCE AND RISK FACTORS FOR PERIOPERATIVE THROMBOEMBOLIC EVENTS AMONG PATIENTS WITH RENAL CELL CARCINOMA AND INFERIOR VENA CAVA TUMOR THROMBUS

The Journal of Urology ◽

10.1016/j.juro.2015.02.2921 ◽

2015 ◽

Vol 193 (4S) ◽

Author(s):

Boyd Viers ◽

Stephen Boorjian ◽

Christine Lohse ◽

Sarah Psutka ◽

Griffin Morrisson ◽

...

Keyword(s):

Risk Factors ◽

Renal Cell Carcinoma ◽

Inferior Vena Cava ◽

Cell Carcinoma ◽

Renal Cell ◽

Tumor Thrombus ◽

Inferior Vena ◽

Vena Cava ◽

Thromboembolic Events

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Outcomes According to MSKCC Risk Score with Focus on the Intermediate-Risk Group in Metastatic Renal Cell Carcinoma Patients Treated with First-Line Sunitinib: A Retrospective Analysis of 2390 Patients

Cancers ◽

10.3390/cancers12040808 ◽

2020 ◽

Vol 12 (4) ◽

pp. 808

Author(s):

Ondrej Fiala ◽

Jindrich Finek ◽

Alexandr Poprach ◽

Bohuslav Melichar ◽

Jindrich Kopecký ◽

...

Keyword(s):

Risk Factors ◽

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Metastatic Renal Cell Carcinoma ◽

Risk Score ◽

Renal Cell ◽

Risk Group ◽

Intermediate Risk ◽

First Line ◽

The Impact

Background: The Memorial Sloan–Kettering Cancer Center (MSKCC) prognostic model has been widely used for the prediction of the outcome of metastatic renal cell carcinoma (mRCC) patients treated with systemic therapies, however, data from large studies are limited. This study aimed at the evaluation of the impact of the MSKCC score on the outcomes in mRCC patients treated with first-line sunitinib, with a focus on the intermediate-risk group. Methods: Clinical data from 2390 mRCC patients were analysed retrospectively. Progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) were analysed according to the MSKCC risk score. Results: ORR, median PFS, and OS for patients with one risk factor were 26.7%, 10.1, and 28.2 months versus 18.7%, 6.2, and 16.2 months, respectively, for those with two risk factors (ORR: p = 0.001, PFS: p < 0.001, OS: p < 0.001). ORR, median PFS, and OS were 33.0%, 17.0, and 44.7 months versus 24.1%, 9.0, and 24.1 months versus 13.4%, 4.5, and 9.5 months in the favourable-, intermediate-, and poor-risk groups, respectively (ORR: p < 0.001, PFS: p < 0.001, OS: p < 0.001). Conclusions: The results of the present retrospective study demonstrate the suitability of the MSKCC model in mRCC patients treated with first-line sunitinib and suggest different outcomes between patients with one or two risk factors.

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The De Ritis and Neutrophil-to-Lymphocyte Ratios May Aid in the Risk Assessment of Patients with Metastatic Renal Cell Carcinoma

Journal of Oncology ◽

10.1155/2018/1953571 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Sung Han Kim ◽

Eun Young Park ◽

Jungnam Joo ◽

Jinsoo Chung

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Metastatic Renal Cell Carcinoma ◽

Renal Cell ◽

Risk Model ◽

Bootstrap Method ◽

Multivariable Analysis ◽

Significant Risk ◽

Inflammatory Factors ◽

Model C

Purpose. This study aimed to determine whether baseline blood inflammatory markers can predict progression-free survival (PFS) and overall survival (OS) in patients with metastatic renal cell carcinoma (mRCC).Methods. The study included 158 patients with mRCC treated with first-line targeted therapy between 2002 and 2016. A multivariable cox proportional hazards model identified inflammatory factors that predict PFS and OS. Using bootstrap method, new prognostic model compared with Heng and modified MSKCC risk model (mMSKCC). The effect of inflammatory factors were investigated by comparing increased C-index adding significant inflammatory factors to Heng and mMSKCC model.Results. On multivariable analysis, nephrectomy (HR 0.48), NLR (HR 1.04), were significant risk factors for PFS; nephrectomy (HR 0.38), hemoglobin (HR 1.71), alkaline phosphatase (HR 1.73), NLR (HR 1.01) and DRR (HR 1.34), were significant factors for OS (p<0.05). Our new model that incorporated NLR and DRR had higher (though insignificant) predictability (C-index=0.610) than mMSKCC risk model (C-index=0.569) in PFS and significantly better predictability (C-index=0.727) than Heng and mMSKCC risk model (C-index, 0.661, 0.612, respectively) in OS. Adding inflammatory factors to the Heng criteria (C-index, 0.697 for OS) and MSKCC (0.691 for OS) tended to improve their predictive abilities.Conclusions. The NLR and DRR may increase predictive ability compared to the established Heng and mMSKCC risk models in mRCC.

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Prognostic Outcomes and Risk Factors for Patients with Renal Cell Carcinoma and Venous Tumor Thrombus after Radical Nephrectomy and Thrombectomy: The Prognostic Significance of Venous Tumor Thrombus Level

BioMed Research International ◽

10.1155/2015/163423 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Qi Tang ◽

Yi Song ◽

Xuesong Li ◽

Maxwell Meng ◽

Qian Zhang ◽

...

Keyword(s):

Risk Factors ◽

Renal Cell Carcinoma ◽

Survival Rate ◽

Cell Carcinoma ◽

Hepatic Vein ◽

Renal Cell ◽

Radical Nephrectomy ◽

Tumor Thrombus ◽

Cancer Specific Survival ◽

Venous Tumor Thrombus

Introduction. To evaluate the prognostic outcomes and risk factors for renal cell carcinoma (RCC) patients with venous tumor thrombus in China.Materials and Methods. We reviewed the clinical information of 169 patients who underwent radical nephrectomy and thrombectomy. Overall and cancer-specific survival rates were analyzed. Univariate and multivariate analyses were used to investigate the potential prognostic factors.Results. The median survival time was 63 months. The five-year overall survival and cancer-specific survival rate were 53.6% and 54.4% for all patients. For all patients, significant survival difference was only observed between early (below hepatic vein) and advanced (above hepatic vein) tumor thrombus. However, significant differences existed between both RV/IVC and early/advanced tumor thrombus groups in N0M0 patients. Multivariate analysis demonstrated that higher tumor thrombus level (p=0.016,RR=1.58), N (p=0.013,RR=2.60), and M (p<0.001,RR=4.14) stages and adrenal gland invasion (p=0.001,RR=4.91) were the most significant negative prognostic predictors.Conclusions. In this study, we reported most cases of RCC patients with venous extension in China. We proved that patients with RCC and venous tumor thrombus may have relative promising long-term survival rate, especially those with early tumor thrombus.

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