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Baboudjian M, Gondran-Tellier B, Khene Z, Bigot P, Mejean A, Lang H, Lebacle C, Doumerc N, Bruyere F, Nouhaud FX, Ouzaid I, Bensalah K, Bernhard JC, Boissier R. Predictive factors of recurrence after surgery in patients with non-metastatic renal cell carcinoma with venous tumor thrombus (UroCCR-56 Study). World J Urol 2023; 41:295-302. [PMID: 33765164 DOI: 10.1007/s00345-021-03640-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/15/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the oncological outcomes of renal cell carcinoma (RCC) associated with tumor thrombus and identify predictive factors of recurrence. METHODS Multi-institutional study that included patients with cT3-4N0-1M0 RCC with tumoral thrombus identified in the prospective UroCCR database (CNIL DR 2013-206; NCT03293563). pT3a without involvement of the renal vein were excluded. All patients underwent radical nephrectomy and a thrombectomy of the renal vein ± inferior vena cava ± right atrium. The primary endpoint was recurrence-free survival (RFS). Thirty-two patients who had adjuvant therapies (tyrosine kinase inhibitors or mTOR inhibitor) were compared to control group (surveillance) in a propensity score-matched 1:1 sub-analysis RESULTS: A total of 432 patients were included: 70.4% pT3a, 20.1% pT3b, 4.2% pT3c and 5.3% pT4. Tumor characteristics were: 90.7% clear cell RCC, 13.9% pN1, and 87.1% high Fuhrman grade. 173 patients (40%) had disease recurrence, and median RFS was 37.3 months (95% CI, 26.4-46.7). In a multivariate analysis (Cox model), predictive factors of recurrence were: pT4 (HR 2.66; 95% CI, 1.42-4.99; p = 0.002), pN1 (HR 2.53; 95% CI, 1.46-4.39; p < 0.001), tumor necrosis (HR 2.92; 95% CI, 1.85-4.62; p < 0.001), tumor size > 10 cm (HR 1.56; 95% CI, 1.08-2.24; p = 0.018). Adjuvant therapy was a protective factor of cancer recurrence (HR 0.33; 95% CI, 0.17-0.66; p = 0.002). Propensity score-matched sub-analysis of adjuvant vs control (surveillance) confirmed adjuvant treatment as a protective factor of cancer recurrence (Log rank p = 0.015). CONCLUSIONS In this contemporary multi-institutional cohort of RCC + tumor thrombus, we reported higher recurrence rate shortly after surgical excision and demonstrated an oncological benefit of adjuvant treatment.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology and Kidney Transplantation, Aix-Marseille University, La Conception Academic Hospital, APHM147 boulevard baille, 13005, Marseille, France
| | - Bastien Gondran-Tellier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, La Conception Academic Hospital, APHM147 boulevard baille, 13005, Marseille, France
| | | | - Pierre Bigot
- Department of Urology, University of Angers, Angers, France
| | - Arnaud Mejean
- Department of Urology, HEGP Hospital, APHP, Paris, France
| | - Hervé Lang
- Department of Urology, University of Strasbourg, Strasbourg, France
| | - Cedric Lebacle
- Department of Urology, Bicetre University Hospital, APHP, University Paris-Saclay, Le Kremlin-Bicetre, France
| | - Nicolas Doumerc
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Franck Bruyere
- Department of Urology, University of Tours, Tours, France
| | | | - Idir Ouzaid
- Department of Urology, Bichat University Hospital, APHP, Paris, France
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | | | - Romain Boissier
- Department of Urology and Kidney Transplantation, Aix-Marseille University, La Conception Academic Hospital, APHM147 boulevard baille, 13005, Marseille, France.
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