Factors associated with surgery in patients with renal cell carcinoma and venous tumor thrombus

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? This is the first published report which is an in-depth analysis of factors associated with surgery versus non-operative management in patients with renal cell carcinoma and venous tumour thrombus. OBJECTIVE Venous tumour thrombus is common in patients with renal cell carcinoma (RCC). Although surgical morbidity has decreased with time, nephrectomy with caval thrombectomy remains a high-risk procedure and may not be performed in all patients with this condition. Little is known about the factors influencing the decision to pursue surgery versus conservative management in patients with RCC and venous tumour thrombus. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results database was used to identify study patients with RCC and venous tumour thrombus. Multiple clinical, pathological and sociodemographic variables were assessed. Univariable and multivariable logistic regression analysis was performed to identify factors associated with surgery. RESULTS We identified 24 396 patients with RCC, of which 2265 (9.3%) had venous tumour thrombus. Distant metastases (odds ratio [OR] 0.1, 95% CI 0.0-0.1), clinical stage T3c (OR 0.3, 95% CI 0.2-0.6), lymph node involvement (OR 0.4, 95% CI 0.2-0.6), being single (OR 0.4, 95% CI 0.3-0.7), and the age categories 61-70 years (OR 0.4, 95% CI 0.2-0.8, P= 0.01), 71-80 years (OR 0.2, 95% CI 0.1-0.3, P < 0.001), and ≥80 years (OR 0.1, 95% CI 0.0-0.1, P < 0.001) were significantly associated with non-surgical management. CONCLUSIONS In this population-based study, over 80% of patients with RCC and venous tumour thrombus underwent surgical management. Although age and TNM stage were strongly associated with the decision to undergo surgery, marital status was also associated with treatment choice. It is unclear whether marital status affects oncological outcomes or complication rates so the reasons behind this association deserve further investigation.