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Presurgical molecular therapy for renal cell carcinoma with venous tumor thrombus: a systematic review and

Kewei Chen1, Lin Zhuo2, Zhuo Liu1

  • 1Department of Urology, Peking University Third Hospital, Beijing, China.

Frontiers in Immunology
|December 15, 2025
PubMed
Abstract

Insights

Presurgical molecular therapy (PMT) effectively reduces tumor thrombus (TT) in renal cell carcinoma (RCC) patients, simplifying surgery. Adverse events associated with PMT are generally manageable.

Area of Science:

  • Oncology
  • Nephrology
  • Medical Therapeutics

Background:

  • Renal cell carcinoma (RCC) with tumor thrombus (TT) presents complex treatment challenges.
  • Presurgical molecular therapy (PMT), including tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs), is increasingly explored for RCC with TT.
  • Outcomes and adverse events (AEs) of PMT in this specific patient population require thorough evaluation.

Purpose of the Study:

  • To evaluate the impact of presurgical molecular therapy (PMT) on tumor thrombus (TT) levels and height in renal cell carcinoma (RCC) patients.
  • To assess the incidence and types of treatment-related adverse events (AEs) associated with PMT in RCC patients with TT.
  • To determine the potential of PMT in simplifying surgical procedures for RCC with TT, particularly for higher Mayo grades.

Main Methods:

  • A systematic literature search was performed across major databases (PubMed, Embase, Cochrane Library, Web of Science) up to June 2023.
  • Studies investigating the effect of PMT on RCC patients with venous TT, regardless of subsequent surgery, were included.
  • Data on TT level changes and treatment-related adverse events were extracted and analyzed.

Main Results:

  • A total of 184 patients were included in the analysis.
  • PMT led to a decrease in TT levels in 30.7% of patients, with an average reduction of 15.2mm observed in 117 patients.
  • The most frequent adverse events were hypertension (49.9%), hand-foot syndrome (25.5%), fatigue (25.3%), and diarrhea (20.2%).

Conclusions:

  • Presurgical molecular therapy (PMT) demonstrates efficacy in reducing tumor thrombus (TT) levels in renal cell carcinoma (RCC) patients.
  • PMT can potentially simplify surgical interventions, especially for patients with higher-grade tumor thrombus (Mayo grade 3/4).
  • The adverse events associated with PMT are generally tolerable and manageable.
Keywords:
presurgical molecular therapyradical nephrectomy and thrombectomyrenal cell carcinomatumor thrombustyrosine kinase inhibitors

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