Abstract
Renal cell carcinoma (RCC) extension into the renal vein or the inferior vena cava occurs in 4 %–10 % of all kidney cancer cases. This entity shows a wide range of different clinical and surgical scenarios, making natural history and oncological outcomes variable and poorly characterized. Infrequency and variability make it necessary to share the experience from different institutions to properly analyze surgical outcomes in this setting. The International Renal Cell Carcinoma–Venous Tumor Thrombus Consortium was created to answer the questions generated by competing results from different retrospective studies in RCC with venous extension on current controversial topics. The aim of this article is to summarize the experience gained from the analysis of the world's largest cohort of patients in this unique setting to date.
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Abbreviations
- RCC:
-
renal cell carcinoma
- IRCCVTC:
-
international renal cell carcinoma-venous thrombus consortium
- IVC:
-
inferior vena cava
- CPB:
-
cardiopulmonary bypass
- RAE:
-
renal artery embolization
- (AJCC):
-
American Joint Committee on Cancer
- (UICC):
-
Union International Contre le Cancer
- SSIGN:
-
Stage, Size, Grade, Necrosis score
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Siegel R, Naishadham D, Jemal A. Cancer Statistics, 2013 Leido. CA Cancer J Clin. 2013;63(1):11–30.
Ljungberg B, Cowan NC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, et al. EAU guidelines on renal cell carcinoma: the 2010 update. European urology. Eur Assoc Urol. 2010;58(3):398–406.
Ljungberg B, Campbell SC, Choi HY, Cho HY, Jacqmin D, Lee JE, et al. The epidemiology of renal cell carcinoma. Eur Urol. 2011;60(4):615–21.
Whitson JM, Reese AC, Meng MV. Population based analysis of survival in patients with renal cell carcinoma and venous tumor thrombus. Urol Oncol. 2013;31(2):259–63. Elsevier Inc.
Méjean A, Oudard S, Thiounn N. Prognostic factors of renal cell carcinoma. J Urol. 2003;169(3):821–7.
Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int. 2004;94(1):33–41.
Hatcher P a, Anderson EE, Paulson DF, Carson CC, Robertson JE. Surgical management and prognosis of renal cell carcinoma invading the vena cava. The Journal of urology. 1991. p. 20–3; discussion 23–4.
Ljungberg B, Hanbury D. Guidelines on renal cell carcinoma. European urology.
Ficarra V, Novara G, Iafrate M, Cappellaro L, Bratti E, Zattoni F, et al. Proposal for reclassification of the TNM staging system in patients with locally advanced (pT3-4) renal cell carcinoma according to the cancer-related outcome. Eur Urol. 2007;51(3):722–9. discussion 729–31.
Haferkamp A, Bastian PJ, Jakobi H, Pritsch M, Pfitzenmaier J, Albers P, et al. Renal cell carcinoma with tumor thrombus extension into the vena cava: prospective long-term followup. J Urol. 2007;177(5):1703–8. Long-term follow-up for locally advanced RCC was analyzed representing radical surgery as the only treatment option with benefit in survival. Tumor thrombus level and metastatic disease were independent prognostic factors.
Glazer AA, Novick AC. Long-term followup after surgical treatment for renal cell carcinoma extending into the right atrium. J Urol. 1996;155(2):448–50.
Kim HL, Zisman A, Han K-R, Figlin RA, Belldegrun AS. Prognostic significance of venous thrombus in renal cell carcinoma. Are renal vein and inferior vena cava involvement different? J Urol. 2004;171(2 Pt 1):588–91.
Moinzadeh A, Libertino JA. Prognostic significance of tumor thrombus level in patients with renal cell carcinoma and venous tumor thrombus extension. Is all T3b the same? J Urol. 2004;171(2 Pt 1):598–601.
Martínez-Salamanca JI, Huang WC, Millán I, Bertini R, Bianco FJ, Carballido JA, et al. Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension. Eur Urol. 2011;59(1):120–7. Tumor thrombus renal vein-only involvement had significant CSS difference with IVC involvement. In N0M0 setting, there was no difference in survival for RV and level 1 extent. Thus N+ and M+ remain strong independent predictors for survival of RCC with venous involvement.
Wagner B, Patard J-J, Méjean A, Bensalah K, Verhoest G, Zigeuner R, et al. Prognostic value of renal vein and inferior vena cava involvement in renal cell carcinoma. Eur Urol. 2009;55(2):452–9.
Sosa RE, Muecke EC, Vaughan ED, McCarron JP. Renal cell carcinoma extending into the inferior vena cava: the prognostic significance of the level of vena caval involvement. The Journal of urology. 1984. p. 1097–100.
Klaver S, Joniau S, Suy R, Oyen R, Van Poppel H. Analysis of renal cell carcinoma with subdiaphragmatic macroscopic venous invasion (T3b). BJU Int. 2008;101(4):444–9.
Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4.
Gettman MT, Boelter CW, Cheville JC, Zincke H, Bryant SC, Blute ML. Charlson co-morbidity index as a predictor of outcome after surgery for renal cell carcinoma with renal vein, vena cava or right atrium extension. J Urol. 2003;169(4):1282–6.
Spiess PE, Kurian T, Lin H-Y, Rawal B, Kim T, Sexton WJ, et al. Preoperative metastatic status, level of thrombus and body mass index predict overall survival in patients undergoing nephrectomy and inferior vena cava thrombectomy. BJU Int. 2012;110(11 Pt B):E470–4.
Tosco L, Van Poppel H, Frea B, Gregoraci G, Joniau S. Survival and impact of clinical prognostic factors in surgically treated metastatic renal cell carcinoma. Eur Urol. 2013;63(4):646–52.
Naitoh J, Kaplan A, Dorey F, Figlin R, Belldegrun A. Metastatic renal cell carcinoma with concurrent inferior vena caval invasion: long-term survival after combination therapy with radical nephrectomy, vena caval thrombectomy and postoperative immunotherapy. J Urol. 1999;162(1):46–50.
Wu J, Durbin-Johnson B, Martínez-Salamanca JI, Bertini R, Bianco FJ, Carballido J. a, et al. 959 the Impact of Local and Distant Metastasis on Survival in Patients With Renal Cell Carcinoma Undergoing Nephrectomy With Tumor Thrombectomy. J Urol. 2011;185(4):e386.
Capitanio U, Cloutier V, Zini L, Isbarn H, Jeldres C, Shariat SF, et al. A critical assessment of the prognostic value of clear cell, papillary and chromophobe histological subtypes in renal cell carcinoma: a population-based study. BJU Int. 2009;103(11):1496–500.
Keegan KA, Schupp CW, Chamie K, Hellenthal NJ, Evans CP, Koppie TM. Histopathology of surgically treated renal cell carcinoma: survival differences by subtype and stage. J Urol. 2012;188(2):391–7.
Cheville JC, Lohse CM, Zincke H, Weaver AL, Blute ML. Comparisons of outcome and prognostic features among histologic subtypes of renal cell carcinoma. Am J Surg Pathol. 2003;27(5):612–24.
Ciancio G, Manoharan M, Katkoori D, De Los Santos R, Soloway MS. Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: single-center experience. Eur Urol. 2010;57(4):667–72.
Kaushik D, Linder BJ, Thompson RH, Eisenberg MS, Lohse CM, Cheville JC, et al. The Impact of Histology on Clinicopathologic Outcomes for Patients With Renal Cell Carcinoma and Venous Tumor Thrombus: A Matched Cohort Analysis. Urology. Elsevier Inc.; 2013 May 1.
Kim KH, You D, Jeong IG, Kwon T-W, Cho YM, Hong JH, et al. Type II papillary histology predicts poor outcome in patients with renal cell carcinoma and vena cava thrombus. BJU Int. 2012;110(11 Pt B):E673–8.
Margulis V, Tamboli P, Matin SF, Swanson DA, Wood CG. Analysis of clinicopathologic predictors of oncologic outcome provides insight into the natural history of surgically managed papillary renal cell carcinoma. Cancer. 2008;112(7):1480–8.
Tilki D, Nguyen HG, Dall’era MA, Bertini R, Carballido JA, Chromecki T, et al. Impact of Histologic Subtype on Cancer-specific Survival in Patients with Renal Cell Carcinoma and Tumor Thrombus. European urology. 2013 Jul 10; pii: S0302-2838(13)00663-5. Histologic subtype analysis was performed by the IRCC-VTC, papilar RCC had worse survival outcome when compared with clear cell RCC. Fat invasion and tumor thrombus level were indepedent prognostic factors.
Almgård LE, Fernström I, Haverling M, Ljungqvist A. Treatment of renal adenocarcinoma by embolic occlusion of the renal circulation. Br J Urol. 1973;45(5):474–9.
May M, Brookman-Amissah S, Pflanz S, Roigas J, Hoschke B, Kendel F. Pre-operative renal arterial embolisation does not provide survival benefit in patients with radical nephrectomy for renal cell carcinoma. Br J Radiol. 2009;82(981):724–31.
Zielinski H, Szmigielski S, Petrovich Z. Comparison of preoperative embolization followed by radical nephrectomy with radical nephrectomy alone for renal cell carcinoma. Am J Clin Oncol. 2000;23(1):6–12.
Latal D, Kautzky W, Wanek R, Kumpan W. [Effect of kidney occlusion on survival in renal cell carcinoma: a 10-year retrospective study]. Z Urol Nephrol. 1990;83(1):27–31.
Martínez Salamanca J.I., Bianco, F., Libertino, J., Novick, A., Carballido Rodríguez, J., Russo, P., Pontes, E., Soloway, M., Ciancio, G., Lane, B., Montorsi, F., Terrone, C., Volpe, A., Briganti A. Prognostic significance of preoperative renal artery embolization in renal cell carcinoma with venous extension: a multiinstitutional experience. SUO annual meeting. 2008. p. Abstract.
Novick AC, Kaye MC, Cosgrove DM, Angermeier K, Pontes JE, Montie JE, et al. Experience with cardiopulmonary bypass and deep hypothermic circulatory arrest in the management of retroperitoneal tumors with large vena caval thrombi. Ann Surg. 1990;212(4):472–6. discussion 476–7.
Casey RG, Raheem OA, Elmusharaf E, Madhavan P, Tolan M, Lynch TH. Renal cell carcinoma with IVC and atrial thrombus: A single centre’s 10 year surgical experience. Surgeon: J R Coll Surg Edinb Irel. 2013;44(0):5–9. Elsevier Ltd.
Kuczyk M. a, Münch T, Machtens S, Grünewald V, Jonas U. The impact of extracorporal circulation on therapy-related mortality and long-term survival of patients with renal cell cancer and intracaval neoplastic extension. World J Urol. 2002;20(4):227–31.
Stewart JR, Carey JA, McDougal WS, Merrill WH, Koch MO, Bender HW. Cavoatrial tumor thrombectomy using cardipulmonary bypass without circulatory arrest. The Annals of Thoracic Surgery. Soc Thorac Surg. 1991;51(5):717–22.
Langenburg SE, Blackbourne LH, Sperling JW, Buchanan SA, Mauney MC, Kron IL, et al. Management of renal tumors involving the inferior vena cava. J Vasc Surg. 1994;20(3):385–8.
Ciancio G, Livingstone AS, Soloway M. Surgical management of renal cell carcinoma with tumor thrombus in the renal and inferior vena cava: the University of Miami experience in using liver transplantation techniques. Eur Urol. 2007;51(4):988–94. discussion 994–5. Surgery still remains the most effective therapeutic option, and aggressive approaches have to be considered. Proper assessment of the level of the thrombus is mandatory; a transabdominal approach can be performed for higher levels when combined with liver transplant techniques.
Shuch B, Crispen PL, Leibovich BC, Larochelle JC, Pouliot F, Pantuck AJ, et al. Cardiopulmonary bypass and renal cell carcinoma with level IV tumour thrombus: can deep hypothermic circulatory arrest limit perioperative mortality? BJU Int. 2011;107(5):724–8.
Martinez-Salamanca JI, Huang W, Capitanio U, Millan I, Bertini R, Bianco F, et al. 1760 Impact of Cardiopulmonary By-Pass in Cancer-Specific Survival in Patients With Renal Cell Carcinoma and Level Iii/Iv Thrombus. International Renal Cell-Carcinoma-Venous Thrombus Consortium. J Urol. 2011;185(4):e706.
Neves RJ, Zincke H. Surgical treatment of renal cancer with vena cava extension. Br J Urol. 1987;59(5):390–5.
Libertino J a, Zinman L, Watkins E. Long-term results of resection of renal cell cancer with extension into inferior vena cava. The Journal of urology. 1987. p. 21–4.
Donat SM. Standards for surgical complication reporting in urologic oncology: time for a change. Urology. 2007;69(2):221–5.
Yoon PD, Chalasani V, Woo HH. Use of Clavien-Dindo Classification in reporting and grading of complications after urologic surgical procedures; Analysis of 2010-2012. The Journal of urology. 2013.
Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111(5):518–26.
Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
Martínez-Salamanca JI, Novara G, Bertini R, Carballido J, Chromecki T, Ciancio G, et al. 1907 Level of Thrombous According To Mayo Clinic Classification Is an Independent Predictor of Perioperative Complications and Cancer-Related Outcome: Data of the Ircvt Rcc Venous Thrombus Consortium. J Urol. 2013;189(4):e782. Elsevier Inc.
Kattan MW, Reuter V, Motzer RJ, Katz J, Russo P. A postoperative prognostic nomogram for renal cell carcinoma. J Urol. 2001;166(1):63–7.
Cindolo L, Patard J-J, Chiodini P, Schips L, Ficarra V, Tostain J, et al. Comparison of predictive accuracy of four prognostic models for nonmetastatic renal cell carcinoma after nephrectomy: a multicenter European study. Cancer. 2005;104(7):1362–71.
Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. An outcome prediction model for patients with clear cell renal cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score. J Urol. 2002;168(6):2395–400.
Karakiewicz PI, Briganti A, Chun FK-H, Trinh Q-D, Perrotte P, Ficarra V, et al. Multi-institutional validation of a new renal cancer-specific survival nomogram. J Clin Oncol: Off J Am Soc Clin Oncol. 2007;25(11):1316–22.
Sorbellini M, Kattan MW, Snyder ME, Reuter V, Motzer R, Goetzl M, et al. A postoperative prognostic nomogram predicting recurrence for patients with conventional clear cell renal cell carcinoma. J Urol. 2005;173(1):48–51.
Veeratterapillay R, Rakhra S, El-sherif A, Johnson M, Soomro N, Heer R. Can the Kattan nomogram still accurately predict prognosis in renal cell carcinoma using the revised 2010 tumor – nodes – metastasis reclassification ? 2012;773–6.
Martinez-Salamanca JI, Capitanio U, Huang W, Millan I, Bertini R, Bianco F, et al. 534 Cancer-Specific Survival Nomogram for Renal Tumors With Venous Extension:International Renal Cell-Carcinoma-Venous Thrombus Consortium. J Urol. 2011;185(4):e217.
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Conflict of Interest
Dr. Juan I. Martínez-Salamanca, Dr. Estefania Linares, Dr. Javier González, Dr. Roberto Bertini, Dr. Joaquín A. Carballido, Dr. Thomas Chromecki, Dr. Sia Daneshmand, Dr. Christopher P. Evans, Dr. Paolo Gontero, Dr. Axel Haferkamp, Dr. Markus Hohenfellner, Dr. William C. Huang, Dr. Theresa M. Koppie, Dr. Viraj A. Master, Dr. Rayan Matloob, Dr. James M. McKiernan, Dr. Carrie M. Mlynarczyk, Dr. Francesco Montorsi, Dr. Hao G. Nguyen, Dr. Giacomo Novara, Dr. Sascha Pahernik, Dr. Juan Palou, Dr. Raj S. Pruthi, Dr. Krishna Ramaswamy, Dr. Oscar Rodriguez Faba, Dr. Paul Russo, Dr. Shahrokh F. Shariat, Dr. Martin Spahn, Dr. Carlo Terrone, Dr. Derya Tilki, Dr. Daniel Vergho, Dr. Eric M. Wallen, Dr. Evanguelos Xylinas, Dr. Richard Zigeuner, and Dr. John A. Libertino each declare no potential conflicts of interest relevant to this article.
Dr. Gaetano Ciancio is a section editor for Current Urology Reports.
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Martínez-Salamanca, J.I., Linares, E., González, J. et al. Lessons learned from the International Renal Cell Carcinoma-Venous Thrombus Consortium (IRCC-VTC). Curr Urol Rep 15, 404 (2014). https://doi.org/10.1007/s11934-014-0404-7
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DOI: https://doi.org/10.1007/s11934-014-0404-7