Venous tumor thrombus linked to pulmonary metastasis in clear cell renal cell carcinoma
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Key takeaways:
- Venous tumor thrombus appeared linked to pulmonary metastasis at presentation and after nephrectomy.
- Risk for pulmonary metastasis did not vary by venous tumor thrombus level.
NASHVILLE, Tenn. — Venous tumor thrombus appeared associated with elevated rates of pulmonary metastasis among patients with clear cell renal cell carcinoma, according to study results.
The findings — presented at International Kidney Cancer Symposium: North America — showed these elevated rates occurred both at presentation and after nephrectomy.
“These results have implications for patient counseling, closer pulmonary surveillance and understanding the biologic rationale of pulmonary tropism in these patients, which can lead to development of more effective therapeutic targets,” Reza Nabavizadeh, MD, a urology specialist with Mayo Clinic in Rochester, Minnesota, and colleagues wrote.
Venous tumor thrombus is linked to poorer oncologic outcomes among patients with clear cell renal cell carcinoma. However, whether venous tumor thrombus may predict pulmonary metastases had not been established.
Nabavizadeh and colleagues used their institution’s registry to identify patients with clear cell renal cell carcinoma who underwent radical nephrectomy between 1970 and 2019.
They used Cox proportional hazards regression models adjusted for factors such as disease progression to evaluate whether venous tumor thrombus was associated with pulmonary metastasis.
The analysis included 3,410 patients (median age at nephrectomy, 63 years; 66% men).
Nearly one-third (30%) of the cohort had venous tumor thrombus.
A higher percentage of patients with venous tumor thrombus than without presented with pulmonary metastasis at the time of nephrectomy (20% vs. 7%; P < .001).
Researchers identified 643 patients who had any site of metastatic disease at nephrectomy. Pulmonary metastasis appeared more common among those with venous tumor thrombus than those without (68% vs. 51%; P < .001). However, risk for pulmonary metastasis did not vary significantly by venous tumor thrombus level.
Multivariable analysis continued to show an association between venous tumor thrombus and post-nephrectomy pulmonary metastasis (HR = 1.31; 95% CI, 1.12-1.53), with no significant difference between renal vein (HR = 1.27) or caval (HR = 1.38) venous tumor thrombus.
“The presence of pulmonary embolism before or at nephrectomy was not associated with increased pulmonary metastasis after surgery,” Nabavizadeh and colleagues wrote.
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Nabavizadeh R, et al. Abstract 39. Presented at: IKCS: North America; Nov. 9-11, 2023; Nashville, Tenn.
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