The Adverse Survival Implications of Bland Thrombus in Renal Cell Carcinoma With Venous Tumor Thrombus

Ryan Hutchinson, Charles Rew, Gong Chen, Solomon Woldu, Laura Maria Krabbe, Matthew Meissner, Kunj Sheth, Nirmish Singla, Nabeel Shakir, Viraj A. Master, Jose A. Karam, Surena F. Matin, Leonardo D. Borregales, Christopher Wood, Timothy Masterson, R. Houston Thompson, Stephen A. Boorjian, Bradley C. Leibovich, E. Jason Abel, Aditya Bagrodia & 1 others Vitaly Margulis

Research output: Contribution to journalArticle

Abstract

Objective: To characterize the presence of bland (nontumor) thrombus in advanced renal cell carcinoma and assess the impact of this finding on cancer-specific survival. Methods: A multi-institutional database of patients treated with nephrectomy with caval thrombectomy for locally-advanced renal tumors was assembled from 5 tertiary care medical centers. Using clinicopathologic variables including patient age, body mass index, Eastern Cooperative Oncology Group performance status, tumor stage, grade, nodal status and histology, and nearest-neighbor and multiple-matching propensity score matched cohorts of bland thrombus vs nonbland thrombus patients were assessed. Multivariable analysis for predictors of cancer-specific survival was performed. Results: From an initial cohort of 579 patients, 446 met inclusion criteria (174 with bland thrombus, 272 without). At baseline, patients with bland thrombus had significantly worse performance status, higher tumor stage, higher prevalence of regional nodal metastases and higher nuclear grade (P <.01 for all). In both nearest-neighbor and multiple-matching propensity score matched cohorts, the presence of bland thrombus presence was associated with inferior median cancer-specific survival (28.1 months vs 156.8 months, and 28.1 months vs 76.7 months, P <.001 for both). The presence of bland thrombus remained independently associated with an increased risk of cancer-specific mortality on multivariable analysis (hazard ratio 4.33, 95% confidence interval 2.79-6.73, P <.001). Conclusion: Presence of bland thrombus is associated with adverse survival outcomes in patients treated surgically for renal tumors with venous tumor thrombus. These findings may have important implications in patient counseling, selection for surgery and inclusion in clinical trials.

Original languageEnglish (US)
JournalUrology
DOIs
StateAccepted/In press - Jan 1 2018

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Renal Cell Carcinoma
Thrombosis
Survival
Neoplasms
Propensity Score
Kidney
Thrombectomy
Venae Cavae
Nephrectomy
Tertiary Care Centers
Patient Selection
Counseling
Histology
Body Mass Index
Clinical Trials
Databases
Confidence Intervals
Neoplasm Metastasis
Mortality

ASJC Scopus subject areas

  • Urology

Cite this

Hutchinson, R., Rew, C., Chen, G., Woldu, S., Krabbe, L. M., Meissner, M., ... Margulis, V. (Accepted/In press). The Adverse Survival Implications of Bland Thrombus in Renal Cell Carcinoma With Venous Tumor Thrombus. Urology. https://doi.org/10.1016/j.urology.2018.02.019

The Adverse Survival Implications of Bland Thrombus in Renal Cell Carcinoma With Venous Tumor Thrombus. / Hutchinson, Ryan; Rew, Charles; Chen, Gong; Woldu, Solomon; Krabbe, Laura Maria; Meissner, Matthew; Sheth, Kunj; Singla, Nirmish; Shakir, Nabeel; Master, Viraj A.; Karam, Jose A.; Matin, Surena F.; Borregales, Leonardo D.; Wood, Christopher; Masterson, Timothy; Thompson, R. Houston; Boorjian, Stephen A.; Leibovich, Bradley C.; Abel, E. Jason; Bagrodia, Aditya; Margulis, Vitaly.

In: Urology, 01.01.2018.

Research output: Contribution to journalArticle

Hutchinson, R, Rew, C, Chen, G, Woldu, S, Krabbe, LM, Meissner, M, Sheth, K, Singla, N, Shakir, N, Master, VA, Karam, JA, Matin, SF, Borregales, LD, Wood, C, Masterson, T, Thompson, RH, Boorjian, SA, Leibovich, BC, Abel, EJ, Bagrodia, A & Margulis, V 2018, 'The Adverse Survival Implications of Bland Thrombus in Renal Cell Carcinoma With Venous Tumor Thrombus', Urology. https://doi.org/10.1016/j.urology.2018.02.019
Hutchinson, Ryan ; Rew, Charles ; Chen, Gong ; Woldu, Solomon ; Krabbe, Laura Maria ; Meissner, Matthew ; Sheth, Kunj ; Singla, Nirmish ; Shakir, Nabeel ; Master, Viraj A. ; Karam, Jose A. ; Matin, Surena F. ; Borregales, Leonardo D. ; Wood, Christopher ; Masterson, Timothy ; Thompson, R. Houston ; Boorjian, Stephen A. ; Leibovich, Bradley C. ; Abel, E. Jason ; Bagrodia, Aditya ; Margulis, Vitaly. / The Adverse Survival Implications of Bland Thrombus in Renal Cell Carcinoma With Venous Tumor Thrombus. In: Urology. 2018.
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abstract = "Objective: To characterize the presence of bland (nontumor) thrombus in advanced renal cell carcinoma and assess the impact of this finding on cancer-specific survival. Methods: A multi-institutional database of patients treated with nephrectomy with caval thrombectomy for locally-advanced renal tumors was assembled from 5 tertiary care medical centers. Using clinicopathologic variables including patient age, body mass index, Eastern Cooperative Oncology Group performance status, tumor stage, grade, nodal status and histology, and nearest-neighbor and multiple-matching propensity score matched cohorts of bland thrombus vs nonbland thrombus patients were assessed. Multivariable analysis for predictors of cancer-specific survival was performed. Results: From an initial cohort of 579 patients, 446 met inclusion criteria (174 with bland thrombus, 272 without). At baseline, patients with bland thrombus had significantly worse performance status, higher tumor stage, higher prevalence of regional nodal metastases and higher nuclear grade (P <.01 for all). In both nearest-neighbor and multiple-matching propensity score matched cohorts, the presence of bland thrombus presence was associated with inferior median cancer-specific survival (28.1 months vs 156.8 months, and 28.1 months vs 76.7 months, P <.001 for both). The presence of bland thrombus remained independently associated with an increased risk of cancer-specific mortality on multivariable analysis (hazard ratio 4.33, 95{\%} confidence interval 2.79-6.73, P <.001). Conclusion: Presence of bland thrombus is associated with adverse survival outcomes in patients treated surgically for renal tumors with venous tumor thrombus. These findings may have important implications in patient counseling, selection for surgery and inclusion in clinical trials.",
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AU - Hutchinson, Ryan

AU - Rew, Charles

AU - Chen, Gong

AU - Woldu, Solomon

AU - Krabbe, Laura Maria

AU - Meissner, Matthew

AU - Sheth, Kunj

AU - Singla, Nirmish

AU - Shakir, Nabeel

AU - Master, Viraj A.

AU - Karam, Jose A.

AU - Matin, Surena F.

AU - Borregales, Leonardo D.

AU - Wood, Christopher

AU - Masterson, Timothy

AU - Thompson, R. Houston

AU - Boorjian, Stephen A.

AU - Leibovich, Bradley C.

AU - Abel, E. Jason

AU - Bagrodia, Aditya

AU - Margulis, Vitaly

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To characterize the presence of bland (nontumor) thrombus in advanced renal cell carcinoma and assess the impact of this finding on cancer-specific survival. Methods: A multi-institutional database of patients treated with nephrectomy with caval thrombectomy for locally-advanced renal tumors was assembled from 5 tertiary care medical centers. Using clinicopathologic variables including patient age, body mass index, Eastern Cooperative Oncology Group performance status, tumor stage, grade, nodal status and histology, and nearest-neighbor and multiple-matching propensity score matched cohorts of bland thrombus vs nonbland thrombus patients were assessed. Multivariable analysis for predictors of cancer-specific survival was performed. Results: From an initial cohort of 579 patients, 446 met inclusion criteria (174 with bland thrombus, 272 without). At baseline, patients with bland thrombus had significantly worse performance status, higher tumor stage, higher prevalence of regional nodal metastases and higher nuclear grade (P <.01 for all). In both nearest-neighbor and multiple-matching propensity score matched cohorts, the presence of bland thrombus presence was associated with inferior median cancer-specific survival (28.1 months vs 156.8 months, and 28.1 months vs 76.7 months, P <.001 for both). The presence of bland thrombus remained independently associated with an increased risk of cancer-specific mortality on multivariable analysis (hazard ratio 4.33, 95% confidence interval 2.79-6.73, P <.001). Conclusion: Presence of bland thrombus is associated with adverse survival outcomes in patients treated surgically for renal tumors with venous tumor thrombus. These findings may have important implications in patient counseling, selection for surgery and inclusion in clinical trials.

AB - Objective: To characterize the presence of bland (nontumor) thrombus in advanced renal cell carcinoma and assess the impact of this finding on cancer-specific survival. Methods: A multi-institutional database of patients treated with nephrectomy with caval thrombectomy for locally-advanced renal tumors was assembled from 5 tertiary care medical centers. Using clinicopathologic variables including patient age, body mass index, Eastern Cooperative Oncology Group performance status, tumor stage, grade, nodal status and histology, and nearest-neighbor and multiple-matching propensity score matched cohorts of bland thrombus vs nonbland thrombus patients were assessed. Multivariable analysis for predictors of cancer-specific survival was performed. Results: From an initial cohort of 579 patients, 446 met inclusion criteria (174 with bland thrombus, 272 without). At baseline, patients with bland thrombus had significantly worse performance status, higher tumor stage, higher prevalence of regional nodal metastases and higher nuclear grade (P <.01 for all). In both nearest-neighbor and multiple-matching propensity score matched cohorts, the presence of bland thrombus presence was associated with inferior median cancer-specific survival (28.1 months vs 156.8 months, and 28.1 months vs 76.7 months, P <.001 for both). The presence of bland thrombus remained independently associated with an increased risk of cancer-specific mortality on multivariable analysis (hazard ratio 4.33, 95% confidence interval 2.79-6.73, P <.001). Conclusion: Presence of bland thrombus is associated with adverse survival outcomes in patients treated surgically for renal tumors with venous tumor thrombus. These findings may have important implications in patient counseling, selection for surgery and inclusion in clinical trials.

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