Venous tumour thrombus in renal cell carcinoma: locally advanced or metastatic disease?

You have accessJournal of UrologyCME1 Apr 2023MP58-12 VENOUS TUMOUR THROMBUS IN RENAL CELL CARCINOMA: LOCALLY ADVANCED OR METASTATIC DISEASE? Giacomo Musso, Giuseppe Basile, Alessandro Nini, Giuseppe Rosiello, Giuseppe Fallara, Chiara Re, Francesco Cei, Federico Belladelli, Daniele Cignoli, Roberta Lucianò, Nazario Tenace, Isaline Rowe, Silvia Patricia Soares Pinto, Daniela Canibus, Andrea Necchi, Laura Marandino, Daniele Raggi, Roberto Bertini, Rayan Matloob, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Alessandro Larcher, and Umberto Capitanio Giacomo MussoGiacomo Musso More articles by this author , Giuseppe BasileGiuseppe Basile More articles by this author , Alessandro NiniAlessandro Nini More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Chiara ReChiara Re More articles by this author , Francesco CeiFrancesco Cei More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Roberta LucianòRoberta Lucianò More articles by this author , Nazario TenaceNazario Tenace More articles by this author , Isaline RoweIsaline Rowe More articles by this author , Silvia Patricia Soares PintoSilvia Patricia Soares Pinto More articles by this author , Daniela CanibusDaniela Canibus More articles by this author , Andrea NecchiAndrea Necchi More articles by this author , Laura MarandinoLaura Marandino More articles by this author , Daniele RaggiDaniele Raggi More articles by this author , Roberto BertiniRoberto Bertini More articles by this author , Rayan MatloobRayan Matloob More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , and Umberto CapitanioUmberto Capitanio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003311.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal cell carcinoma (RCC) with venous tumour thrombus (TT) is associated with worse outcomes. It is debated whether the presence of TT should be classified as a locally advanced or metastatic disease. The aim of the study is to compare the survival outcomes of patients with TT to those with lymphatic or metastatic involvement. METHODS: Overall, 79 TT+ cN0 cM0 (Group A) patients, 235 TT- cN1 cM0 (Group B) and 114 TT- cN0 single site cM1 (Group C) treated with radical (RN) or partial nephrectomy (PN) (with thrombectomy, in case of TT) were identified from a prospectively collected single-center database of 3,796 patients. Kaplan-Meier curves were used to compare the 5-yr progression-free survival (PFS) and cancer-specific survival (CSS) among the three groups. Finally, univariable and multivariable Cox regression analyses (MVA) investigated predictors of progression and cancer-specific mortality (CSM) among age, gender, Charlson comorbidity index, tumour size, tumour grade and the three different groups of patients. RESULTS: After a median follow-up of 43 months [interquartile range (IQR): 20-78], the 5-yr PFS rates were 37% (95%CI: 27-50), 71% (95%CI: 65-78) and 29% (95%CI: 21-41) (p<0.0001) for Group A vs B vs C, respectively. The 5-yr CSS rates were 76% (95%CI: 66.1-87), 86% (95%CI: 82-92) and 42% (95%CI: 33-54) (p<0.0001), for Group A vs B vs C, respectively. At MVA, group B had a low risk of PFS [hazard ratio (HR) 0.27, 95%CI: 0.19-0.38, p<0.0001] and CSM (HR 0.17, 95%CI: 0.11-0.26, p<0.0001) as compared to group C. Similarly, group A had a lower risk of progression (HR: 0.65, 95CI: 0.45-0.94, p=0.02) and CSM (HR: 0.34, 95%CI: 0.20-0.57, p<0.0001) as compared to group C. CONCLUSIONS: TT+ cN0 cM0 RCC patients had higher risk of progression and mortality than TT- cN1 cM0 but lower risk relative to TT- cN0 cM1 patients. Thus, TT+ cN0 cM0 RCC should be regarded as a locally-advanced disease. In this setting, surgical treatment is a therapeutic option with curative intent. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e800 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giacomo Musso More articles by this author Giuseppe Basile More articles by this author Alessandro Nini More articles by this author Giuseppe Rosiello More articles by this author Giuseppe Fallara More articles by this author Chiara Re More articles by this author Francesco Cei More articles by this author Federico Belladelli More articles by this author Daniele Cignoli More articles by this author Roberta Lucianò More articles by this author Nazario Tenace More articles by this author Isaline Rowe More articles by this author Silvia Patricia Soares Pinto More articles by this author Daniela Canibus More articles by this author Andrea Necchi More articles by this author Laura Marandino More articles by this author Daniele Raggi More articles by this author Roberto Bertini More articles by this author Rayan Matloob More articles by this author Andrea Salonia More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Alessandro Larcher More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement PDF downloadLoading ...