Abstract: PD73-03
Sources of Funding: none

Introduction

Invasion of main renal vein (RV) wall is not defined as an adverse pathological feature in the current TNM staging in patients with renal cell carcinoma (RCC) & inferior vena cava (IVC) tumor thrombus. In some recent studies, RV wall invasion is suggested as a predictor of poor outcomes. In this study, we sought to determine the impact of renal vein wall invasion on the risk of recurrence and death in patients with RCC and caval tumor thrombus._x000D_

Methods

A cohort of 257 patients with non-metastatic RCC and level II-IV IVC thrombus who underwent surgery between 1990-2015 at our institution were studied. Patient demographics, clinical, pathological features including renal and IVC wall invasion, and outcomes information were obtained. Univariable and Multivariable Cox-proportional hazard model were used for analysis.

Results

Median age of the cohort at surgery was 64 years. A total of 45% patients had renal artery embolization prior to surgery. On preoperative imaging tumor thrombus level was noted as level 2 in 112 patients (42%), level 3 in 90 patients (35%) and level 4 in 51 patients (20%). A total of 35% had recurrence with mean time to recurrence of 15 months. At mean follow up time of 21 months, 53% were alive. Main RV and IVC wall invasion was present in 57% and 15% patients respectively._x000D_ _x000D_ On univariable analysis, microscopic main RV wall invasion was not significantly associated with increased risk of recurrence (Hazard ratio[HR]=1.13) or death (HR=1.07) (both p>0.05). Invasion of IVC wall was associated with increased risk of recurrence (HR=1.9, p<0.05) but was not significantly associated with increased risk of death (HR=0.87, p=0.7). Lower preoperative hemoglobin, need for bypass, need for blood transfusion, older age, and longer operative time were associated with poor survival (all p<0.05)._x000D_

Conclusions

Main RV wall invasion is present in significant proportion of patients with non-metastatic RCC with IVC tumor thrombus, however, in our cohort it was not associated with increased risk of recurrence or death. Main RV wall invasion should be reported by the pathologist until the impact of this finding is clearly defined.

Funding

none