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Does Tumor Thrombus Affect Outcomes With Cytoreductive Nephrectomy?

By: Kayci Reyer
Posted: Tuesday, April 23, 2019

More than one-quarter of patients with metastatic renal cell carcinoma develop tumor thrombus, and the presence of tumor thrombus appears to be linked to increased rates of cytoreductive nephrectomy. According to research published in Urologic Oncology, there seems to be an association between cytoreductive nephrectomy and outcomes for these patients, but the location of thrombus may determine whether there is a survival benefit or not.

“Despite discrepancies in utilization, [cytroreductive nephrectomy] is associated with improved [overall survival], although this affect appears to be limited to those with metastatic renal cell carcinoma and tumor thrombus limited to the renal vein and infradiaphragmatic [inferior vena cava],” concluded Andrew T. Lenis, MD, MS, of the David Geffen School of Medicine at the University of California Los Angeles, and colleagues.

Using the National Cancer Database, the researchers identified 8,629 patients diagnosed with metastatic renal cell carcinoma between 2010 and 2013. Of the 8,134 patients who met inclusion criteria, 2,334 (28.7%) also had tumor thrombus. Tumor thrombus was present in the renal vein in 78.2%, the infradiaphragmatic inferior vena cava in 16.5%, and the supradiaphragmatic inferior vena cava in 5.4%.

An association was noted between cytoreductive nephrectomy utilization and improved overall survival in both patients without thrombus and patients with either renal vein or infradiaphragmatic thrombus (all P < .01). Overall, the use of cytoreductive nephrectomy did not benefit patients with supradiaphragmatic thrombus (P = .46).

In addition, the investigators found an association between thrombus diagnosis and an increased frequency of cytoreductive nephrectomy use. However, as the thrombus level increased, an inverse correlation with cytoreductive nephrectomy utilization was observed.

Disclosure: The study authors’ disclosure information may be found at sciencedirect.com.



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