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

Abstract Purpose To explore the effect of tumor thrombus growing against the direction of venous return (GADVR) tumor thrombus on the choice of surgical approach, the impact on the complexity of the surgery and the prognosis. Methods We retrospectively analyzed the clinicopathological data of 213 patients, who underwent surgery in a single center of Peking University Third Hospital between January 2016 and June 2020. For right renal cell carcinoma (RCC) and venous tumor thrombus (VTT), imaging revealed a filling defect in the left renal vein, which was significantly enhanced in enhanced imaging, suggesting that the tumor thrombus grew against the direction of venous return into the left renal vein. For left RCC and VTT, at least one of the left renal vein branches has tumor thrombus. The branches include the left adrenal vein, the left gonadal vein (testicular vein or ovarian vein), and the left ascending lumbar vein. The patients were divided into two groups according to whether they were GADVR tumor thrombus, and we compare the clinicopathological characteristics of GADVR tumor thrombus and non-GADVR tumor thrombus. Univariate and multivariate Cox regression analyses were performed to explore the risk factors that affect the prognosis of patients with RCC and VTT. Kaplan–Meier plots were conducted to evaluate the effect of GADVR on progression-free survival (PFS). Results Compared with non-GADVR tumor thrombus, patients with GADVR tumor thrombus had a higher proportion of open surgery (76.2% vs. 52.1%, P = 0.035), a higher proportion of tumor thrombus adhering to the inferior vena cava (IVC) vessel wall (81% vs. 45.8%, P = 0.002), a higher proportion of segmental resection of the IVC vessel wall (61.9% vs. 15.6%, P < 0.001); higher preoperative serum creatinine value (110.0 μmol/L vs. 91.0 μmol/L, P = 0.015), a higher proportion of tumor thrombus combined with bland thrombus (non-tumor thrombus) (57.1% vs. 19.8%, P < 0.001). In terms of surgical complexity, patients with GADVR tumor thrombus had a longer median operation time (379 min vs. 308 min, P = 0.038), more median surgical blood loss (1400 mL vs. 600 mL, P = 0.018), and more postoperative complications (52.4% vs. 30.7%, P = 0.045). Multivariate Cox regression analysis showed that GADVR tumor thrombus, symptoms, postoperative serum creatinine, distant metastasis, sarcomatoid feature, pathological type, lymph node dissection were independent risk factors for PFS. Patients with GADVR tumor thrombus’s median survival time was 14.0 months, while patients with non-GADVR tumor thrombus were 32.0 months (P = 0.016). GADVR tumor thrombus is an independent risk factor for PFS in patients with RCC and VTT. Conclusion GADVR tumor thrombus is a characteristic feature of tumor thrombus, with an incidence of 9.9%. It has a higher proportion of open surgery and higher surgical complexity, which is an independent risk factor for PFS.

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

10.21203/rs.3.rs-415158/v1 ◽

2021 ◽

Author(s):

Zhuo Liu ◽

Yuxuan Li ◽

Xun Zhao ◽

Liyuan Ge ◽

Guodong Zhu ◽

...

Keyword(s):

Risk Factors ◽

Renal Vein ◽

Vessel Wall ◽

Open Surgery ◽

Tumor Thrombus ◽

Independent Risk Factor ◽

Venous Return ◽

Cox Regression ◽

Left Renal Vein ◽

Surgical Complexity

Abstract Purpose: To explore the effect of tumor thrombus growing against the direction of venous return (GADVR) tumor thrombus on the choice of surgical approach, the impact on the complexity of the surgery and the prognosis.Methods: We retrospectively analyzed the clinicopathological data of 213 patients, who underwent surgery in a single center of Peking University Third Hospital between January 2016 and June 2020. For right renal cell carcinoma (RCC) and venous tumor thrombus (VTT), imaging revealed a filling defect in the left renal vein, which was significantly enhanced in enhanced imaging, suggesting that the tumor thrombus grew against the direction of venous return into the left renal vein. For left RCC and VTT, at least one of the left renal vein branches has tumor thrombus. The branches include the left adrenal vein, the left gonadal vein (testicular vein or ovarian vein), and the left ascending lumbar vein. The patients were divided into two groups according to whether they were GADVR tumor thrombus, and we compare the clinicopathological characteristics of GADVR tumor thrombus and non-GADVR tumor thrombus. Univariate and multivariate Cox regression analyses were performed to explore the risk factors that affect the prognosis of patients with RCC and VTT. Kaplan-Meier plots were conducted to evaluate the effect of GADVR on progression-free survival (PFS).Results: Compared with non-GADVR tumor thrombus, patients with GADVR tumor thrombus had a higher proportion of open surgery (76.2% vs. 52.1%, P=0.035), a higher proportion of tumor thrombus adhering to the inferior vena cava (IVC) vessel wall (81% vs. 45.8%, P=0.002), a higher proportion of segmental resection of the IVC vessel wall (61.9% vs. 15.6%, P＜0.001); higher preoperative serum creatinine value (110.0μmol/ L vs. 91.0μmol/L, P=0.015), a higher proportion of tumor thrombus combined with bland thrombus (non-tumor thrombus) (57.1% vs. 19.8%, P<0.001). In terms of surgical complexity, patients with GADVR tumor thrombus had a longer median operation time (379.0 min vs. 308 min, P=0.038), more median surgical blood loss (1400ml vs. 600ml, P=0.018), and more postoperative complications (52.4% vs. 30.7%, P=0.045). Multivariate Cox regression analysis showed that GADVR tumor thrombus, symptoms, postoperative serum creatinine, distant metastasis, sarcomatoid feature, pathological type, lymph node dissection were independent risk factors for PFS. Patients with GADVR tumor thrombus's median survival time was 14.0 months, while patients with non-GADVR tumor thrombus were 32.0 months (P = 0.016). GADVR tumor thrombus is an independent risk factor for PFS in patients with RCC and VTT.Conclusion: GADVR tumor thrombus is a characteristic feature of tumor thrombus, with an incidence of 9.9%. It has a higher proportion of open surgery and higher surgical complexity, which is an independent risk factor for PFS.

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Utility of preoperative vascular embolization of renal tumors with left renal vein tumor thrombus

Actas Urológicas Españolas (English Edition) ◽

10.1016/j.acuroe.2021.02.009 ◽

2021 ◽

Author(s):

J. Caño Velasco ◽

L. Polanco Pujol ◽

F. Herranz Amo ◽

J. González García ◽

J. Aragón Chamizo ◽

...

Keyword(s):

Renal Vein ◽

Tumor Thrombus ◽

Left Renal Vein ◽

Renal Tumors

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P6243Impact of coronary flow reserve as an important predictor for major adverse cardiac and cerebrovascular event in hemodialysis patients even in patients without myocardial perfusion abnormality

European Heart Journal ◽

10.1093/eurheartj/ehz746.0844 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

N Umemoto ◽

S Ooshima ◽

R Itou ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Myocardial Perfusion ◽

Coronary Flow ◽

Poor Prognosis ◽

Independent Risk Factor ◽

Cox Regression ◽

Cerebrovascular Event ◽

Intergroup Difference ◽

Flow Reserve

Abstract Background In the clinical setting, ischemic heart disease (IHD) is a major problem not only in general patients but also in regular hemodialysis (HD) patients. 13N-ammonia positron emission tomography (13NH3PET) is an established and excellent diagnostic test for IHD. We have reported about the predictability of coronary flow reserve (CFR) in poor prognosis in HD population. Some prior studies show that low CFR predicts poor prognosis for not only cardiovascular event but also all-cause mortality. Although it is well-known that CFR is an important predictor, there are limited data about CFR of patients without myocardial perfusion (MP) abnormality. We investigated the prognostic predictability of adverse cardiac and cerebrovascular event (MACCE) in HD patients without MP abnormality. Methods A total 438 of HD patients who underwent 13NH3PET for suspected IHD were enrolled. All patients were underwent 13NH3PET at our facility. After we excluded patients whose summed stress score (SSS) >3, we identified 182 eligible patients. Patients were divided into two group according to the median value of CFR; low CFR group (≤2.405) and high CFR group (>2.405). We followed up them up to 4.2 years (median 2.4 years) and collected their data. We evaluated their major adverse cardiac cerebrovascular event. We performed Kaplan-Meyer analysis and multivariable cox regression models. Furthermore, we evaluated the incremental value with C-index, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) when CFR added into a model with established risk factors. Results There were intergroup difference in baseline characteristics: age, gender, prior CVD and diabetes. Kaplan-Meyer analysis shows statistically intergroup difference [log rank p=0.04, hazard ratio (HR) 0.54, 95% confidential interval (CI) 0.30–0.97]. Multivariable cox regression model for MACCE shows CFR is an independent risk factor (p=0.04, HR 0.54, 95% CI 0.30–0.97). As regarding model discrimination, all of C-index (0.82 vs 0.80, p=0.23), NRI (0.51, p<0.01) and IDI (0.03, p=0.03) were greatest in a predicting model with established risk factors plus CFR. Conclusions The low CFR group had poor prognosis in MACCE comparing to the high CFR group. CFR would be an independent risk factor for MACCE. Adding CFR on conventional risk factors could more accurately predict MACCE in HD patients, even in patients without MP abnormality.

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Preoperative Risk Factors for Predicting Missed Diagnosis of Renal Vein Tumor Thrombus in Renal Cell Carcinoma: A Retrospective Cohort Study

10.21203/rs.2.10631/v1 ◽

2019 ◽

Author(s):

Weixing Jiang ◽

Chuanzhen Cao ◽

Hongzhe Shi ◽

Jianzhong Shou ◽

Dong Wang ◽

...

Keyword(s):

Risk Factors ◽

Renal Cell Carcinoma ◽

Contrast Agents ◽

Renal Cell ◽

Renal Vein ◽

Tumor Thrombus ◽

Renal Tumor ◽

Middle Part ◽

Missed Diagnosis ◽

Collateral Vessels

Abstract Purpose: Previously, we have found some renal cell carcinoma (RCC) patients with renal vein tumor thrombus (RVTT) were misdiagnosed preoperatively. To improve the accuracy of diagnosis of RVTT in RCC, the clinical characteristics of RCC with missed diagnosis of RVTT were analyzed. Methods: We retrospectively reviewed RCC patients with RVTT between January 2000 and December 2015. Survival analysis was estimated using Kaplan-Meier. Cox proportional hazard models were applied to identify risk factors. Results: Missed diagnosis rate of RVTT in RCC was 30.5%. In multivariate analysis, maximal tumor diameter (OR=1.218, p=0.034)，tumor located in the middle part (OR=1.354, p=0.003), renal vein contrast agents filling not well (OR=1.252, p=0.015) and tumor with collateral vessels (OR=1.218, p=0.037) were independent predictors of missed diagnosis of RVTT. A missed-diagnosis score presented an AUC of 0.852 (p<0.001). In addition, missed diagnosis group patients had relative favorable prognosis, and tumor with collateral vessels was an independent prognostic indicator of poor OS of RVTT (HR=1.153, p=0.025). Conclusions: To our knowledge, this was the first study that explored clinical features as predictors of missed diagnosis of RVTT. It should be alert to the possibility of complicating tumor thrombus at once with preoperative presence of renal tumor located in the middle part, renal tumor with collateral vessels, renal vein contrast agents filling not well.

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