Impact of Systemic Therapy for Renal Cell Carcinoma With a Tumor Thrombus: Results From the Intercontinental Collaboration on Renal Cell Carcinoma Database
Year: 2025
Type: article
Study design: Observational Study
Abstract: PURPOSE: 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. 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 (p = .0007). Median CSS was 27.6 months in the systemic therapy grouping and 6 months in the non-systemic therapy grouping (p = .0007). 315 patients were in the last analysis, and of these, 119 (37.8%) received systemic therapy after RN-TT and 196 (62.2%) did not. OS, CSS, and MFS did not differ (p > .05). CONCLUSION: There appears to be an OS and CSS benefit to preoperative systemic therapy for mRCC-TT. Further analysis is required to elucidate the best therapy regimens and ideal timing.
Source: Clinical Genitourinary Cancer
Authors: 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
Institutions: Atrium Health Wake Forest Baptist, Moffitt Cancer Center, Icahn School of Medicine at Mount Sinai, University of South Florida, University of Alabama, University of Alabama at Birmingham, UAB Medicine, Seoul National University, Seoul National University Bundang Hospital, Puigvert Foundation, Instituto Alexander Fleming, Hospital Italiano de Buenos Aires, AC Camargo Hospital, University of Miami, Brigham and Women's Hospital, Brigham and Women's Faulkner Hospital, Institut Pasteur de Montevideo
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,530
OpenAlex ID: W4414559638