Introduction:
Surgery for renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus is a complex procedure with significant morbidity. Patient selection is critical for the benefit to outweigh the risk of the procedure. We aim to identify and stratify risk factors associated with overall survival (OS) in patients with RCC with IVC thrombus.
Methods:
We retrospectively reviewed our institutional database and identified patients with RCC with IVC tumor thrombus (pT3b, pT3c) who underwent radical nephrectomy with tumor thrombectomy between December 1993 and June 2009. Kaplan-Meier method was used to determine the median OS. Cox proportional hazards models were applied to determine the association between risk factors and OS. A risk score was obtained by rounding each result to the nearest integer and using the group with less risk of dying as the reference.
Results:
Two hundred and twenty-one patients were eligible with a median follow-up of 26.9 months (interquartile range: 10.1-64.7 months). A total of 45.2% had metastasis at presentation, 84.3% had cT3B, and 90.8% had clear cell RCC. The factors significantly associated with the risk of death are cT3c, cN1, and cM1. For the risk score, patients were stratified into 3 groups depending on the number of risk factors (RF) present at diagnosis. Group 1 (0 RF) had a median OS of 77.6 months (95% CI, 50.5-90.4), group 2 (1 RF) had a median OS of 26.0 months (95% CI, 19.5-35.2), and group 3 (≥2 RF) had a median OS of 8.9 months (95% CI, 5.2-12.9); p<0.001.
Conclusion:
In patients with RCC and IVC thrombus, stratification of patients allows us to predict survival. In patients with a score ≥ 2, new strategies with preoperative systemic therapy could be considered to improve survival.
Funding: N/A
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Predictors of Survival in Surgical Patients with Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus
Category
Kidney Cancer > Advanced
Description
Poster #17
Wednesday, Dec 1
2:00 p.m. - 3:00 p.m.
Kidney 1
Presented By: Alberto Pieretti
Authors:
Alberto Pieretti
Mary E. Westerman
Graciela M. Nogueras-Gonzales
Manuel Ozambela
Luis A. Segarra
Ara Vaporciyan
Wayne Hofstetter
Tam Huynh
Saad Aldousari
Surena F. Matin
Christopher G. Wood
Jose A. Karam