Cytoreductive Nephrectomy for Renal Cell Carcinoma with Venous Tumor Thrombus

E. Jason Abel, Philippe E. Spiess, Vitaly Margulis, Viraj A. Master, Michael Mann, Kamran Zargar-Shoshtari, Leonardo D. Borregales, Wade J. Sexton, Datta Patil, Surena F. Matin, Christopher G. Wood, Jose A. Karam

Research output: Contribution to journalArticle

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Abstract

Purpose: Careful selection is critical to identify those with metastatic renal cell carcinoma who are most likely to benefit from cytoreductive nephrectomy. Surgery in patients who have metastatic renal cell carcinoma with tumor thrombus is complex and may not benefit some patients with poor overall survival. We evaluated whether preoperative variables or risk stratification systems could predict overall survival following cytoreductive nephrectomy. Materials and Methods: Prognostic factors for overall survival after surgery were evaluated in patients who had metastatic renal cell carcinoma with venous tumor thrombus at 5 institutions from 2000 to 2014. Prognostic variables, including metastatic renal cell carcinoma risk models, were evaluated for associations with overall survival. Multivariable analysis was used to determine independent associations of preoperative variables with overall survival. Results: A total of 427 patients with metastatic renal cell carcinoma were identified with tumor thrombus. Patients with inferior vena cava thrombus above the diaphragm had shorter median overall survival vs those with renal vein only thrombus (9.2 months, IQR 4.2-30.8, vs 21.7, IQR 7.7-42.8, p = 0.0165). Individual risk factors from prognostic models were evaluated among other preoperative characteristics for associations with overall survival in 122 patients (32%) who died within 270 days of surgery. Independent predictors of overall survival included lactate dehydrogenase greater than the upper limit of normal (p = 0.003), systemic symptoms (p = 0.003), inferior vena cava thrombus above the diaphragm (p = 0.02) and sarcomatoid features (p = 0.005). Conclusions: Poor overall survival following cytoreductive nephrectomy in patients with metastatic renal cell carcinoma with tumor thrombus is associated with inferior vena cava thrombus above the diaphragm, poor risk group, systemic symptoms or sarcomatoid dedifferentiation. Patients with expected poor overall survival should be considered for preoperative systemic therapy clinical trials.

Original languageEnglish (US)
JournalJournal of Urology
DOIs
StateAccepted/In press - 2017

Fingerprint

Nephrectomy
Renal Cell Carcinoma
Thrombosis
Survival
Neoplasms
Inferior Vena Cava
Diaphragm
Renal Veins
Ambulatory Surgical Procedures
L-Lactate Dehydrogenase
Clinical Trials

Keywords

  • Carcinoma
  • Inferior
  • Mortality
  • Neoplasm metastasis
  • Renal cell
  • Thrombosis
  • Vena cava

ASJC Scopus subject areas

  • Urology

Cite this

Abel, E. J., Spiess, P. E., Margulis, V., Master, V. A., Mann, M., Zargar-Shoshtari, K., ... Karam, J. A. (Accepted/In press). Cytoreductive Nephrectomy for Renal Cell Carcinoma with Venous Tumor Thrombus. Journal of Urology. https://doi.org/10.1016/j.juro.2017.03.011

Cytoreductive Nephrectomy for Renal Cell Carcinoma with Venous Tumor Thrombus. / Abel, E. Jason; Spiess, Philippe E.; Margulis, Vitaly; Master, Viraj A.; Mann, Michael; Zargar-Shoshtari, Kamran; Borregales, Leonardo D.; Sexton, Wade J.; Patil, Datta; Matin, Surena F.; Wood, Christopher G.; Karam, Jose A.

In: Journal of Urology, 2017.

Research output: Contribution to journalArticle

Abel, EJ, Spiess, PE, Margulis, V, Master, VA, Mann, M, Zargar-Shoshtari, K, Borregales, LD, Sexton, WJ, Patil, D, Matin, SF, Wood, CG & Karam, JA 2017, 'Cytoreductive Nephrectomy for Renal Cell Carcinoma with Venous Tumor Thrombus', Journal of Urology. https://doi.org/10.1016/j.juro.2017.03.011
Abel, E. Jason ; Spiess, Philippe E. ; Margulis, Vitaly ; Master, Viraj A. ; Mann, Michael ; Zargar-Shoshtari, Kamran ; Borregales, Leonardo D. ; Sexton, Wade J. ; Patil, Datta ; Matin, Surena F. ; Wood, Christopher G. ; Karam, Jose A. / Cytoreductive Nephrectomy for Renal Cell Carcinoma with Venous Tumor Thrombus. In: Journal of Urology. 2017.
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abstract = "Purpose: Careful selection is critical to identify those with metastatic renal cell carcinoma who are most likely to benefit from cytoreductive nephrectomy. Surgery in patients who have metastatic renal cell carcinoma with tumor thrombus is complex and may not benefit some patients with poor overall survival. We evaluated whether preoperative variables or risk stratification systems could predict overall survival following cytoreductive nephrectomy. Materials and Methods: Prognostic factors for overall survival after surgery were evaluated in patients who had metastatic renal cell carcinoma with venous tumor thrombus at 5 institutions from 2000 to 2014. Prognostic variables, including metastatic renal cell carcinoma risk models, were evaluated for associations with overall survival. Multivariable analysis was used to determine independent associations of preoperative variables with overall survival. Results: A total of 427 patients with metastatic renal cell carcinoma were identified with tumor thrombus. Patients with inferior vena cava thrombus above the diaphragm had shorter median overall survival vs those with renal vein only thrombus (9.2 months, IQR 4.2-30.8, vs 21.7, IQR 7.7-42.8, p = 0.0165). Individual risk factors from prognostic models were evaluated among other preoperative characteristics for associations with overall survival in 122 patients (32{\%}) who died within 270 days of surgery. Independent predictors of overall survival included lactate dehydrogenase greater than the upper limit of normal (p = 0.003), systemic symptoms (p = 0.003), inferior vena cava thrombus above the diaphragm (p = 0.02) and sarcomatoid features (p = 0.005). Conclusions: Poor overall survival following cytoreductive nephrectomy in patients with metastatic renal cell carcinoma with tumor thrombus is associated with inferior vena cava thrombus above the diaphragm, poor risk group, systemic symptoms or sarcomatoid dedifferentiation. Patients with expected poor overall survival should be considered for preoperative systemic therapy clinical trials.",
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author = "Abel, {E. Jason} and Spiess, {Philippe E.} and Vitaly Margulis and Master, {Viraj A.} and Michael Mann and Kamran Zargar-Shoshtari and Borregales, {Leonardo D.} and Sexton, {Wade J.} and Datta Patil and Matin, {Surena F.} and Wood, {Christopher G.} and Karam, {Jose A.}",
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T1 - Cytoreductive Nephrectomy for Renal Cell Carcinoma with Venous Tumor Thrombus

AU - Abel, E. Jason

AU - Spiess, Philippe E.

AU - Margulis, Vitaly

AU - Master, Viraj A.

AU - Mann, Michael

AU - Zargar-Shoshtari, Kamran

AU - Borregales, Leonardo D.

AU - Sexton, Wade J.

AU - Patil, Datta

AU - Matin, Surena F.

AU - Wood, Christopher G.

AU - Karam, Jose A.

PY - 2017

Y1 - 2017

N2 - Purpose: Careful selection is critical to identify those with metastatic renal cell carcinoma who are most likely to benefit from cytoreductive nephrectomy. Surgery in patients who have metastatic renal cell carcinoma with tumor thrombus is complex and may not benefit some patients with poor overall survival. We evaluated whether preoperative variables or risk stratification systems could predict overall survival following cytoreductive nephrectomy. Materials and Methods: Prognostic factors for overall survival after surgery were evaluated in patients who had metastatic renal cell carcinoma with venous tumor thrombus at 5 institutions from 2000 to 2014. Prognostic variables, including metastatic renal cell carcinoma risk models, were evaluated for associations with overall survival. Multivariable analysis was used to determine independent associations of preoperative variables with overall survival. Results: A total of 427 patients with metastatic renal cell carcinoma were identified with tumor thrombus. Patients with inferior vena cava thrombus above the diaphragm had shorter median overall survival vs those with renal vein only thrombus (9.2 months, IQR 4.2-30.8, vs 21.7, IQR 7.7-42.8, p = 0.0165). Individual risk factors from prognostic models were evaluated among other preoperative characteristics for associations with overall survival in 122 patients (32%) who died within 270 days of surgery. Independent predictors of overall survival included lactate dehydrogenase greater than the upper limit of normal (p = 0.003), systemic symptoms (p = 0.003), inferior vena cava thrombus above the diaphragm (p = 0.02) and sarcomatoid features (p = 0.005). Conclusions: Poor overall survival following cytoreductive nephrectomy in patients with metastatic renal cell carcinoma with tumor thrombus is associated with inferior vena cava thrombus above the diaphragm, poor risk group, systemic symptoms or sarcomatoid dedifferentiation. Patients with expected poor overall survival should be considered for preoperative systemic therapy clinical trials.

AB - Purpose: Careful selection is critical to identify those with metastatic renal cell carcinoma who are most likely to benefit from cytoreductive nephrectomy. Surgery in patients who have metastatic renal cell carcinoma with tumor thrombus is complex and may not benefit some patients with poor overall survival. We evaluated whether preoperative variables or risk stratification systems could predict overall survival following cytoreductive nephrectomy. Materials and Methods: Prognostic factors for overall survival after surgery were evaluated in patients who had metastatic renal cell carcinoma with venous tumor thrombus at 5 institutions from 2000 to 2014. Prognostic variables, including metastatic renal cell carcinoma risk models, were evaluated for associations with overall survival. Multivariable analysis was used to determine independent associations of preoperative variables with overall survival. Results: A total of 427 patients with metastatic renal cell carcinoma were identified with tumor thrombus. Patients with inferior vena cava thrombus above the diaphragm had shorter median overall survival vs those with renal vein only thrombus (9.2 months, IQR 4.2-30.8, vs 21.7, IQR 7.7-42.8, p = 0.0165). Individual risk factors from prognostic models were evaluated among other preoperative characteristics for associations with overall survival in 122 patients (32%) who died within 270 days of surgery. Independent predictors of overall survival included lactate dehydrogenase greater than the upper limit of normal (p = 0.003), systemic symptoms (p = 0.003), inferior vena cava thrombus above the diaphragm (p = 0.02) and sarcomatoid features (p = 0.005). Conclusions: Poor overall survival following cytoreductive nephrectomy in patients with metastatic renal cell carcinoma with tumor thrombus is associated with inferior vena cava thrombus above the diaphragm, poor risk group, systemic symptoms or sarcomatoid dedifferentiation. Patients with expected poor overall survival should be considered for preoperative systemic therapy clinical trials.

KW - Carcinoma

KW - Inferior

KW - Mortality

KW - Neoplasm metastasis

KW - Renal cell

KW - Thrombosis

KW - Vena cava

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