Risk factors for recurrence after surgery in non-metastatic RCC with thrombus: A contemporary multicentre analysis

E. Jason Abel, Vitaly Margulis, Tyler M. Bauman, Jose A. Karam, William P. Christensen, Laura Maria Krabbe, Ahmed Haddad, Vishnukamal Golla, Christopher G. Wood

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Abstract

Objective: To determine the predictors of post-surgical recurrence for patients with non-metastatic renal cell carcinoma (RCC) and venous thrombus. Methods: Records from consecutive patients with non-metastatic RCC with tumour thrombus, treated surgically between 2000 and 2012 at one of three centres, were reviewed. Univariable and multivariable analysis were used to evaluate the association of risk factors for post-surgical recurrence. Results: A total of 465 patients with non-metastatic RCC were identified, including patients with thrombus present in the renal vein (257 patients, 55.3%), infrahepatic inferior vena cava (IVC; 144 patients, 31.0%) and suprahepatic IVC (64 patients, 13.8%). The median (interquartile range) follow-up was 28.3 (12.2-56.4) months, with metastatic RCC developing in 188 patients (40.5%). Independent predictors of recurrence included: body mass index ≤20 kg/m2 (hazard ratio [HR] 2.66; 95% confidence interval [CI] 1.29-5.49), low preoperative haemoglobin (HR 1.54; 95% CI 1.07-2.20), perinephric fat invasion (HR 1.51; 95% CI 1.09-2.10), IVC thrombus height (HR 2.64; 95% CI 1.47-4.74), tumour diameter (HR 1.04 95% CI 1.00-1.09), nuclear grade (HR 1.56 95% CI 1.12-2.15) and non-clear-cell histology (HR 2.13; 95% CI 1.30-3.50). Independently predictive variables were used to create a recurrence model for three risk groups based on 0, 1-2, or >2 risk factors, respectively. The 5-year recurrence-free survival rate was significantly different in patients with favourable-risk (79.1%) compared with intermediate- (55.1%) or high-risk (22.1%) disease (P <0.001). Conclusions: Seven risk factors for recurrence were identified for patients with non-metastatic RCC with thrombus, which can be used to select patients who may benefit from increased surveillance or adjuvant therapy clinical trials.

Original languageEnglish (US)
JournalBJU International
DOIs
StateAccepted/In press - 2015

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Renal Cell Carcinoma
Thrombosis
Recurrence
Confidence Intervals
Renal Veins
Inferior Vena Cava
Neoplasms
Histology
Hemoglobins
Body Mass Index
Survival Rate
Fats
Clinical Trials

Keywords

  • Kidney cancer
  • Outcomes
  • Recurrence
  • Renal cell carcinoma
  • Thrombus

ASJC Scopus subject areas

  • Urology

Cite this

Risk factors for recurrence after surgery in non-metastatic RCC with thrombus : A contemporary multicentre analysis. / Abel, E. Jason; Margulis, Vitaly; Bauman, Tyler M.; Karam, Jose A.; Christensen, William P.; Krabbe, Laura Maria; Haddad, Ahmed; Golla, Vishnukamal; Wood, Christopher G.

In: BJU International, 2015.

Research output: Contribution to journalArticle

Abel, E. Jason ; Margulis, Vitaly ; Bauman, Tyler M. ; Karam, Jose A. ; Christensen, William P. ; Krabbe, Laura Maria ; Haddad, Ahmed ; Golla, Vishnukamal ; Wood, Christopher G. / Risk factors for recurrence after surgery in non-metastatic RCC with thrombus : A contemporary multicentre analysis. In: BJU International. 2015.
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abstract = "Objective: To determine the predictors of post-surgical recurrence for patients with non-metastatic renal cell carcinoma (RCC) and venous thrombus. Methods: Records from consecutive patients with non-metastatic RCC with tumour thrombus, treated surgically between 2000 and 2012 at one of three centres, were reviewed. Univariable and multivariable analysis were used to evaluate the association of risk factors for post-surgical recurrence. Results: A total of 465 patients with non-metastatic RCC were identified, including patients with thrombus present in the renal vein (257 patients, 55.3{\%}), infrahepatic inferior vena cava (IVC; 144 patients, 31.0{\%}) and suprahepatic IVC (64 patients, 13.8{\%}). The median (interquartile range) follow-up was 28.3 (12.2-56.4) months, with metastatic RCC developing in 188 patients (40.5{\%}). Independent predictors of recurrence included: body mass index ≤20 kg/m2 (hazard ratio [HR] 2.66; 95{\%} confidence interval [CI] 1.29-5.49), low preoperative haemoglobin (HR 1.54; 95{\%} CI 1.07-2.20), perinephric fat invasion (HR 1.51; 95{\%} CI 1.09-2.10), IVC thrombus height (HR 2.64; 95{\%} CI 1.47-4.74), tumour diameter (HR 1.04 95{\%} CI 1.00-1.09), nuclear grade (HR 1.56 95{\%} CI 1.12-2.15) and non-clear-cell histology (HR 2.13; 95{\%} CI 1.30-3.50). Independently predictive variables were used to create a recurrence model for three risk groups based on 0, 1-2, or >2 risk factors, respectively. The 5-year recurrence-free survival rate was significantly different in patients with favourable-risk (79.1{\%}) compared with intermediate- (55.1{\%}) or high-risk (22.1{\%}) disease (P <0.001). Conclusions: Seven risk factors for recurrence were identified for patients with non-metastatic RCC with thrombus, which can be used to select patients who may benefit from increased surveillance or adjuvant therapy clinical trials.",
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T1 - Risk factors for recurrence after surgery in non-metastatic RCC with thrombus

T2 - A contemporary multicentre analysis

AU - Abel, E. Jason

AU - Margulis, Vitaly

AU - Bauman, Tyler M.

AU - Karam, Jose A.

AU - Christensen, William P.

AU - Krabbe, Laura Maria

AU - Haddad, Ahmed

AU - Golla, Vishnukamal

AU - Wood, Christopher G.

PY - 2015

Y1 - 2015

N2 - Objective: To determine the predictors of post-surgical recurrence for patients with non-metastatic renal cell carcinoma (RCC) and venous thrombus. Methods: Records from consecutive patients with non-metastatic RCC with tumour thrombus, treated surgically between 2000 and 2012 at one of three centres, were reviewed. Univariable and multivariable analysis were used to evaluate the association of risk factors for post-surgical recurrence. Results: A total of 465 patients with non-metastatic RCC were identified, including patients with thrombus present in the renal vein (257 patients, 55.3%), infrahepatic inferior vena cava (IVC; 144 patients, 31.0%) and suprahepatic IVC (64 patients, 13.8%). The median (interquartile range) follow-up was 28.3 (12.2-56.4) months, with metastatic RCC developing in 188 patients (40.5%). Independent predictors of recurrence included: body mass index ≤20 kg/m2 (hazard ratio [HR] 2.66; 95% confidence interval [CI] 1.29-5.49), low preoperative haemoglobin (HR 1.54; 95% CI 1.07-2.20), perinephric fat invasion (HR 1.51; 95% CI 1.09-2.10), IVC thrombus height (HR 2.64; 95% CI 1.47-4.74), tumour diameter (HR 1.04 95% CI 1.00-1.09), nuclear grade (HR 1.56 95% CI 1.12-2.15) and non-clear-cell histology (HR 2.13; 95% CI 1.30-3.50). Independently predictive variables were used to create a recurrence model for three risk groups based on 0, 1-2, or >2 risk factors, respectively. The 5-year recurrence-free survival rate was significantly different in patients with favourable-risk (79.1%) compared with intermediate- (55.1%) or high-risk (22.1%) disease (P <0.001). Conclusions: Seven risk factors for recurrence were identified for patients with non-metastatic RCC with thrombus, which can be used to select patients who may benefit from increased surveillance or adjuvant therapy clinical trials.

AB - Objective: To determine the predictors of post-surgical recurrence for patients with non-metastatic renal cell carcinoma (RCC) and venous thrombus. Methods: Records from consecutive patients with non-metastatic RCC with tumour thrombus, treated surgically between 2000 and 2012 at one of three centres, were reviewed. Univariable and multivariable analysis were used to evaluate the association of risk factors for post-surgical recurrence. Results: A total of 465 patients with non-metastatic RCC were identified, including patients with thrombus present in the renal vein (257 patients, 55.3%), infrahepatic inferior vena cava (IVC; 144 patients, 31.0%) and suprahepatic IVC (64 patients, 13.8%). The median (interquartile range) follow-up was 28.3 (12.2-56.4) months, with metastatic RCC developing in 188 patients (40.5%). Independent predictors of recurrence included: body mass index ≤20 kg/m2 (hazard ratio [HR] 2.66; 95% confidence interval [CI] 1.29-5.49), low preoperative haemoglobin (HR 1.54; 95% CI 1.07-2.20), perinephric fat invasion (HR 1.51; 95% CI 1.09-2.10), IVC thrombus height (HR 2.64; 95% CI 1.47-4.74), tumour diameter (HR 1.04 95% CI 1.00-1.09), nuclear grade (HR 1.56 95% CI 1.12-2.15) and non-clear-cell histology (HR 2.13; 95% CI 1.30-3.50). Independently predictive variables were used to create a recurrence model for three risk groups based on 0, 1-2, or >2 risk factors, respectively. The 5-year recurrence-free survival rate was significantly different in patients with favourable-risk (79.1%) compared with intermediate- (55.1%) or high-risk (22.1%) disease (P <0.001). Conclusions: Seven risk factors for recurrence were identified for patients with non-metastatic RCC with thrombus, which can be used to select patients who may benefit from increased surveillance or adjuvant therapy clinical trials.

KW - Kidney cancer

KW - Outcomes

KW - Recurrence

KW - Renal cell carcinoma

KW - Thrombus

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