Presence of Bland Thrombus Is a Negative Indicator for Cancer Specific Survival in Patients Undergoing Nephrectomy for Kidney Tumors with Venous Tumor Thrombus

PURPOSE: We sought to evaluate the oncologic outcomes of patients undergoing nephrectomy for tumors with venous tumor thrombus with respect to presence or absence of bland thrombus. METHODS: Multi-institutional, IRB approved retrospective nephrectomy databases were reviewed for identification of patients with and without bland thrombus identified on preoperative imaging, intraoperatively, or during final pathologic evaluation. RESULTS: 388 patients were identified including 225 without bland thrombus and 163 with bland thrombus. Median patient age was 62 and median ECOG performance status was 1. Median survival time for tumors without bland thrombus was 76.7 months (95% CI: 57.7 - 95.8) versus 28.3 months (95% CI: 23.0 - 33.5) for those with bland thrombus. Bland thrombus was not associated with histologic subtype (p = 0.069) or sarcomatoid differentiation (p= 0.60) and was highly associated with tumor stage (p<0.001), level of tumor thrombus (p<0.001) and positive margin status (p<0.001). Presence of bland thrombus was associated with decreased cancer-specific survival (HR 2.03, p < 0.001) CONCLUSION: Presence of bland tumor thrombus is associated with adverse pathologic features and inferior oncologic outcomes in patients treated for RCC and venous tumor thrombus. Pre-surgical identification of bland tumor thrombus may play a role in patient counseling and selection for surgery.