Skip to main content

Advertisement

Log in

The Choi response criteria for inferior vena cava tumor thrombus in renal cell carcinoma treated with targeted therapy

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the prognostic significance of the Choi criteria for assessing the responses of a renal mass and inferior vena cava (IVC) tumor thrombus in patients with renal cell carcinoma (RCC) receiving targeted therapy.

Materials and methods

We reviewed the medical records of 22 patients diagnosed with RCC and IVC thrombus between 2005 and 2012. The efficacy of targeted therapy in renal mass and IVC tumor thrombus was evaluated using response evaluation criteria in solid tumors (RECIST) and Choi criteria, respectively. Overall survival was estimated, and the prognostic significance of each variable was estimated using Cox proportional-hazards regression modeling.

Results

There were no significant differences in overall survival between patients with partial response (PR) and nonresponse according to RECIST criteria (19.3 vs 43 months; p = 0.212) or Choi criteria (9.0 vs 23.3 months; p = 0.109) in primary tumor. Regarding the response of IVC tumor thrombi, according to Choi criteria, nine patients (40.9 %) demonstrated PR and longer survival than patients with stable disease (7.2 vs 23.3 months; p = 0.014). In multivariable analysis, response to IVC thrombus according to Choi criteria was the only significant predictive factor. Patients with IVC thrombus who demonstrate the PR according to Choi criteria were at 0.35-fold greater overall risk of death compared with patients who did not demonstrate this response (p = 0.043).

Conclusions

A response according to Choi criteria in IVC tumor thrombus was an independent prognostic predictor in patients with RCC and IVC thrombus who receive targeted therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  • Ayres FJ, Zuffo MK, Rangayyan RM, Boag GS, Filho VO, Valente M (2004) Estimation of the tissue composition of the tumour mass in neuroblastoma using segmented CT images. Med Biol Eng Comput 42:366–377

    Article  PubMed  CAS  Google Scholar 

  • Baccala A Jr, Hedgepeth R, Kaouk J, Magi-Galluzzi C, Gilligan T, Fergany A (2007) Pathological evidence of necrosis in recurrent renal mass following treatment with sunitinib. Int J Urol 14:1095–1097; discussion 1097

  • Choi H, Charnsangavej C, Faria SC, Macapinlac HA, Burgess MA, Patel SR, Chen LL, Podoloff DA, Benjamin RS (2007) Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol 25:1753–1759

    Article  PubMed  Google Scholar 

  • Cost NG, Delacroix SE Jr, Sleeper JP, Smith PJ, Youssef RF, Chapin BF, Karam JA, Culp S, Abel EJ, Brugarolas J, Raj GV, Sagalowsky AI, Wood CG, Margulis V (2011) The impact of targeted molecular therapies on the level of renal cell carcinoma vena caval tumor thrombus. Eur Urol 59:912–918

    Article  PubMed  CAS  Google Scholar 

  • Cowey CL, Fielding JR, Rathmell WK (2010) The loss of radiographic enhancement in primary renal cell carcinoma tumors following multitargeted receptor tyrosine kinase therapy is an additional indicator of response. Urology 75:1108–1113

    Article  PubMed  Google Scholar 

  • Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247

    Article  PubMed  CAS  Google Scholar 

  • Escudier B, Eisen T, Stadler WM, Szczylik C, Oudard S, Siebels M, Negrier S, Chevreau C, Solska E, Desai AA, Rolland F, Demkow T, Hutson TE, Gore M, Freeman S, Schwartz B, Shan M, Simantov R, Bukowski RM (2007) Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med 356:125–134

    Article  PubMed  CAS  Google Scholar 

  • Flaherty KT (2007) Sorafenib in renal cell carcinoma. Clin Cancer Res 13:747s–752s

    Article  PubMed  CAS  Google Scholar 

  • Fuhrman SA, Lasky LC, Limas C (1982) Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 6:655–663

    Article  PubMed  CAS  Google Scholar 

  • Hittinger M, Staehler M, Schramm N, Ubleis C, Becker C, Reiser M, Berger F (2012) Course of size and density of metastatic renal cell carcinoma lesions in the early follow-up of molecular targeted therapy. Urol Oncol 30:695–703

    Article  PubMed  Google Scholar 

  • Klatte T, Pantuck AJ, Riggs SB, Kleid MD, Shuch B, Zomorodian N, Kabbinavar FF, Belldegrun AS (2007) Prognostic factors for renal cell carcinoma with tumor thrombus extension. J Urol 178:1189–1195; discussion 1195

  • Martinez-Salamanca JI, Huang WC, Millan I, Bertini R, Bianco FJ, Carballido JA, Ciancio G, Hernandez C, Herranz F, Haferkamp A, Hohenfellner M, Hu B, Koppie T, Martinez-Ballesteros C, Montorsi F, Palou J, Pontes JE, Russo P, Terrone C, Villavicencio H, Volpe A, Libertino JA (2011) Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension. Eur Urol 59:120–127

    Article  PubMed  Google Scholar 

  • Miles KA (1999) Tumour angiogenesis and its relation to contrast enhancement on computed tomography: a review. Eur J Radiol 30:198–205

    Article  PubMed  CAS  Google Scholar 

  • Motzer RJ (2011) New perspectives on the treatment of metastatic renal cell carcinoma: an introduction and historical overview. Oncologist 16(Suppl 2):1–3

    Article  PubMed  PubMed Central  Google Scholar 

  • Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J (1999) Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 17:2530–2540

    PubMed  CAS  Google Scholar 

  • Motzer RJ, Bacik J, Murphy BA, Russo P, Mazumdar M (2002) Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 20:289–296

    Article  PubMed  CAS  Google Scholar 

  • Motzer RJ, Michaelson MD, Redman BG, Hudes GR, Wilding G, Figlin RA, Ginsberg MS, Kim ST, Baum CM, DePrimo SE, Li JZ, Bello CL, Theuer CP, George DJ, Rini BI (2006) Activity of SU11248, a multitargeted inhibitor of vascular endothelial growth factor receptor and platelet-derived growth factor receptor, in patients with metastatic renal cell carcinoma. J Clin Oncol 24:16–24

    Article  PubMed  CAS  Google Scholar 

  • Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Rixe O, Oudard S, Negrier S, Szczylik C, Kim ST, Chen I, Bycott PW, Baum CM, Figlin RA (2007) Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 356:115–124

    Article  PubMed  CAS  Google Scholar 

  • Neves RJ, Zincke H (1987) Surgical treatment of renal cancer with vena cava extension. Br J Urol 59:390–395

    Article  PubMed  CAS  Google Scholar 

  • Pantuck AJ, Zisman A, Belldegrun AS (2001) The changing natural history of renal cell carcinoma. J Urol 166:1611–1623

    Article  PubMed  CAS  Google Scholar 

  • Patard JJ, Leray E, Cindolo L, Ficarra V, Rodriguez A, De La Taille A, Tostain J, Artibani W, Abbou CC, Guille F, Chopin DK, Lobel B (2004) Multi-institutional validation of a symptom based classification for renal cell carcinoma. J Urol 172:858–862

    Article  PubMed  Google Scholar 

  • Pouliot F, Shuch B, Larochelle JC, Pantuck A, Belldegrun AS (2010) Contemporary management of renal tumors with venous tumor thrombus. J Urol 184:833–841; quiz 1235

  • Ratain MJ, Eckhardt SG (2004) Phase II studies of modern drugs directed against new targets: if you are fazed, too, then resist RECIST. J Clin Oncol 22:4442–4445

    Article  PubMed  Google Scholar 

  • Reese AC, Whitson JM, Meng MV (2013) Natural history of untreated renal cell carcinoma with venous tumor thrombus. Urol Oncol 31:1305–1309

  • Smith AD, Lieber ML, Shah SN (2010a) Assessing tumor response and detecting recurrence in metastatic renal cell carcinoma on targeted therapy: importance of size and attenuation on contrast-enhanced CT. AJR Am J Roentgenol 194:157–165

    Article  PubMed  Google Scholar 

  • Smith AD, Shah SN, Rini BI, Lieber ML, Remer EM (2010b) Morphology, attenuation, size, and structure (MASS) criteria: assessing response and predicting clinical outcome in metastatic renal cell carcinoma on antiangiogenic targeted therapy. AJR Am J Roentgenol 194:1470–1478

    Article  PubMed  Google Scholar 

  • Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216

    Article  PubMed  CAS  Google Scholar 

  • van der Veldt AA, Meijerink MR, van den Eertwegh AJ, Bex A, de Gast G, Haanen JB, Boven E (2008) Sunitinib for treatment of advanced renal cell cancer: primary tumor response. Clin Cancer Res 14:2431–2436

    Article  PubMed  Google Scholar 

  • van der Veldt AA, Meijerink MR, van den Eertwegh AJ, Haanen JB, Boven E (2010) Choi response criteria for early prediction of clinical outcome in patients with metastatic renal cell cancer treated with sunitinib. Br J Cancer 102:803–809

    Article  PubMed  PubMed Central  Google Scholar 

  • Zastrow S, Leike S, Oehlschlager S, Grimm MO, Wirth M (2011) Surgery for renal cell cancer extending into the inferior vena cava - evaluation of survival and perioperative complications using a standardized classification system. BJU Int 108:1439–1443

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors have no conflict of interest or financial disclosures.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jun Hyuk Hong.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kwon, T., Lee, JL., Kim, J.K. et al. The Choi response criteria for inferior vena cava tumor thrombus in renal cell carcinoma treated with targeted therapy. J Cancer Res Clin Oncol 140, 1751–1758 (2014). https://doi.org/10.1007/s00432-014-1703-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-014-1703-6

Keywords

Navigation