PB0924 - Prevalence, treatment and prognosis of tumor thrombi in renal cell carcinoma

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Fleur H.J. Kaptein, MD

PhD student
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
Leiden, Zuid-Holland, Netherlands

Co-Author(s)

Tv

Tom van Der Hulle

Senior medical specialist
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
SB

SJE Braken

Department of Thrombosis and Hemostasis
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
Ev

EJ van Gennep

Department of Urology
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
JB

Jeroen Buijs

Post Doc
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
MB

MC Burgmans

Department of Radiology
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
SC

Suzanne C. Cannegieter, MD PhD

Professor
Department of Clinical Epidemiology, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
ED

EME Du Chatinier

Department of Thrombosis and Hemostasis
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
MH

Menno V. Huisman

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands
Ev

EL van Persijn van Meerten

Department of Radiology
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
HV

Henri Versteeg

Professor
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
RP

RCM Pelger

Department of Urology
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
Frederikus A. Klok, MD, PhD

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands

Background: Renal cell carcinoma (RCC) can be complicated by a venous tumor thrombus (TT), of which the optimal management is unknown.

Aims: Our aim was to assess the prevalence of TT in RCC, its current management and its association with venous thromboembolism (VTE), arterial thromboembolism (ATE), major bleeding (MB) and mortality.

Methods: 647 patients diagnosed with RCC between 2010-2019 in our hospital were included and followed from RCC diagnosis until two years after, or until an outcome of interest (VTE, ATE and MB) or death occurred, depending on the analysis. The study was approved by the local Institutional Review Board and oral informed consent was obtained. Cumulative incidences were estimated with death as a competing risk. Cox regression was used to identify predictors and the prognostic impact.

Results: At RCC diagnosis 86 patients had a TT (13%), of which 34 were limited to the renal vein (‘RV’), 37 to the inferior vena cava below the diaphragm (‘IVC’), and 15 extended above the diaphragm (‘AD’); 20 patients (23%) started therapeutic anticoagulation and 45 (52%) underwent thrombectomy with/without anticoagulant therapy. During a median follow-up of 24 months (IQR 7.0-24), 36 patients were diagnosed with VTE (5.6%), 11 with ATE (1.7%) and 45 with MB (7.0%). Patients with TT were more often diagnosed with VTE (aHR 6.1, 95%CI 2.5-15; Figure 1), with increasing VTE risks in more proximal TT levels (adjusted 2-year cumulative incidence RV 7.4%, IVC 22% and AD 45%, respectively; Figure 2). TT patients receiving anticoagulation were less often diagnosed with VTE (HR 0.56, 95%CI 0.13-2.5), with a tendency to have more MB events (HR 3.4, 95%CI 0.95-12) compared to those without anticoagulation.

Conclusion(s): Patients with RCC-associated TT were at high risk of developing VTE. Future studies should establish which of these patients benefit from anticoagulation therapy.