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Presurgical axitinib therapy increases fibrotic reactions within tumor thrombus in renal cell carcinoma with thrombus extending to the inferior vena cava

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Abstract

Background

Clinical benefits of presurgical axitinib therapy for renal cell carcinoma (RCC) extending into the inferior vena cava (IVC) remain unclear. We aimed to investigate surgical benefits and pathological antitumor effects of presurgical axitinib therapy for RCC with IVC thrombus.

Methods

Of 56 consecutive RCC patients with IVC thrombus between January 1994 and December 2016, 41 patients who underwent radical nephrectomy (RN) were categorized as upfront RN (Upfront group) or presurgical axitinib followed by RN (Presurgical group). We retrospectively evaluated safety, radiologic tumor responses, and Ki-67 proliferation index before and after axitinib administration in the Presurgical group. Surgical outcomes, postoperative complications, and fibrosis within the IVC thrombus were compared between the Upfront and Presurgical groups.

Results

The number of patients in the Upfront and Presurgical groups was 31 and 10, respectively. Major presurgical axitinib-related adverse events were grade 2 or 3 hypertension (50%). The median radiological tumor response in the renal tumor, IVC thrombus length, and IVC thrombus volume were −19%, −21 mm, and −54%, respectively. The fibrosis within the IVC thrombus was significantly higher in the Presurgical group (10%) than in the Upfront group (3.4%). The Ki-67 proliferation index was significantly decreased in RN specimens (7.3%) versus needle biopsy specimens (23%) in the Presurgical group. Blood loss and operative duration were significantly lower and shorter, respectively, in the Presurgical group than in the Upfront group.

Conclusions

Presurgical axitinib therapy enhanced tumor reduction accompanied by fibrosis and may contribute to surgical risk reduction for selected patients.

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Acknowledgements

We thank Yuki Fujita, Yukie Nishizawa, Kaname Higuchi, Satomi Sakamoto, and Masako Isono for their invaluable help with the data and sample collection.

Author information

Authors and Affiliations

  1. Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan

    Yoshimi Tanaka, Shingo Hatakeyama, Shogo Hosogoe, Toshikazu Tanaka, Itsuto Hamano, Ayumu Kusaka, Hiromich Iwamura, Naoki Fujita, Hayato Yamamoto, Yuki Tobisawa, Takahiro Yoneyama, Takuya Koie & Chikara Ohyama

  2. Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

    Tohru Yoneyama, Yasuhiro Hashimoto & Chikara Ohyama

Authors
  1. Yoshimi Tanaka
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  2. Shingo Hatakeyama
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  3. Shogo Hosogoe
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  4. Toshikazu Tanaka
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  5. Itsuto Hamano
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  8. Naoki Fujita
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  9. Hayato Yamamoto
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  12. Takahiro Yoneyama
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  13. Yasuhiro Hashimoto
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  14. Takuya Koie
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  15. Chikara Ohyama
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Corresponding author

Correspondence to Shingo Hatakeyama.

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Source of funding

This work was supported by a Grant-in-Aid for Scientific Research (nos. 15H02563 15K15579, 17K11118, 17K11119, 17K16768, 17K16770, and 17K16771) from the Japan Society for the Promotion of Science.

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required. Pursuant to the provisions of the ethics committee and the ethic guideline in Japan, written consent was not required in exchange for public disclosure of study information in the case of retrospective and/or observational study using a material such as the existing documentation. The study information was open for the public consumption at http://www.med.hirosaki-u.ac.jp/~uro/html/IRB/IRBdoc.html.

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Tanaka, Y., Hatakeyama, S., Hosogoe, S. et al. Presurgical axitinib therapy increases fibrotic reactions within tumor thrombus in renal cell carcinoma with thrombus extending to the inferior vena cava. Int J Clin Oncol 23, 134–141 (2018). https://doi.org/10.1007/s10147-017-1169-z

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  • DOI: https://doi.org/10.1007/s10147-017-1169-z

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