Presence of a tumor thrombus in renal cell carcinoma was associated with a significantly higher risk of venous thromboembolism compared to non-TT patients (adjusted HR 6.61; 95% CI 3.18-13.73).
Cohort (n=647)
No
Is the presence of a venous tumor thrombus in renal cell carcinoma associated with increased risks of VTE, ATE, major bleeding, and mortality?
Patients with RCC-associated tumor thrombus are at a substantially high risk of developing VTE, and the use of anticoagulation in these patients may increase major bleeding without clearly preventing VTE.
Effect estimate: adjusted HR 6.61 (95% CI 3.18-13.73)
Renal cell carcinoma (RCC) can be complicated by a venous tumor thrombus (TT), of which the optimal management is unknown. This study sought 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. Patients diagnosed with RCC between 2010 and 2019 in our hospital were included and followed from RCC diagnosis until 2 years after, or until an outcome of interest (VTE, ATE, and MB) or death occurred, depending on the analysis. Cumulative incidences were estimated with death as a competing risk. Cause-specific hazard models were used to identify predictors and the prognostic impact. Of the 647 patients, 86 had a TT (prevalence 13.3%) at RCC diagnosis, of which 34 were limited to the renal vein, 37 were limited to the inferior vena cava below the diaphragm, and 15 extended above the diaphragm; 20 patients started therapeutic anticoagulation and 45 underwent thrombectomy with/without anticoagulation. During follow-up (median 24.0 IQR: 7.0-24.0 months), 17 TT patients developed a VTE, 0 developed an ATE, and 11 developed MB. TT patients were more often diagnosed with VTE (adjusted HR: 6.61; 95% CI: 3.18-13.73) than non-TT patients, with increasing VTE risks in more proximal TT levels. TT patients receiving anticoagulation still developed VTE (HR: 0.56; 95% CI: 0.13-2.48), at the cost of more MB events (HR: 3.44; 95% CI: 0.95-12.42) compared with those without anticoagulation. Patients with RCC-associated TT were at high risk of developing VTE. Future studies should establish which of these patients benefit from anticoagulation therapy.
Kaptein et al. (2022) conducted a cohort in Renal cell carcinoma (RCC) (n=647). Tumor thrombus (TT) vs. No tumor thrombus (non-TT) was evaluated on Venous thromboembolism (VTE) (adjusted HR 6.61, 95% CI 3.18-13.73). Presence of a tumor thrombus in renal cell carcinoma was associated with a significantly higher risk of venous thromboembolism compared to non-TT patients (adjusted HR 6.61; 95% CI 3.18-13.73).