Outcomes of Renal Cell Carcinoma with Associated Venous Tumor Thrombus: Experience from a Large Cohort and Short Time Span in a Single Center

Background: The surgical management and outcomes of renal cell carcinoma (RCC) with venous tumor thrombus (VTT) have been reported in limited sample size, and there remain discrepancies over the factors that influence oncologic outcomes after radical nephrectomy with thrombectomy (RNTE).The aim of the study was to analyze the outcomes of the patients with RCC with VTT in our institution and identify the independent prognostic factors. Methods: Patients with RCC with VTT were enrolled for the study from February 2015 to December 2018. All patients underwent RNTE. Clinical data were compared using the chi-square and Fisher’s exact tests. Over-all survival (OS) was estimated using the Kaplan-Meier method. Univariable and multivariable survival analyses were performed using COX.Results: 121 patients (91 men & 30 women) were identified with a mean age of (59.3±10.8) years. VTT level was 0 in 25 patients, I in 20, II in 50, III in 12 and IV in 14. The mean follow-up time was (25.7±14.6) months. During the follow-up period, 50 (41.3%) patients died and 69 (57.0%) patients experienced recurrence or metastasis. The 3-year and 5-year OS rate were 57.8% and 38.9%. Among the several factors examined, positive lymph node (P=0.008), tumor necrosis (P =0.022), sarcomatoid differentiation (P <0.001) and perinephric fat invasion (P =0.041) were demonstrated as independent significant risk factors on multivariate analysis. Conclusion: The OS was poor for patients with RCC with VTT. Rather than VTT level, positive lymph node, tumor necrosis, sarcomatoid differentiation and perinephric fat invasion were independent prognostic predictors.