Impact of Systemic Therapy for Renal Cell Carcinoma With a Tumor Thrombus: Results From the Intercontinental Collaboration on Renal Cell Carcinoma Database

PURPOSE: The primary objective of this study was to assess the utility of using systemic therapy for patients with renal cell carcinoma with tumor thrombus (RCC-TT) in the setting of both metastatic (mRCC-TT) and non-mRCC-TT disease. METHODS: This was a multi-institutional retrospective analysis from 1999-present, and every patient underwent radical nephrectomy with tumor thrombectomy (RN-TT) plus/minus systemic therapy. Systemic therapy was defined as chemotherapy, immunotherapy, targeted therapy, or any combination administered ≤12 months from RN-TT. Overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival (MFS) were studied. We examined the effect of preoperative systemic therapy before RN-TT for non-mRCC-TT, preoperative systemic therapy before RN-TT for mRCC-TT, and postoperative systemic therapy after RN-TT. RESULTS: A total of 206 patients were nonmetastatic before RN-TT, and 146 (70.9%) did not receive systemic therapy and 60 (29.1%) did. There was no difference in OS and CSS (p > .05), but MFS was significantly better in the no systemic therapy group (Median not reached; 80 months 50.6% of the cohort did not experience metastatic event vs. 13 months; p < .0001). 117 patients had mRCC-TT before RN-TT, and of these, 84 (71.2%) received preoperative systemic therapy and 33 (28.2%) did not receive systemic therapy before surgery. Median OS was 24 months in the systemic therapy group and 5.7 months in the non-systemic therapy group (p = .0007). Median CSS was 27.6 months in the systemic therapy grouping and 6 months in the non-systemic therapy grouping (p = .0007). 315 patients were in the last analysis, and of these, 119 (37.8%) received systemic therapy after RN-TT and 196 (62.2%) did not. OS, CSS, and MFS did not differ (p > .05). CONCLUSION: There appears to be an OS and CSS benefit to preoperative systemic therapy for mRCC-TT. Further analysis is required to elucidate the best therapy regimens and ideal timing.