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Renal Cell Carcinoma With Venous Tumor Thrombus Has a Predilection for the Lungs
Reza Nabavizadeh1, Rodrigo Rodrigues Pessoa1, John C Cheville2
1Department of Urology, Mayo Clinic, Rochester, MN.
Objective:
To investigate the association between venous tumor thrombus (VTT) and the risk of pulmonary metastases in patients with clear cell renal cell carcinoma (ccRCC).
Methods:
We queried our institutional registry for ccRCC patients undergoing radical nephrectomy (1970-2019). Cox proportional hazards regression models, adjusting for factors associated with ccRCC progression, were used to determine whether VTT was associated with pulmonary metastases.
Results:
Of 3410 patients studied, 1025 (30%) had VTT. Patients with VTT were more likely to present with synchronous pulmonary metastasis (20% vs 7%, P<.001). Within the VTT subset, level of VTT was not significantly associated with synchronous pulmonary metastasis (P=.3). Moreover, among patients with metastatic disease at nephrectomy (n=643), pulmonary metastases were more common in those with VTT versus those without VTT (68% vs 51%, P<.001). Further, excluding patients with synchronous pulmonary metastases, on multivariable analysis, VTT remained associated with an increased risk of developing metachronous pulmonary metastases (hazard ratio (HR) 1.31, P<.001). Interestingly, the presence of PE in the setting of VTT was also identified to be associated with an increased pulmonary metastases post-nephrectomy (HR 2.31, P<.001).
Conclusion:
VTT is associated with disproportionately increased pulmonary metastases at presentation and post-nephrectomy in ccRCC. Further, the presence of PE at nephrectomy for VTT was associated with increased pulmonary metastases post-nephrectomy. These results support a metastatic predilection of ccRCC with VTT in the lungs.
