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01.12.2024 | Original Article

Long-term functional outcomes in patients undergoing radical nephrectomy for renal cell carcinoma and tumor thrombus

verfasst von: Pietro Scilipoti, Giuseppe Rosiello, Alessandro Larcher, Giuseppe Fallara, Daniele Cignoli, Chiara Re, Giacomo Musso, Francesco Cei, Zhe Tian, Pierre I. Karakiewicz, Alexandre Mottrie, Francesco Trevisani, Daniele Raggi, Andrea Necchi, Roberto Bertini, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Umberto Capitanio

Erschienen in: World Journal of Urology | Ausgabe 1/2024

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Abstract

Background

Up to 15% of patients with locally advanced renal cell carcinoma (RCC) harbors tumor thrombus (TT). In those cases, radical nephrectomy (RN) and thrombectomy represents the standard of care. We assessed the impact of TT on long-term functional and oncological outcomes in a large contemporary cohort.

Methods

Within a prospective maintained database, 1207 patients undergoing RN for non-metastatic RCC between 2000 and 2021 at a single tertiary centre were identified. Of these, 172 (14%) harbored TT. Multivariable logistic regression analyses evaluated the impact of TT on the risk of postoperative acute kidney injury (AKI). Multivariable Poisson regression analyses estimated the risk of long-term chronic kidney disease (CKD). Kaplan Meier plots estimated disease-free survival and cancer specific survival. Multivariable Cox regression models assessed the main predictors of clinical progression (CP) and cancer specific mortality (CSM).

Results

Patients with TT showed lower BMI (24 vs. 26 kg/m²) and preoperative Hb (11 vs. 14 g/mL; all—p < 0.05). Clinical tumor size was higher in patients with TT (9.6 vs. 6.5 cm; p < 0.001). After adjusting for potential confounders, the presence of TT was significantly associated with a higher risk of postoperative AKI (OR 2.03, 95% CI 1.49–3.6; p < 0.001) and long-term CKD (OR: 1.32, 95% CI 1.10–1.58; p < 0.01). Notably, patients with TT showed worse long-term oncological outcomes and TT was a predictor for CP (2.02, CI 95% 1.49–2.73, p < 0.001) and CSM (HR 1.61, CI 95% 1.04–2.49, p < 0.03).

Conclusions

The presence of TT in RCC patients represents a key risk factor for worse perioperative, as well as long-term renal function. Specifically, patients with TT harbor a significant and early estimated glomerular filtration rate (eGFR) decrease. However, despite TT patients show a greater eGFR decline after surgery, they retain acceptable renal function, which remains stable over time.

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Titel: Long-term functional outcomes in patients undergoing radical nephrectomy for renal cell carcinoma and tumor thrombus
verfasst von: Pietro Scilipoti
Giuseppe Rosiello
Alessandro Larcher
Giuseppe Fallara
Daniele Cignoli
Chiara Re
Giacomo Musso
Francesco Cei
Zhe Tian
Pierre I. Karakiewicz
Alexandre Mottrie
Francesco Trevisani
Daniele Raggi
Andrea Necchi
Roberto Bertini
Andrea Salonia
Alberto Briganti
Francesco Montorsi
Umberto Capitanio
Publikationsdatum: 01.12.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 1/2024
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-024-04976-5

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Long-term functional outcomes in patients undergoing radical nephrectomy for renal cell carcinoma and tumor thrombus