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Authors Peng C, Gu L, Wang L, Huang Q, Wang B, Guo G, Fan Y, Gao Y, Ma X, Zhang X
Received 26 November 2017
Accepted for publication 16 January 2018
Published 6 April 2018 Volume 2018:11 Pages 1997—2005
DOI https://doi.org/10.2147/OTT.S158114
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Ru Chen
Peer reviewer comments 4
Editor who approved publication: Dr Ingrid Espinoza
Purpose: The
clinical benefit of targeted molecular therapy (TMT) in renal cell carcinoma
(RCC) with an inferior vena cava (IVC) tumor thrombus remains controversial.
The aim of this study was to investigate the effects of presurgical TMT on the
heights and levels of IVC thrombi, and to assess its impact on surgical
strategy.
Patients and
methods: We retrospectively reviewed data from 18
patients with RCC involving IVC tumor thrombi who were treated at our hospital
with presurgical TMT followed by an IVC thrombectomy. The changes in heights
and levels of the IVC thrombi were compared using computed tomography or
magnetic resonance imaging. Clinicopathological factors were also evaluated to
assess their association with TMT efficacy.
Results: The
tumor thrombus levels before TMT were stage I in 1 patient (5.6%), II in 12
patients (66.7%), III in 4 patients (22.2%), and IV in 1 patient (5.6%). After
a median of two treatment cycles (range: 1–3), the thrombus height decreased
measurably in 11 patients (61.1%) with an average shrinkage of 17.7%. The
thrombus height remained stable in five patients (27.8%) and was enlarged in
two (11.1%). Downstaging of the thrombus level occurred in four patients
(22.2%); the surgical strategy was modified in three patients (16.7%) to avoid
cardiopulmonary bypass and complicated liver mobilization under robot-assisted
laparoscopy. Furthermore, a higher neutrophil count tended to be associated
with a worse clinical TMT-associated outcome (P =0.056).
Conclusion: Our
data suggest a limited influence of presurgical TMT with a positive benefit in
RCC patients with level III and IV thrombus. Thrombus-level regression may potentially
alter the surgical strategy, especially robotic surgery. However, our findings
require validation with additional prospective investigations.
Keywords: presurgical
TMT, surgical strategy, sorafenib, sunitinib