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Purpose <p>To characterize the impact of histology on survival outcomes in a population-based cohort of patients treated surgically for renal cell carcinoma (RCC) with tumor thrombus (TT) extension.</p> Methods <p>The Surveillance, Epidemiology, and End Results database was used to identify adult patients with node-negative, non-metastatic RCC and TT who underwent surgical resection between 2010 and 2021. The Kaplan-Meier method and log-rank test were used to compare overall survival (OS) probabilities for clear cell RCC (ccRCC) versus non-clear cell RCC (nccRCC). Cox and Fine-Gray competing risk regression analyses were performed to evaluate histology-specific risks of all-cause and cancer-specific mortality (CSM), respectively.</p> Results <p>A total of 6553 patients were included, of whom 381 (5.8%) had nccRCC. Over a median follow up of 3.2 years, 1757 (26.8%) deaths occurred, of which 1165 (66.3%) were attributable to RCC. There was no difference in OS between patients with ccRCC versus nccRCC (5-year OS: 70.9% versus 65.6%, <i>p</i> = 0.09). Histologic subtype was not significantly predictive of all-cause mortality on multivariable Cox regression (hazard ratio (HR) = 1.12, 95% confidence interval (CI): 0.92–1.37, <i>p</i> = 0.3). On multivariable competing risk regression analysis, nccRCC was not associated with increased hazard of CSM (HR = 1.24, 95% CI: 0.96–1.58, <i>p</i> = 0.09) compared to ccRCC. Similar findings were noted in the subcohort of patients with TT extension to the IVC.</p> Conclusions <p>No statistically significant differences in survival outcomes by histology were detected among patients with TT arising from RCC after definitive surgical resection. Multimodal treatment strategies, particularly for nccRCC, are needed to further improve outcomes in these patients.</p>

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Survival outcomes after surgical treatment for non-clear cell renal cell carcinoma with tumor thrombus extension: a population-based cohort study

  • 期刊论文

  • 发表日期：

    2026年3月7日

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  • Joseph G. Cheaib,
  • Carlos A. Rivera López,
  • Craig Cronin,
  • Mark N. Alshak,
  • Adnan El-Achkar,
  • Sunil H. Patel,
  • Nirmish Singla

摘要

Purpose

To characterize the impact of histology on survival outcomes in a population-based cohort of patients treated surgically for renal cell carcinoma (RCC) with tumor thrombus (TT) extension.

Methods

The Surveillance, Epidemiology, and End Results database was used to identify adult patients with node-negative, non-metastatic RCC and TT who underwent surgical resection between 2010 and 2021. The Kaplan-Meier method and log-rank test were used to compare overall survival (OS) probabilities for clear cell RCC (ccRCC) versus non-clear cell RCC (nccRCC). Cox and Fine-Gray competing risk regression analyses were performed to evaluate histology-specific risks of all-cause and cancer-specific mortality (CSM), respectively.

Results

A total of 6553 patients were included, of whom 381 (5.8%) had nccRCC. Over a median follow up of 3.2 years, 1757 (26.8%) deaths occurred, of which 1165 (66.3%) were attributable to RCC. There was no difference in OS between patients with ccRCC versus nccRCC (5-year OS: 70.9% versus 65.6%, p = 0.09). Histologic subtype was not significantly predictive of all-cause mortality on multivariable Cox regression (hazard ratio (HR) = 1.12, 95% confidence interval (CI): 0.92–1.37, p = 0.3). On multivariable competing risk regression analysis, nccRCC was not associated with increased hazard of CSM (HR = 1.24, 95% CI: 0.96–1.58, p = 0.09) compared to ccRCC. Similar findings were noted in the subcohort of patients with TT extension to the IVC.

Conclusions

No statistically significant differences in survival outcomes by histology were detected among patients with TT arising from RCC after definitive surgical resection. Multimodal treatment strategies, particularly for nccRCC, are needed to further improve outcomes in these patients.