Introduction:

The vascular margin after radical nephrectomy with tumor thrombectomy for RCC is difficult to interpret clinically. We examined the prognostic implications of positive vascular margins (PVM) based on the strict definition of tumor cells invading the vein wall at the surgical margin.

Methods:

Retrospective review identified 85 patients with pT3N0M0 renal cell carcinoma who underwent radical nephrectomy with tumor thrombectomy between 2001-2017 at the University of Chicago. Kaplan-Meier analysis was used to evaluate if a PVM was associated with recurrence-free survival (RFS) or overall survival (OS).

Results:

Tumor invasion at the venous margin was identified in 39 patients (46%). Tumor thrombus level (Mayo) was 0 in 41 (48%), I in 11 (13%), II in 17 (20%), III in 10 (12%), and IV in 6 (7%).  Patients with a PVM were more likely to have thrombus within the IVC, 74% level I or higher vs 33% in negative margin (NVM) group (p=0.002). At a median follow-up of 32 months, there was no difference in local recurrence: 8% PVM vs 11% NVM (p=0.7). Median RFS was 6.3 and 7.9 months, respectively (p-log-rank =0.7). The 2 and 5-year OS were 88% and 78% for NVM and 84% and 65% for PVM.  (p-log-rank =0.6). Controlling for tumor diameter, margin status was not a predictor of RFS (p=0.8).

Conclusion:

Recurrence-free and overall survival after radical nephrectomy with tumor thrombectomy for RCC do not appear to be impacted by a positive vascular margin. Vascular wall invasion is likely a surrogate of aggressive disease without prognostic impact.

Funding: N/A