Renal Cell Carcinoma With Venous Tumor Thrombus Has a Predilection for the Lungs

Abstract

Objective

To investigate the association between venous tumor thrombus (VTT) and the risk of pulmonary metastases in patients with clear cell renal cell carcinoma (ccRCC).

Methods

We queried our institutional registry for ccRCC patients undergoing radical nephrectomy (1970-2019). Cox proportional hazards regression models, adjusting for factors associated with ccRCC progression, were used to determine whether VTT was associated with pulmonary metastases.

Results

Of 3410 patients studied, 1025 (30%) had VTT. Patients with VTT were more likely to present with synchronous pulmonary metastasis (20% vs 7%, P <.001). Within the VTT subset, level of VTT was not significantly associated with synchronous pulmonary metastasis (P = .3). Moreover, among patients with metastatic disease at nephrectomy (n = 643), pulmonary metastases were more common in those with VTT versus those without VTT (68% vs 51%, P <.001). Further, excluding patients with synchronous pulmonary metastases, on multivariable analysis, VTT remained associated with an increased risk of developing metachronous pulmonary metastases (hazard ratio (HR) 1.31, P <.001). Interestingly, the presence of PE in the setting of VTT was also identified to be associated with an increased pulmonary metastases post-nephrectomy (HR 2.31, P <.001).

Conclusion

VTT is associated with disproportionately increased pulmonary metastases at presentation and post-nephrectomy in ccRCC. Further, the presence of PE at nephrectomy for VTT was associated with increased pulmonary metastases post-nephrectomy. These results support a metastatic predilection of ccRCC with VTT in the lungs.