Maxwell Sandberg, Gregory Russell, Dana Feldman, Mitchell Hayes, Reuben Ben David, Justin Miller, Kartik Patel, Brejjette Aljabi, Seok-Soon Byun, Oscar Rodriguez Faba, Donato Cannoletta, Tatiana Letowski, Gustavo Villoldo, Patricio Garcia Marchinena, Thiago Mourao, Gaetano Ciancio, Charles C. Peyton, Rafael Zanotti, Steven Chang, Philippe E. Spiess, Reza Mehrazin, Diego Abreu, Stenio de Cassio Zequi, Alejandro Rodriguez.

Abstract

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.

Purpose

The role of systemic therapy in the management of these renal cell carcinoma with a tumor thrombus (RCCC-TT) patients is poorly understood. In this multi-institutional analysis, we study preoperative systemic therapy for non-metastatic and metastatic patients as well as postoperative systemic therapy. We find preoperative systemic therapy for metastatic RCC-TT patients was associated with a prolonged overall and cancer-specific survival.

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.