IRCCS San Raffaele Scientific Institute, Milan, Italy
Introduction: 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
