Outcome of surgery for patients with renal cell carcinoma and tumour thrombus in the era of modern targeted therapy.
OBJECTIVE
This study evaluated the clinical outcome of patients with renal cell carcinoma (RCC) with tumour thrombus (TT) after surgical management.


METHODS
In total, 142 consecutive RCC patients with TT who were operated on in Helsinki University Hospital between 2006 and 2014 were analysed. Eighty-eight (62%) of these patients had been operated on with radical intention and 54 (38%) with cytoreductive intention. A total of 73 patients (51%) received postoperative targeted therapy. The primary endpoint was cancer-specific survival (CSS).


RESULTS
The 5 year CSS for level of involvement of TT in the renal vein, subdiaphragmatic vena cava and supradiaphragmatic vena cava was 60% (81 patients), 43% (52 patients) and 51% (nine patients), respectively (p = .42). The median CSS for lymph-node involvement was 63 months for patients with no lymph-node involvement but 10 months for patients with lymph-node involvement (p < .01). The median CSS for metastasis status was 63 months for patients with no metastases compared with 18 months for patients with metastases (p < .01). Among several factors examined, WHO performance status (p = .04), tumour necrosis (p = .05), presence of distant metastases (p = .04) and tumour histology (p = .05) were associated with CSS in the multivariate analysis.


CONCLUSIONS
Operative treatment for RCC with TT is associated with good prognosis when there is no lymph-node involvement or distant metastases.
a Department of Urology , Helsinki University Hospital , Helsinki , Finland ;|b University of Helsinki , Faculty of Medicine , Helsinki , Finland ;
Sara V
SV
Tornberg
a Department of Urology , Helsinki University Hospital , Helsinki , Finland ;|b University of Helsinki , Faculty of Medicine , Helsinki , Finland ;
Harry
H
Nisen
a Department of Urology , Helsinki University Hospital , Helsinki , Finland ;|b University of Helsinki , Faculty of Medicine , Helsinki , Finland ;|c Comprehensive Cancer Center , Helsinki University Hospital , Helsinki , Finland ;
Harri
H
Visapää
a Department of Urology , Helsinki University Hospital , Helsinki , Finland ;|b University of Helsinki , Faculty of Medicine , Helsinki , Finland ;
Tuomas P
TP
Kilpeläinen
a Department of Urology , Helsinki University Hospital , Helsinki , Finland ;|b University of Helsinki , Faculty of Medicine , Helsinki , Finland ;
Riikka
R
Järvinen
b University of Helsinki , Faculty of Medicine , Helsinki , Finland ;|d Department of Pathology at HUSLAB Laboratory Services , Helsinki University Hospital , Helsinki , Finland ;|e Institute for Molecular Medicine Finland (FIMM) and Medicum , University of Helsinki , Finland ;
Tuomas
T
Mirtti
b University of Helsinki , Faculty of Medicine , Helsinki , Finland ;|f Department of Vascular Surgery , Helsinki University Hospital , Helsinki , Finland ;
Ilkka
I
Kantonen
b University of Helsinki , Faculty of Medicine , Helsinki , Finland ;|g Heart and Lung Center , Helsinki University Hospital , Helsinki , Finland.
Jarmo
J
Simpanen
b University of Helsinki , Faculty of Medicine , Helsinki , Finland ;|c Comprehensive Cancer Center , Helsinki University Hospital , Helsinki , Finland ;
Petri
P
Bono
a Department of Urology , Helsinki University Hospital , Helsinki , Finland ;|b University of Helsinki , Faculty of Medicine , Helsinki , Finland ;
Kimmo
K
Taari
a Department of Urology , Helsinki University Hospital , Helsinki , Finland ;|b University of Helsinki , Faculty of Medicine , Helsinki , Finland ;
Petrus
P
Järvinen
D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
Complications; prognostic factors; renal cell carcinoma; surgery; tumour thrombus