A proposal of post-operative nomogram for overall survival in patients with renal cell carcinoma and venous tumor thrombus.

OBJECTIVETo identify the predictors of overall survival (OS) and create a post-operative prognostic model for patients with renal cell carcinoma (RCC) and venous tumor thrombus (VTT). PATIENTS AND METHODSThe study cohort included patients with RCC and VTT that underwent full surgical resection between 2006 and 2016. Univariate and multivariate analyses were used to determine the prognostic factors of OS. A nomogram was developed and internally calibrated by bootstrap resampling method. RESULTSA total of 185 patients were identified, including patients with thrombus present in the renal vein (109 patients, 58.9%), infrahepatic inferior vena cava (IVC; 68 patients, 36.8%), and suprahepatic IVC (8 patients, 4.3%). After a median follow-up of 30.2 months (interquartile range, 12.1-48.4 months), 63 (34.1%) patients died. Independent prognostic factors for OS included histological subtype, collecting system invasion, metastasis at surgery, De Ritis ratio (AST/ALT), and serum albumin. Independently predictive variables were used to create a nomogram, which achieved a concordance index of 0.75 for OS. CONCLUSIONSFor patients with RCC and VTT, the developed and internally validated post-operative nomogram can be used to select patients who may benefit from aggressive surveillance regimens or adjuvant therapy clinical trials.