Efficacy and safety of cytoreductive nephrectomy combined with thrombectomy in metastatic renal cell carcinoma with venous tumor thrombus: a real-world study based on inverse probability of treatment weighting.
Cytoreductive nephrectomy (CN) combined with thrombectomy remains controversial for metastatic renal cell carcinoma with venous tumor thrombus (mRCC-VTT), and optimal patient selection remains undefined.
We retrospectively analyzed 238 patients with RCC-VTT treated at a single center between February 2006 and December 2023. Patients were stratified as non-metastatic surgical (nmRCC-VTT-S, n = 135), metastatic surgical (mRCC-VTT-S, n = 53), or metastatic non-surgical (mRCC-VTT-NS, n = 50). Inverse probability of treatment weighting (IPTW) was used to reduce measured confounding. Perioperative outcomes, OS, PFS, subgroup heterogeneity, and 3-month landmark sensitivity analyses were evaluated.
After IPTW adjustment, perioperative outcomes were comparable between metastatic and non-metastatic surgical cohorts (all P > 0.05). In the metastatic cohort, surgery was associated with longer OS than non-surgical management (P = 0.027), and this association remained significant in the 3-month landmark analysis after re-estimating IPTW (P = 0.018). PFS showed no significant difference after primary IPTW adjustment (P = 0.517) and showed only a non-significant favorable trend after landmark IPTW adjustment (P = 0.064). Mayo level modified the association between surgery and OS (P for interaction < 0.001) and PFS (P for interaction = 0.034). For OS, surgery was associated with longer survival in Mayo 0-II thrombi (HR 0.56, P = 0.045), whereas patients with Mayo III-IV thrombi had worse outcomes after surgery (HR 6.22, P = 0.016).
CN combined with thrombectomy appeared feasible and was associated with improved OS in selected patients with mRCC-VTT, particularly those with low-level thrombi. Mayo level should inform surgical decision-making, and systemic therapy-first strategies should be considered for high-level thrombi.
We retrospectively analyzed 238 patients with RCC-VTT treated at a single center between February 2006 and December 2023. Patients were stratified as non-metastatic surgical (nmRCC-VTT-S, n = 135), metastatic surgical (mRCC-VTT-S, n = 53), or metastatic non-surgical (mRCC-VTT-NS, n = 50). Inverse probability of treatment weighting (IPTW) was used to reduce measured confounding. Perioperative outcomes, OS, PFS, subgroup heterogeneity, and 3-month landmark sensitivity analyses were evaluated.
After IPTW adjustment, perioperative outcomes were comparable between metastatic and non-metastatic surgical cohorts (all P > 0.05). In the metastatic cohort, surgery was associated with longer OS than non-surgical management (P = 0.027), and this association remained significant in the 3-month landmark analysis after re-estimating IPTW (P = 0.018). PFS showed no significant difference after primary IPTW adjustment (P = 0.517) and showed only a non-significant favorable trend after landmark IPTW adjustment (P = 0.064). Mayo level modified the association between surgery and OS (P for interaction < 0.001) and PFS (P for interaction = 0.034). For OS, surgery was associated with longer survival in Mayo 0-II thrombi (HR 0.56, P = 0.045), whereas patients with Mayo III-IV thrombi had worse outcomes after surgery (HR 6.22, P = 0.016).
CN combined with thrombectomy appeared feasible and was associated with improved OS in selected patients with mRCC-VTT, particularly those with low-level thrombi. Mayo level should inform surgical decision-making, and systemic therapy-first strategies should be considered for high-level thrombi.
Authors
Shi Shi, Peng Peng, Song Song, Jiao Jiao, Chen Chen, Yang Yang, Lv Lv, Zhang Zhang, Gu Gu, Ma Ma, Huang Huang
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