The role of cytoreductive nephrectomy and systemic therapy in the management of tumour thrombus in patients with metastatic renal cell carcinoma

Mittal, A. et al. (2023) The role of cytoreductive nephrectomy and systemic therapy in the management of tumour thrombus in patients with metastatic renal cell carcinoma. British Journal of Cancer, 128(10), pp. 1888-1896. (doi: 10.1038/s41416-023-02166-5) (PMID:36859686) (PMCID:PMC10147707)

Abstract

Background: Outcomes for patients with metastatic renal cell carcinoma (mRCC) and tumour thrombus remain poor. Recent data suggest limited role for cytoreductive nephrectomy (CN) and data on thrombus response to systemic therapy (ST) is scarce. Here, we describe response and survival of patients with de novo mRCC and thrombi treated with ST with or without CN. Methods: Demographics, disease characteristics and survival of patients with de novo mRCC were collected. Progression-free survival (PFS) and overall survival (OS) in months (m) was calculated using the Kaplan–Meier method (log-rank). Results: Between 2002 and 2019, 226 patients with mRCC were identified, 64 (28.3%) had tumour thrombus out of which 18 (28.1%) received only ST. Among 12 evaluable patients, thrombus response, stability and progression were seen in 3 (25%), 6 (50%) and 3 (25%) patients, respectively. Median OS was similar for patients with and without tumour thrombus treated with systemic therapy alone [OS: 12.1 m (8.8–27.7) vs. 13.9 m (7.9–21.5), p = 0.87]. CN predicted for better OS in patients with tumour thrombus [OS: 29.4 m (17.4–48.9) vs. 12.1 m (8.8–27.7), p = 0.01]. Conclusion: In this retrospective series of patients with mRCC and tumour thrombus, addition of CN to ST improved outcomes. Validation of these findings with contemporary regimens is needed.

• Item Type: Articles
• Additional Information: Open Access funding enabled and organized by CAUL and its Member Institutions.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Spiliopoulou, Dr Pavlina
• Authors: Mittal, A., Al-Ezzi, E., Li, X., Moloney, B., Wilson, B., Spiliopoulou, P., Sridhar, S., Fallah-Rad, N., Chung, P., James Hamilton, R., O’malley, M., and Hansen, A. R.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences
• Journal Name: British Journal of Cancer
• Publisher: Springer Nature
• ISSN: 0007-0920
• ISSN (Online): 1532-1827
• Published Online: 01 March 2023
• Copyright Holders: Copyright © 2023 The Author(s)
• First Published: First published in British Journal of Cancer 128(10):1888-1896
• Publisher Policy: Reproduced under a Creative Commons license