Session: PD08: Kidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I
PD08-09: Interim analysis of a national retrospective study of cT3b+ renal cell carcinoma patients’ pulmonary embolism risk and thromboprophylaxis management
Introduction: Up to 10% of patients with renal cell carcinoma (RCC) have venous tumour thrombus at diagnosis. The incidence of PE in patients with RCC invading the venous system is unknown. The role of anticoagulation to prevent PE in such patients is also unknown and there is currently no guidance on whether patients should receive anticoagulation at diagnosis. We aimed to determine the incidence of PE is patients with RCC invading the inferior vena cava, understand the pattern of prophylactic anticoagulation prescribing in such patients and assess the effect of anticoagulation of PE risk. Methods: We performed a retrospective review of records for all consecutive patients with cT3b, cT3c or cT4 with associated IVC thrombus (T3b+) RCC from 9 centres across a nation between Jan 2017 and Dec 2020. Patient demographics, comorbidities, anticoagulation prescription and outcomes were recorded. Results: Data from 6 of 9 units was available for analysis, including 162 patients with RCC and IVC thrombus. 94(58%) patients were male and the median age was 68yrs (range: 31-93yrs). 112 (69.1%) patients died during follow-up. 42(25.9%) patients developed a PE during the study period. PE was more common with larger venous tumour thrombus (10/64 patients [15.5%] level 1, 32/98 patients [32.7%] level 2+; p=0.17). 27(16.7%) patients had a PE at initial RCC diagnosis while 15 (11.1%) of the remaining 135 patients subsequently developed a PE during their management. Of the 135 patients, 11 (8.1%) patients , 27(20%) patients, and 97(71.9%) patients were commenced on prophylactic dose, treatment dose or no anticoagulation respectively. While not significant, there was a trend for higher rate of PE in the non-anticoagulated group, compared with those receiving prophylactic anticoagulation and treatment dose anticoagulation after diagnosis of T3b+ RCC (13[13.4%], 1[9.0%] and 1[3.7%] respectively, p=0.357). There was a higher rate of post-diagnosis haematuria in the anticoagulated group compared to the non-anticoagulated group (15.4% and 7.7%, p=0.122). Conclusions: In this interim analysis, we demonstrate a significant risk of concurrent or subsequent diagnosis of PE in those patients with cT3b+ RCC, which is related to venous tumour thrombus level. There is heterogeneity in the approach to prescribing anticoagulant prophylaxis in these patients. However, there is a trend for a reduction in the diagnosis of PE in those patients who receive anticoagulation following diagnosis of cT3b+ RCC, although this may result in higher rates of haematuria. SOURCE OF Funding: NA
