Study Evaluates Role of Cytoreductive Nephrectomy in RCC With Venous Tumor Thrombus

Patients with metastatic renal cell carcinoma (mRCC) with inferior vena caval (IVC) thrombosis above the diaphragm or patients classified as unfavorable using The University of Texas M.D. Anderson Cancer Center (MDACC) criteria have poor overall survival and may not benefit from cytoreductive nephrectomy in the presence of venous tumor thrombus.¹

Patients with RCC and tumor thrombus may require a complex operation to remove the primary tumor, but some patients with tumor venous thrombus and mRCC are unlikely to benefit from cytoreductive nephrectomy. Therefore, researchers sought to identify risk factors for poor overall survival in this patient population.

For the study, researchers analyzed data from 293 patients with mRCC and venous thrombus at presentation treated surgically from 2000 to 2014.

Results showed that median overall survival was 6.8 months (95% CI, 2.2 – 19.1) for patients with IVC thrombus above the diaphragm compared with 18.8 months (95% CI, 8.1 – 37.8) for patients with renal vein thrombus and 18.9 months (95% CI, 6.7 – 44.5) for patients with IVC thrombus below the diaphragm (P = .03).

Researchers also found that Memorial Sloan Kettering Cancer Center (MSKCC) criteria or International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk grouping were not predictive of overall survival for patients classified as having favorable, intermediate, or poor risk (P = .14 and .99, respectively).

However, the study demonstrated that median overall survival was higher in favorable-risk patients compared with unfavorable-risk patients when using MDACC criteria (18.8 months vs 8.2 months; P = .008).

Independent predictors of overall survival included preoperative variables such as body mass index, IVC thrombus above the diaphragm, lactate dehydrogenase greater than the upper limit of normal, and retroperitoneal lymphadenopathy.

Reference

1. Abel EJ, Zargar K, Margulis V, et al. Role of cytoreductive nephrectomy in renal cell cancer (RCC) with venous tumor thrombus. J Clin Oncol. 2016; 34 (suppl 2S; abstr 496).