Oncologic Outcomes of Renal Cell Carcinoma Patients Undergoing Radical Nephrectomy and Venous Thrombectomy: Prospective Follow-Up from a Single Center

Abstract

Purpose. To evaluate the long-term oncologic outcomes of renal cell carcinoma (RCC) patients with venous thrombus after radical nephrectomy and venous thrombectomy (RN-VT) and to determine the prognostic factors. Methods and Materials. We reported our follow-up data of RCC patients with venous thrombus from January 2014 to September 2020. We used the Kaplan-Meier method to assess the overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). The Cox proportional hazards regression model and competing risk model were used. Results. After a median follow-up of 31 mon, eight-five patients (31.5%) died, and cancer-specific deaths occurred in 60 patients (22.2%). The 1 yr and 3 yr CSS were 89.3% and 72.7%, respectively. The median OS was 56.0 mon (95% CI 47.6-64.3 mon), and the 1 yr, 3 yr, and 5 yr OS were 87.0%, 62.1%, and 44.8%, respectively. For M1 patients, the median OS was 27.0 mon (95% CI 22.0-42.0 mon), and the 1 yr, 3 yr, and 5 yr OS were 78.0%, 41.5%, and 23.3%, respectively. For M0 patients, the median RFS was 38.0 mon (95% CI 32.5-43.5 mon), and the 1 yr and 3 yr RFS were 81.2% and 52.3%, respectively. Multivariate analyses showed that papillary RCC (HR 2.95, 95% CI 1.80-4.82, $P<0.001$ ) or other RCC (HR 3.88, 95% CI 2.03-7.41, $P<0.001$ ), perinephric fat invasion (HR 1.53, 95% CI 1.03-2.26, $P=0.04$ ), sarcomatoid differentiation (HR 2.85, 95% CI 1.64-4.95, $P<0.001$ ), Fuhrman grade 3 (HR 2.10, 95% CI 1.28-3.44, $P=0.003$ ) or 4 (HR 3.55, 95% CI 2.09-6.03, $P<0.001$ ), and distant metastasis (HR 1.76, 95% CI 1.18-2.63, $P=0.006$ ) were associated with a worse CSS. Adjuvant therapy (HR 0.63, 95% CI 0.43-0.92, $P=0.02$ ) was associated with a better CSS. Conclusions. RCC patients can have an acceptable long-term survival after RN-VT. Prognostic factors influencing CSS included nonclear cell RCC histology, higher Fuhrman grade, sarcomatoid differentiation, perinephric fat invasion, distant metastasis, and adjuvant therapy.