Oncologic outcomes following surgical resection of renal cell carcinoma with inferior vena caval thrombus extending above the hepatic veins: A contemporary multicenter cohort

Ahmed Q. Haddad, Christopher G. Wood, E. Jason Abel, Laura Maria Krabbe, Oussama M. Darwish, R. Houston Thompson, Jennifer E. Heckman, Megan M. Merril, Bishoy A. Gayed, Arthur I. Sagalowsky, Stephen A. Boorjian, Vitaly Margulis, Bradley C. Leibovich

Research output: Contribution to journalArticle

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Abstract

Purpose Suprahepatic inferior vena caval tumor thrombus in renal cell carcinoma cases has historically portended a poor prognosis. With advances in perioperative treatment of patients with high level thrombus contemporary outcomes are hypothesized to be improved. We evaluated long-term oncologic outcomes of contemporary surgical treatment of patients with renal cell carcinoma in whom level III-IV inferior vena caval thrombus was managed at high volume centers. Materials and Methods We examined clinical and pathological data on patients with renal cell carcinoma and level III-IV thrombus treated with surgery from January 2000 to June 2013 at 4 tertiary referral centers. Survival outcomes and associated prognostic variables were assessed by Kaplan-Meier and multivariate Cox regression analyses. Results We identified 166 patients, including 69 with level III and 97 with level IV thrombus. Median postoperative followup was 27.8 months. Patients with no evidence of nodal or distant metastasis (pN0/X, M0) had 5-year 49.0% cancer specific survival and 42.2% overall survival. There was no difference in survival based on tumor thrombus level or pathological tumor stage. Variables associated with an increased risk of death from kidney cancer on multivariate analysis were regional nodal metastases (HR 3.94, p <0.0001), systemic metastases (HR 2.39, p = 0.01), tumor grade 4 (HR 2.25, p = 0.02), histological tissue necrosis (HR 3.11, p = 0.004) and increased preoperative serum alkaline phosphatase (HR 2.30, p = 0.006). Conclusions Contemporary surgical management achieves almost 50% 5-year survival in patients without metastasis who have renal cell carcinoma thrombus above the hepatic veins. Factors associated with increased mortality included nodal/distant metastases, advanced grade, histological necrosis and increased preoperative serum alkaline phosphatase. These findings support an aggressive surgical approach to the treatment of patients with renal cell carcinoma who have advanced tumor thrombus.

Original languageEnglish (US)
Pages (from-to)1050-1056
Number of pages7
JournalJournal of Urology
Volume192
Issue number4
DOIs
StatePublished - Oct 1 2014

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Venae Cavae
Hepatic Veins
Renal Cell Carcinoma
Thrombosis
Neoplasm Metastasis
Survival
Neoplasms
Alkaline Phosphatase
Necrosis
Kidney Neoplasms
Serum
Tertiary Care Centers
Therapeutics
Multivariate Analysis
Regression Analysis
Mortality

Keywords

  • carcinoma
  • inferior
  • kidney
  • mortality
  • renal cell
  • thrombosis
  • vena cava

ASJC Scopus subject areas

  • Urology
  • Medicine(all)

Cite this

Oncologic outcomes following surgical resection of renal cell carcinoma with inferior vena caval thrombus extending above the hepatic veins : A contemporary multicenter cohort. / Haddad, Ahmed Q.; Wood, Christopher G.; Abel, E. Jason; Krabbe, Laura Maria; Darwish, Oussama M.; Thompson, R. Houston; Heckman, Jennifer E.; Merril, Megan M.; Gayed, Bishoy A.; Sagalowsky, Arthur I.; Boorjian, Stephen A.; Margulis, Vitaly; Leibovich, Bradley C.

In: Journal of Urology, Vol. 192, No. 4, 01.10.2014, p. 1050-1056.

Research output: Contribution to journalArticle

Haddad, AQ, Wood, CG, Abel, EJ, Krabbe, LM, Darwish, OM, Thompson, RH, Heckman, JE, Merril, MM, Gayed, BA, Sagalowsky, AI, Boorjian, SA, Margulis, V & Leibovich, BC 2014, 'Oncologic outcomes following surgical resection of renal cell carcinoma with inferior vena caval thrombus extending above the hepatic veins: A contemporary multicenter cohort', Journal of Urology, vol. 192, no. 4, pp. 1050-1056. https://doi.org/10.1016/j.juro.2014.03.111
Haddad, Ahmed Q. ; Wood, Christopher G. ; Abel, E. Jason ; Krabbe, Laura Maria ; Darwish, Oussama M. ; Thompson, R. Houston ; Heckman, Jennifer E. ; Merril, Megan M. ; Gayed, Bishoy A. ; Sagalowsky, Arthur I. ; Boorjian, Stephen A. ; Margulis, Vitaly ; Leibovich, Bradley C. / Oncologic outcomes following surgical resection of renal cell carcinoma with inferior vena caval thrombus extending above the hepatic veins : A contemporary multicenter cohort. In: Journal of Urology. 2014 ; Vol. 192, No. 4. pp. 1050-1056.
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abstract = "Purpose Suprahepatic inferior vena caval tumor thrombus in renal cell carcinoma cases has historically portended a poor prognosis. With advances in perioperative treatment of patients with high level thrombus contemporary outcomes are hypothesized to be improved. We evaluated long-term oncologic outcomes of contemporary surgical treatment of patients with renal cell carcinoma in whom level III-IV inferior vena caval thrombus was managed at high volume centers. Materials and Methods We examined clinical and pathological data on patients with renal cell carcinoma and level III-IV thrombus treated with surgery from January 2000 to June 2013 at 4 tertiary referral centers. Survival outcomes and associated prognostic variables were assessed by Kaplan-Meier and multivariate Cox regression analyses. Results We identified 166 patients, including 69 with level III and 97 with level IV thrombus. Median postoperative followup was 27.8 months. Patients with no evidence of nodal or distant metastasis (pN0/X, M0) had 5-year 49.0{\%} cancer specific survival and 42.2{\%} overall survival. There was no difference in survival based on tumor thrombus level or pathological tumor stage. Variables associated with an increased risk of death from kidney cancer on multivariate analysis were regional nodal metastases (HR 3.94, p <0.0001), systemic metastases (HR 2.39, p = 0.01), tumor grade 4 (HR 2.25, p = 0.02), histological tissue necrosis (HR 3.11, p = 0.004) and increased preoperative serum alkaline phosphatase (HR 2.30, p = 0.006). Conclusions Contemporary surgical management achieves almost 50{\%} 5-year survival in patients without metastasis who have renal cell carcinoma thrombus above the hepatic veins. Factors associated with increased mortality included nodal/distant metastases, advanced grade, histological necrosis and increased preoperative serum alkaline phosphatase. These findings support an aggressive surgical approach to the treatment of patients with renal cell carcinoma who have advanced tumor thrombus.",
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T1 - Oncologic outcomes following surgical resection of renal cell carcinoma with inferior vena caval thrombus extending above the hepatic veins

T2 - A contemporary multicenter cohort

AU - Haddad, Ahmed Q.

AU - Wood, Christopher G.

AU - Abel, E. Jason

AU - Krabbe, Laura Maria

AU - Darwish, Oussama M.

AU - Thompson, R. Houston

AU - Heckman, Jennifer E.

AU - Merril, Megan M.

AU - Gayed, Bishoy A.

AU - Sagalowsky, Arthur I.

AU - Boorjian, Stephen A.

AU - Margulis, Vitaly

AU - Leibovich, Bradley C.

PY - 2014/10/1

Y1 - 2014/10/1

N2 - Purpose Suprahepatic inferior vena caval tumor thrombus in renal cell carcinoma cases has historically portended a poor prognosis. With advances in perioperative treatment of patients with high level thrombus contemporary outcomes are hypothesized to be improved. We evaluated long-term oncologic outcomes of contemporary surgical treatment of patients with renal cell carcinoma in whom level III-IV inferior vena caval thrombus was managed at high volume centers. Materials and Methods We examined clinical and pathological data on patients with renal cell carcinoma and level III-IV thrombus treated with surgery from January 2000 to June 2013 at 4 tertiary referral centers. Survival outcomes and associated prognostic variables were assessed by Kaplan-Meier and multivariate Cox regression analyses. Results We identified 166 patients, including 69 with level III and 97 with level IV thrombus. Median postoperative followup was 27.8 months. Patients with no evidence of nodal or distant metastasis (pN0/X, M0) had 5-year 49.0% cancer specific survival and 42.2% overall survival. There was no difference in survival based on tumor thrombus level or pathological tumor stage. Variables associated with an increased risk of death from kidney cancer on multivariate analysis were regional nodal metastases (HR 3.94, p <0.0001), systemic metastases (HR 2.39, p = 0.01), tumor grade 4 (HR 2.25, p = 0.02), histological tissue necrosis (HR 3.11, p = 0.004) and increased preoperative serum alkaline phosphatase (HR 2.30, p = 0.006). Conclusions Contemporary surgical management achieves almost 50% 5-year survival in patients without metastasis who have renal cell carcinoma thrombus above the hepatic veins. Factors associated with increased mortality included nodal/distant metastases, advanced grade, histological necrosis and increased preoperative serum alkaline phosphatase. These findings support an aggressive surgical approach to the treatment of patients with renal cell carcinoma who have advanced tumor thrombus.

AB - Purpose Suprahepatic inferior vena caval tumor thrombus in renal cell carcinoma cases has historically portended a poor prognosis. With advances in perioperative treatment of patients with high level thrombus contemporary outcomes are hypothesized to be improved. We evaluated long-term oncologic outcomes of contemporary surgical treatment of patients with renal cell carcinoma in whom level III-IV inferior vena caval thrombus was managed at high volume centers. Materials and Methods We examined clinical and pathological data on patients with renal cell carcinoma and level III-IV thrombus treated with surgery from January 2000 to June 2013 at 4 tertiary referral centers. Survival outcomes and associated prognostic variables were assessed by Kaplan-Meier and multivariate Cox regression analyses. Results We identified 166 patients, including 69 with level III and 97 with level IV thrombus. Median postoperative followup was 27.8 months. Patients with no evidence of nodal or distant metastasis (pN0/X, M0) had 5-year 49.0% cancer specific survival and 42.2% overall survival. There was no difference in survival based on tumor thrombus level or pathological tumor stage. Variables associated with an increased risk of death from kidney cancer on multivariate analysis were regional nodal metastases (HR 3.94, p <0.0001), systemic metastases (HR 2.39, p = 0.01), tumor grade 4 (HR 2.25, p = 0.02), histological tissue necrosis (HR 3.11, p = 0.004) and increased preoperative serum alkaline phosphatase (HR 2.30, p = 0.006). Conclusions Contemporary surgical management achieves almost 50% 5-year survival in patients without metastasis who have renal cell carcinoma thrombus above the hepatic veins. Factors associated with increased mortality included nodal/distant metastases, advanced grade, histological necrosis and increased preoperative serum alkaline phosphatase. These findings support an aggressive surgical approach to the treatment of patients with renal cell carcinoma who have advanced tumor thrombus.

KW - carcinoma

KW - inferior

KW - kidney

KW - mortality

KW - renal cell

KW - thrombosis

KW - vena cava

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