Introduction

Cytoreductive nephrectomy (CN) for metastatic renal cell cancer (mRCC) with tumor thrombus is complex and pre-surgical targeted therapy may be used in selected patients who have a very limited life expectancy. The purpose of this study was to evaluate overall survival (OS) for mRCC patients with thrombus treated with pre-surgical therapy prior to CN compared to upfront cytoreductive surgery. .

Methods

Comprehensive data was reviewed for 486 mRCC patients with tumor thrombus treated surgically between 2000 to 2015 at six centers. Patients were divided into two groups: PSCN, (pre-surgical therapy +CN; N=39); upfront CN (n=447).Patients were stratified using IMDC criteria into risk groups (61 patients excluded for missing data) and OS compared using the Kaplan Meier method.

Results

Thrombus level (Neves) was 0,1,2,3, and 4 in 131(29.3%), 59(13.1%),154(34.4%), 61(13.6%) and 42 (9.4%) in upfront CN patients and 13 (13.3%),10 (25.6%), 9 (23.1%), 5(12.8%) and 2 (5.1%) in PSCN patients. _x000D_ _x000D_ After risk stratification, 26/39 (66.6%) PSCN and 209/387 (54.0%) upfront CN patients were IMDC intermediate risk. Median OS (IQR) month was not different for PSCN 26.2(13.1-na) vs. upfront CN 24.6(9.9-50.1) IMDC intermediate risk patients, (p=0.36). _x000D_ _x000D_ A total of 13/39 (33.3%) PSCN and 178/398 (47.5%) upfront CN patients were IMDC poor risk. Median OS (IQR) was not different for PSCN 38.1 months (10.1-49.4) vs. UCN 13.4 months (5.1-33.8) IMDC poor risk patients, (p=0.28)._x000D_ _x000D_

Conclusions

No difference was identified in OS for patients who received neoadjuvant targeted therapy prior to CN compared to upfront CN. Future studies should evaluate the optimal use of neoadjuvant therapy in poor risk mRCC patients with thrombus. _x000D_ _x000D_

Funding

none