Surgical Management and Oncologic Outcomes of Renal Cell Carcinoma and Inferior Vena Caval Thrombi With Aggressive Histologic Variants.

Autor: Lewis KC; Cleveland Clinic Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH. Electronic address: Kevinchlewis@gmail.com., Werneburg GT; Cleveland Clinic Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH., Dewitt-Foy ME; Cleveland Clinic Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH., Lundy SD; Cleveland Clinic Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH., Eltemamy M; Cleveland Clinic Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH., Murthy PB; Cleveland Clinic Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH., Przybycin CG; Cleveland Clinic Learner College of Medicine, Department of Pathology, Cleveland, OH., Campbell SC; Cleveland Clinic Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH., Weight C; Cleveland Clinic Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH., Krishnamurthi V; Cleveland Clinic Glickman Urological and Kidney Institute, Department of Urology, Cleveland, OH.
Jazyk: angličtina
Zdroj: Urology [Urology] 2024 Feb; Vol. 184, pp. 128-134. Date of Electronic Publication: 2023 Nov 02.
DOI: 10.1016/j.urology.2023.10.015
Abstrakt: Objective: To characterize the surgical management, perioperative, and cancer-specific outcomes, and the influence of aggressive histologic variants (AHV) on operative management among patients with renal cell carcinoma (RCC) and inferior vena cava (IVC) thrombus. RCC with rhabdoid and/or sarcomatoid differentiation, which we defined as AHV, portends a worse prognosis. AHV can be associated with a desmoplastic reaction which may complicate resection.
Methods: We reviewed patients undergoing radical nephrectomy and IVC thrombectomy between 1990 and 2020. Comparative statistics were employed as appropriate. Survival analysis was performed according to the Kaplan-Meier method, and intergroup analysis performed with log-rank statistics. Multivariable cox proportional hazards regression was used to assess the effect of AHV, age, thrombus level, vena cavectomy, metastases, and medical comorbidities on recurrence and overall survival (OS).
Results: Ninety-four of 403 (23.3%) patients had AHV, including 43 (46%) rhabdoid, 39 (41%) sarcomatoid, and 12 (13%) with both. AHV were more likely to present with advanced disease; however, increased perioperative complications or decreased OS were not observed. Median (IQR) survival was 16.7 (4.8-47) months without AHV and 12.6 (4-29) months with AHV (P = .157). Sarcomatoid differentiation was independently associated with worse OS (HR = 2.016, CI 1.38-2.95, P <.001), whereas rhabdoid alone or with sarcomatoid demonstrated similar OS (P = 0.063).
Conclusion: RCC and IVC thrombus with AHV are more likely to present with metastatic disease, and sarcomatoid differentiation is associated with a worse OS. Resection of tumors with and without AHV have similar perioperative complications, suggesting that surgery can be safely accomplished in patients with RCC and IVC thrombus with AHV.
Competing Interests: Declaration of Competing Interest All authors have no conflicts of interest to disclose.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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