Prognosis in metastatic renal cell cancer (mRCC) with major venous involvement (MVI): A population-based study.
Authors: Ayaz Ahsan , Khan Manahil , Naqvi Syed Arsalan Ahmed , Afzal Muhammad Umar , Cobran Ewan Kemar , Mir Sajid Ahmad , Abdul-Muhsin Haidar , Singh Parminder , Riaz Irbaz Bin , Zakharia Yousef 
Published: February 2025

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Background:
Limited data exist on outcomes in mRCC patients with major venous involvement (MVI). Assessment of impact of a given variable on prognosis in cancer patients is challenging given competing causes of death (PMID: 25417239). This analysis aims to estimate cancer prognosis in mRCC patients with MVI, considering death from competing causes.
Methods:
Data from the Surveillance Epidemiology and End Results (SEER) database (2010-2020) were analyzed for survival and mortality in mRCC patients with MVI. 5-year (y) overall survival (OS) and 5-y probability of cancer death were calculated using the actuarial method in SEER*Stat 8.4.4, reported as percentages with 95% confidence intervals (CI). Results were based on the site of MVI (renal vein, inferior vena cava [IVC]) and stratified by age (<65, >65 years), gender (male, female), and race/ethnicity (Non-Hispanic [NH] White, NH Black, NH Asian/Pacific Islander [API], Hispanic).
Results:
A total of 89047 mRCC patients were included in our analysis of whom 10785 (12%) had major venous involvement (MVI). Overall, patients who experienced MVI had worse prognosis as compared to those who did not have MVI (5-y OS: 53.2% vs 84.4% and 5-y cancer death: 38.6% vs 8.2% respectively). Among cohort with MVI, prognosis was poor with IVC involvement as compared to involvement of renal vein (5-y OS: 36% vs 57%; 5-y cancer death: 56% vs 35% respectively). Patients who had the worst prognosis with MVI included older adults (>65 y) (5-y OS: 47.8%; 5-y cancer death: 40.8%) and NH Black (5-y OS: 41.5%; 5-y cancer death: 49.8%) (Table).
Conclusions:
Prognosis in mRCC with MVI, especially with IVC involvement, was poor, particularly for older adults (>65 y) and NH Black patients. Further research is needed for better prognostication and risk stratification to improve outcomes for high-risk patients.

Subgroup
No MVI
MVI

N

5-year OS (%),
95% CI

5-year Cancer
death (%), 95% CI

N

5-year OS (%),
95% CI

5-year Cancer
death (%), 95% CI

Overall population
78,262
84.4 (84.1-84.7)
8.2 (8.0-8.4)
10,785
53.2 (52.0-54.3)
38.6 (37.5-39.7)

Age
<65 y
49,217
89.0 (88.6-89.2)
6.5 (6.3-6.8)
5,897
57.5 (56.0-59.0)
36.8 (35.4-38.3)

>65 y
29,045
77.0 (76.1-77.2)
10.9 (10.5-11.4)
4,888
47.8 (46.0-49.5)
40.8 (39.2-42.4)

Gender
Male
49,221
83.0 (82.7-83.5)
8.9 (8.6-9.2)
7,503
53.2 (51.8-54.6)
38.3 (37.0-39.6)

Female
29,041
86.5 (86.0-86.9)
7.0 (6.7-7.4)
3,282
53.0 (51.0-55.0)
39.4 (37.4-41.3)

Race/ethnicity
NH White
49,520
84.0 (83.7-84.4)
8.3 (8.0-8.5)
7,182
53.5 (52.1-54.8)
38.0 (36.7-39.3)

NH Black
8,878
82.0 (81.0-82.9)
8.1 (7.5-8.8)
685
41.5 (37.1-45.9)
49.8 (45.4-54.1)

NH API
4,747
86.0 (85.1-87.4)
8.5 (7.6-9.4)
713
52.9 (48.2-57.3)
39.9 (35.5-44.1)

Hispanic (All Races)
13,826
86.5 (85.8-87.2)
7.9 (7.4-8.4)
2,014
56.2 (53.4-58.8)
36.7 (34.1-39.2)

N: number of cases; OS: overall survival; CI: confidence interval; NH: Non-Hispanic; API: Asian/Pacific Islander; MVI: major venous involvement.