Neoadjuvant therapy demonstrates both safety and clinical feasibility for renal cell carcinoma patients with tumor thrombus

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BACKGROUND: While the applications of neoadjuvant therapies on patients diagnosed with renal cell carcinoma (RCC) with tumor thrombus (TT) is growing, the safety of preoperative therapies has yet to be clarified. METHODS: 451 patients diagnosed with RCC with TT undergoing radical nephrectomy and thrombectomy were included. Propensity score-matched cohorts were used to investigate the safety and feasibility of neoadjuvant therapies. We compared perioperative parameters and postoperative complications. Postoperative complications were assessed within 30 days of the operation and were graded using the Clavien-Dindo grading system. A Cox regression and Kaplan-Meier curves were used to assess the impact of neoadjuvant therapies on patients' overall survival (OS) and cancer-specific survival (CSS). RESULTS: After 1:3 ratio propensity-score matching (PSM), 56 patients receiving neoadjuvant therapy and 153 patients receiving non-neoadjuvant therapy were included in the analysis. No significant difference was found between the two groups after PSM in terms of baseline information (P > 0.05). The rate of blood transfusion (71.4% vs. 52.3%, P = 0.01) was higher in neoadjuvant therapy. 8 patients (14.3%) in neoadjuvant therapy group experienced serious complications while 15 patients (14.9%) in non-neoadjuvant therapy group experienced serious complications. The perioperative parameters and postoperative complications did not show significant differences in preoperative-combined therapy group and non-preoperative-combined therapy group. No significant differences were found in OS or CSS between the neoadjuvant therapy group and non-neoadjuvant therapy group. CONCLUSIONS: Neoadjuvant therapies can be safely administered to RCC patients with TT. Neoadjuvant therapies recipients' OS or CSS did not differ significantly from those who did not receive the treatment.

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