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Long-term functional outcomes in patients undergoing radical nephrectomy for renal cell carcinoma and tumor thrombus

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Abstract

Background

Up to 15% of patients with locally advanced renal cell carcinoma (RCC) harbors tumor thrombus (TT). In those cases, radical nephrectomy (RN) and thrombectomy represents the standard of care. We assessed the impact of TT on long-term functional and oncological outcomes in a large contemporary cohort.

Methods

Within a prospective maintained database, 1207 patients undergoing RN for non-metastatic RCC between 2000 and 2021 at a single tertiary centre were identified. Of these, 172 (14%) harbored TT. Multivariable logistic regression analyses evaluated the impact of TT on the risk of postoperative acute kidney injury (AKI). Multivariable Poisson regression analyses estimated the risk of long-term chronic kidney disease (CKD). Kaplan Meier plots estimated disease-free survival and cancer specific survival. Multivariable Cox regression models assessed the main predictors of clinical progression (CP) and cancer specific mortality (CSM).

Results

Patients with TT showed lower BMI (24 vs. 26 kg/m2) and preoperative Hb (11 vs. 14 g/mL; all—p < 0.05). Clinical tumor size was higher in patients with TT (9.6 vs. 6.5 cm; p < 0.001). After adjusting for potential confounders, the presence of TT was significantly associated with a higher risk of postoperative AKI (OR 2.03, 95% CI 1.49–3.6; p < 0.001) and long-term CKD (OR: 1.32, 95% CI 1.10–1.58; p < 0.01). Notably, patients with TT showed worse long-term oncological outcomes and TT was a predictor for CP (2.02, CI 95% 1.49–2.73, p < 0.001) and CSM (HR 1.61, CI 95% 1.04–2.49, p < 0.03).

Conclusions

The presence of TT in RCC patients represents a key risk factor for worse perioperative, as well as long-term renal function. Specifically, patients with TT harbor a significant and early estimated glomerular filtration rate (eGFR) decrease. However, despite TT patients show a greater eGFR decline after surgery, they retain acceptable renal function, which remains stable over time.

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Data availability

All data supporting the findings of this study are available within the paper and its material.

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Acknowledgements

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina, 60, 20132, Milan, Italy

    Pietro Scilipoti, Giuseppe Rosiello, Alessandro Larcher, Giuseppe Fallara, Daniele Cignoli, Chiara Re, Giacomo Musso, Francesco Cei, Francesco Trevisani, Daniele Raggi, Andrea Necchi, Roberto Bertini, Andrea Salonia, Alberto Briganti, Francesco Montorsi & Umberto Capitanio

  2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada

    Zhe Tian & Pierre I. Karakiewicz

  3. Department of Urology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium

    Alexandre Mottrie

  4. ORSI Academy, Melle, Belgium

    Alexandre Mottrie

Authors
  1. Pietro Scilipoti
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  2. Giuseppe Rosiello
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  8. Francesco Cei
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  18. Francesco Montorsi
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  19. Umberto Capitanio
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Contributions

Pietro Scilipoti: project development, data collection, manuscript writing; Giuseppe Rosiello: project development, data collection, data analyses, manuscript writing; Alessandro Larcher: project development, manuscript writing; Giuseppe Fallara: data collection, manuscript editing; Daniele Cignoli: data collection, manuscript editing; Chiara Re: data collection, manuscript editing; Giacomo Musso: data collection, manuscript editing; Francesco Cei: data collection, manuscript editing; Zhe Tian: data analyses; Pierre I. Karakiewicz: data collection, manuscript editing; Alexandre Mottrie: data collection, manuscript editing; Francesco Trevisani: data collection, manuscript editing; Daniele Raggi: data collection, manuscript editing; Andrea Necchi: data collection, manuscript editing; Roberto Bertini: project development, data collection, manuscript writing; Andrea Salonia: project development, data collection, manuscript writing; Alberto Briganti: project development, data collection, manuscript writing; Francesco Montorsi: project development, data collection, manuscript writing; Umberto Capitanio: project development, data collection, data analyses, manuscript writing.

Corresponding author

Correspondence to Giuseppe Rosiello.

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Scilipoti, P., Rosiello, G., Larcher, A. et al. Long-term functional outcomes in patients undergoing radical nephrectomy for renal cell carcinoma and tumor thrombus. World J Urol 42, 264 (2024). https://doi.org/10.1007/s00345-024-04976-5

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