Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Limited benefit of targeted molecular therapy for inferior vena cava thrombus associated with renal cell carcinoma

  • 282 Accesses

  • 3 Citations



The clinical benefit of targeted molecular therapy (TMT) for an inferior vena cava (IVC) tumor thrombus associated with renal cell carcinoma (RCC) is unclear. The aim of the present study was to assess the change in IVC thrombus height during TMT and to identify the factors associated with the effect of TMT on an IVC thrombus in RCC patients.


The present study retrospectively analyzed 21 patients with an IVC thrombus who were treated with TMT at our hospital. Thrombus height and level before and after TMT were assessed using CT or MRI. Furthermore, we examined the factors associated with the effect of TMT on the IVC thrombus.


The tumor thrombus level before TMT was I in 2 patients (10%), II in 10 (47%), III in 4 (19%), and IV in 5 (24%). Following TMT, the tumor thrombus height decreased in 16 patients (76%), and the mean decrease was 17 mm. The tumor thrombus height increased in 5 patients (24%), and the mean increase was 30 mm. The tumor thrombus level decreased in 4 patients (19%), remained stable in 15 patients (71%), and increased in 2 patients (10%). We found that the clinical nodal stage (p = 0.025) was significantly associated with and the serum neutrophil count (p = 0.067) tended to be associated with the reduction in the IVC thrombus.


The clinical benefit of TMT for an IVC thrombus associated with RCC is limited.

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

Fig. 1
Fig. 2


  1. 1.

    Marshall FF, Dietrick DD, Baumgartner WA et al (1988) Surgical management of renal cell carcinoma with intracaval neoplastic extension above the hepatic veins. J Urol 139(6):1166–1172

  2. 2.

    Hatcher PA, Anderson EE, Paulson DF et al (1991) Surgical management and prognosis of renal cell carcinoma invading the vena cava. J Urol 145(1):20–23 (discussion 23–24)

  3. 3.

    Lambert EH, Pierorazio PM, Shabsigh A et al (2007) Prognostic risk stratification and clinical outcomes in patients undergoing surgical treatment for renal cell carcinoma with vascular tumor thrombus. Urology 69(6):1054–1058

  4. 4.

    Lawindy SM, Kurian T, Kim T et al (2012) Important surgical considerations in the management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumour thrombus. BJU Int 110(7):926–939

  5. 5.

    Sweeney P, Wood CG, Pisters LL et al (2003) Surgical management of renal cell carcinoma associated with complex inferior vena caval thrombi. Urol Oncol Semin Orig Investig 21(5):327–333

  6. 6.

    Al Otaibi M, Abou Youssif T, Alkhaldi A et al (2009) Renal cell carcinoma with inferior vena caval extention: impact of tumour extent on surgical outcome. BJU Int 104(10):1467–1470

  7. 7.

    Blute ML, Leibovich BC, Lohse CM et al (2004) The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int 94(1):33–41

  8. 8.

    Karnes RJ, Blute ML (2008) Surgery insight: management of renal cell carcinoma with associated inferior vena cava thrombus. Nat Clin Pract Urol 5(6):329–339

  9. 9.

    Motzer RJ, Hutson TE, Tomczak P et al (2007) Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med 356(2):115–124

  10. 10.

    Escudier B, Szczylik C, Hutson TE et al (2009) Randomized phase II trial of first-line treatment with sorafenib versus interferon Alfa-2a in patients with metastatic renal cell carcinoma. J Clin Oncol Off J Am Soc Clin Oncol 27(8):1280–1289

  11. 11.

    Coppin C, Le L, Porzsolt F et al (2008) Targeted therapy for advanced renal cell carcinoma. Cochrane Database Syst Rev CD006017. doi:10.1002/14651858.CD006017.pub2

  12. 12.

    Karakiewicz PI, Suardi N, Jeldres C et al (2008) Neoadjuvant sutent induction therapy may effectively down-stage renal cell carcinoma atrial thrombi. Eur Urol 53(4):845–848

  13. 13.

    Cost NG, Delacroix SE Jr, Sleeper JP et al (2011) The impact of targeted molecular therapies on the level of renal cell carcinoma vena caval tumor thrombus. Eur Urol 59(6):912–918

  14. 14.

    Di Silverio F, Sciarra A, Parente U et al (2008) Neoadjuvant therapy with sorafenib in advanced renal cell carcinoma with vena cava extension submitted to radical nephrectomy. Urol Int 80(4):451–453

  15. 15.

    Shuch B, Riggs SB, LaRochelle JC et al (2008) Neoadjuvant targeted therapy and advanced kidney cancer: observations and implications for a new treatment paradigm. BJU Int 102(6):692–696

  16. 16.

    Harshman LC, Srinivas S, Kamaya A et al (2009) Laparoscopic radical nephrectomy after shrinkage of a caval tumor thrombus with sunitinib. Nat Rev Urol 6(6):338–343

  17. 17.

    Robert G, Gabbay G, Bram R et al (2009) Case study of the month. Complete histologic remission after sunitinib neoadjuvant therapy in T3b renal cell carcinoma. Eur Urol 55(6):1477–1480

  18. 18.

    Kondo T, Hashimoto Y, Kobayashi H et al (2010) Presurgical targeted therapy with tyrosine kinase inhibitors for advanced renal cell carcinoma: clinical results and histopathological therapeutic effects. Jpn J Clin Oncol 40(12):1173–1179

  19. 19.

    Sassa N, Kato M, Funahashi Y et al (2014) Efficacy of pre-surgical axitinib for shrinkage of inferior vena cava thrombus in a patient with advanced renal cell carcinoma. Jpn J Clin Oncol 44(4):370–373

  20. 20.

    Bigot P, Fardoun T, Bernhard JC et al (2014) Neoadjuvant targeted molecular therapies in patients undergoing nephrectomy and inferior vena cava thrombectomy: is it useful? World J Urol 32(1):109–114

  21. 21.

    Martinez-Salamanca JI, Huang WC, Millan I et al (2011) Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension. Eur Urol 59(1):120–127

  22. 22.

    Wagner B, Patard JJ, Mejean A et al (2009) Prognostic value of renal vein and inferior vena cava involvement in renal cell carcinoma. Eur Urol 55(2):452–459

  23. 23.

    Huang J, Dahl DM, Dong L et al (2015) Preoperative neutrophil-to-lymphocyte ratio and neutrophilia are independent predictors of recurrence in patients with localized papillary renal cell carcinoma. Biomed Res Int 2015:891045

  24. 24.

    Azuma T, Matayoshi Y, Nagase Y et al (2012) Neutrophil number after interferon-alfa treatment is an independent predictive marker of overall survival in metastatic renal cell carcinoma. Clin Genitourin Cancer 10(3):180–184

  25. 25.

    de Martino M, Pantuck AJ, Hofbauer S et al (2013) Prognostic impact of preoperative neutrophil-to-lymphocyte ratio in localized nonclear cell renal cell carcinoma. J Urol 190(6):1999–2004

Download references


The authors thank Satoru Shimizu for providing advice on statistical analysis and Noriko Hata for secretarial assistance.

Author information

Correspondence to Tsunenori Kondo.

Ethics declarations

Conflict of interest

Tsunenori Kondo received honoraria from Bayer Yakuhin Ltd., Pfizer, and Novartis. All other authors declare no conflicts of interest with regard to this study.

About this article

Verify currency and authenticity via CrossMark

Cite this article

Fukuda, H., Kondo, T., Takagi, T. et al. Limited benefit of targeted molecular therapy for inferior vena cava thrombus associated with renal cell carcinoma. Int J Clin Oncol 22, 767–773 (2017).

Download citation


  • Renal cell carcinoma
  • Tumor thrombus
  • Targeted molecular therapy