Prevalence, treatment and prognosis of tumor thrombi in renal cell carcinoma

F. Kaptein¹, T. van der Hulle¹, S. Braken¹, E. van Gennep¹, J. Buijs¹, M. Burgmans¹, S. Cannegieter¹, E. Du Chatinier¹, M. Huisman², E. van Persijn van Meerten¹, H. Versteeg¹, R. Pelger¹, F. Klok³

¹Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands, ²Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands, Leiden, Zuid-Holland, Netherlands, ³Leiden University Medical Center, Leiden, the Netherlands, Leiden, Zuid-Holland, Netherlands

Abstract Number: PB0924

Meeting: ISTH 2022 Congress

Theme: Venous Thromboembolism » Cancer Associated Thrombosis

Background: Renal cell carcinoma (RCC) can be complicated by a venous tumor thrombus (TT), of which the optimal management is unknown.

Aims: Our aim was to assess the prevalence of TT in RCC, its current management and its association with venous thromboembolism (VTE), arterial thromboembolism (ATE), major bleeding (MB) and mortality.

Methods: 647 patients diagnosed with RCC between 2010-2019 in our hospital were included and followed from RCC diagnosis until two years after, or until an outcome of interest (VTE, ATE and MB) or death occurred, depending on the analysis. The study was approved by the local Institutional Review Board and oral informed consent was obtained. Cumulative incidences were estimated with death as a competing risk. Cox regression was used to identify predictors and the prognostic impact.

Results: At RCC diagnosis 86 patients had a TT (13%), of which 34 were limited to the renal vein (‘RV’), 37 to the inferior vena cava below the diaphragm (‘IVC’), and 15 extended above the diaphragm (‘AD’); 20 patients (23%) started therapeutic anticoagulation and 45 (52%) underwent thrombectomy with/without anticoagulant therapy. During a median follow-up of 24 months (IQR 7.0-24), 36 patients were diagnosed with VTE (5.6%), 11 with ATE (1.7%) and 45 with MB (7.0%). Patients with TT were more often diagnosed with VTE (aHR 6.1, 95%CI 2.5-15; Figure 1), with increasing VTE risks in more proximal TT levels (adjusted 2-year cumulative incidence RV 7.4%, IVC 22% and AD 45%, respectively; Figure 2). TT patients receiving anticoagulation were less often diagnosed with VTE (HR 0.56, 95%CI 0.13-2.5), with a tendency to have more MB events (HR 3.4, 95%CI 0.95-12) compared to those without anticoagulation.

Conclusion(s): Patients with RCC-associated TT were at high risk of developing VTE. Future studies should establish which of these patients benefit from anticoagulation therapy.

Table

Adverse outcomes in the total cohort and in tumor thrombi patients

Figure

Adjusted cumulative incidences of VTE and MB among patients with and without a TT at RCC diagnosis -irrespective of the TT treatment-

To cite this abstract in AMA style:

Kaptein F, van der Hulle T, Braken S, van Gennep E, Buijs J, Burgmans M, Cannegieter S, Du Chatinier E, Huisman M, van Persijn van Meerten E, Versteeg H, Pelger R, Klok F. Prevalence, treatment and prognosis of tumor thrombi in renal cell carcinoma [abstract]. https://abstracts.isth.org/abstract/prevalence-treatment-and-prognosis-of-tumor-thrombi-in-renal-cell-carcinoma-2/. Accessed September 24, 2023.

« Back to ISTH 2022 Congress

ISTH Congress Abstracts - https://abstracts.isth.org/abstract/prevalence-treatment-and-prognosis-of-tumor-thrombi-in-renal-cell-carcinoma-2/