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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (4): 644-649. doi: 10.19723/j.issn.1671-167X.2025.04.003

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Clinicopathological and prognostic differences between clear cell and non-clear cell renal cell carcinoma with venous tumor thrombus

Boda GUO1, Min LU2, Guoliang WANG1, Hongxian ZHANG1, Lei LIU1, Xiaofei HOU1, Lei ZHAO1, Xiaojun TIAN1, Shudong ZHANG1,*()   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Pathology, Peking University Third Hospital, Peking University School of Basic Medical Sciences, Beijing, 100191, China
  • Received:2025-03-14 Online:2025-08-18 Published:2025-08-02
  • Contact: Shudong ZHANG
  • Supported by:
    the National Natural Science Foundation of China(82473287); the Beijing Natural Science Foundation(7232212)

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Abstract:

Objective: To compare the clinicopathological characteristics and prognostic outcomes between patients with clear cell renal cell carcinoma (ccRCC) and non-clear cell renal cell carcinoma (nccRCC) accompanied by venous tumor thrombus. Methods: A retrospective analysis was conducted on clinical and pathological data from patients with RCC and venous tumor thrombus treated in the Department of Urology at Peking University Third Hospital between January 2014 and February 2024. Patients were stratified into two groups based on pathological type: ccRCC and nccRCC. Comparisons of baseline characteristics, intraoperative situation, and prognosis between the two groups were performed using t-tests, Mann-Whitney U tests, chi-square tests, and Log-rank tests. Survival curves were generated using the Kaplan-Meier method. Results: A total of 437 patients were included, with a median age of 58 years, including 317 males and 120 females. The cohort comprised 366 cases of ccRCC and 71 cases of nccRCC. The non-clear cell group included 38 cases (53.5%) of papillary renal cell carcinoma, 2 cases (2.8%) of chromophobe renal cell carcinoma, 11 cases (15.5%) of unclassified renal cell carcinoma, 19 cases (26.8%) of molecularly defined renal cell carcinoma, and 1 case (1.4%) of collecting duct carcinoma. Compared with the clear cell renal carcinoma group, patients in the non-clear cell carcinoma group demonstrated a younger age at diagnosis (59 years vs. 55 years, P=0.010), larger tumor size (8.4 cm vs. 9.5 cm, P=0.025), higher rates of lymph node metastasis (56.8% vs. 70.6%, P=0.034), more advanced tumor thrombus (P < 0.001) and pathological grading (P=0.010), longer surgical duration (272 minutes vs. 289 minutes, P=0.023), and shorter overall survival (80 months vs. 35 months, P < 0.001). Multivariate Cox analysis indicated that histologic type, distant metastasis, tumor thrombus grading, and sarcomatoid/rhabdoid differentiation were prognostic factors in the renal cell carcinoma patients with venous tumor thrombus. No significant differences were observed between the two groups in terms of gender, body mass index, tumor laterality, distant metastasis, sarcomatoid or rhabdoid differentiation, American Society of Anesthesiologists (ASA) score, surgical approach, conversion to open surgery, blood loss, or transfusion of red blood cells and plasma. Conclusion: Compared with patients with clear cell renal carcinoma and venous tumor thrombus, those with non-clear cell carcinoma and venous tumor thrombus exhibit earlier onset, more aggressive disease progression, and poorer prognosis.

Key words: Renal cell carcinoma, Venous tumor thrombus, Retrospective, Prognosis

CLC Number: 

  • R737.11

Table 1

Baseline clinical and tumor characteristics of clear cell and non-clear cell renal cell carcinoma patients with venous tumor thrombus"

Variables Total ccRCC nccRCC P
Number of patients 437 (100.0) 366 (83.8) 71 (16.2)
Age/years 58 (14) 59 (8) 55 (18) 0.010
Gender 0.191
  Male 317 (72.5) 270 (73.8) 47 (66.2)
  Female 120 (27.5) 96 (26.2) 24 (33.8)
BMI/(kg/m2) 24.0 (4.7) 24.0 (5.0) 24.1 (4.1) 0.734
Tumor laterality 0.194
  Left 167 (38.2) 135 (36.9) 32 (45.1)
  Right 270 (61.8) 231 (63.1) 39 (54.9)
Histologic type
  Clear cell 366 (83.8) 366 (100) -
  Papillary 38 (8.7) - 38 (53.5)
  Chromophobe 2 (0.5) - 2 (2.8)
  Unclassified 11 (2.5) - 11 (15.5)
  Molecularly defined 19 (4.3) - 19 (26.8)
  Collecting duct 1 (0.2) - 1 (1.4)
Tumor diameter/cm 8.6 (3.8) 8.4 (3.9) 9.5 (4.1) 0.025
N 0.034
  N0 177 (40.5) 158 (43.2) 20 (29.4)
  N1 260 (59.5) 208 (56.8) 48 (70.6)
M 0.074
  M0 315 (72.1) 270 (73.8) 45 (63.4)
  M1 122 (27.9) 96 (26.2) 26 (37.6)
Tumor thrombus grading < 0.001
  0 112 (25.6) 97 (26.5) 15 (21.1)
  1 73 (16.7) 61 (16.7) 12 (16.9)
  2 182 (41.6) 154 (42.1) 28 (39.4)
  3 37 (8.5) 25 (6.8) 12 (16.9)
  4 33 (7.6) 29 (7.9) 4 (5.7)
Sarcomatoid/rhabdoid differentiation 0.118
  Absent 374 (85.6) 309 (84.4) 65 (91.5)
  Present 63 (14.4) 57 (15.6) 6 (8.5)
Pathologic grade 0.010
  1-2 157 (35.9) 141 (38.5) 16 (22.5)
  3-4 280 (64.1) 225 (61.5) 55 (77.5)
ASA grade 0.233
  1-2 367 (84.0%) 304 (83.1) 63 (88.7)
  3-4 70 (16.0) 62 (16.9) 8 (11.3)

Table 2

Intraoperative situation of clear cell and non-clear cell renal cell carcinoma patients with venous tumor thrombus"

Variables Total ccRCC nccRCC P
Number of patients 437 (100.0) 366 (83.8) 71 (16.2)
Radical nephrectomy approach 0.112
  Open 157 (35.9) 124 (33.9) 33 (46.5)
  Laparoscopic 181 (41.4) 158 (43.2) 23 (32.4)
  Robotic 99 (22.7) 84 (22.9) 15 (21.1)
Conversion to open surgery* 8 (2.9) 7 (2.9) 1 (2.6) >0.999
Duration of surgery/min 273 (171) 272 (164) 289 (170) 0.023
Estimated blood loss/mL 500 (900) 500 (900) 575 (857) 0.361
RBC transfusion/mL 400 (800) 400 (800) 0 (800) 0.316
Plasma transfusion/mL 0 (400) 0 (400) 0 (400) 0.591

Table 3

Prognosis-related Cox regression analysis in patients with renal cell carcinoma patients with venous tumor thrombus"

Variables Univariate analysis Multivariate analysis
HR (95%CI) P HR (95%CI) P
Age/years
   < 60
  ≥60 1.344 (0.981, 1.841) 0.066
Gender
  Male
  Female 0.931 (0.651, 1.332) 0.695
BMI/(kg/m2)
   < 24
  ≥24 0.626 (0.456, 0.859) 0.004 0.772 (0.553, 1.078) 0.128
Tumor laterality
  Left
  Right 0.921 (0.671, 1.264) 0.611
Histologic type
  Clear cell
  Non-clear cell 2.386 (1.670, 3.409) < 0.001 2.277 (1.561, 3.321) < 0.001
Tumor size/cm
   < 8.5
  ≥8.5 1.199 (0.879, 1.637) 0.252
N
  N0
  N1 1.270 (0.919, 1.756) 0.148
M
  M0
  M1 2.582 (1.882, 3.543) < 0.001 2.250 (1.609, 3.146) < 0.001
Tumor thrombus grading
  0
  1 1.102 (0.657, 1.848) 0.712 0.986 (0.584, 1.666) 0.958
  2 1.246 (0.818, 1.896) 0.306 1.275 (0.824, 1.975) 0.276
  3 2.082 (1.207, 3.589) 0.008 1.502 (0.816, 2.766) 0.192
  4 2.399 (1.367, 4.211) 0.002 2.208 (1.207, 4.040) 0.010
Sarcomatoid/rhabdoid differentiation
  Absent
  Present 2.168 (1.454, 3.235) < 0.001 2.309 (1.520, 3.509) < 0.001
Pathologic grade
  1-2
  3-4 1.931 (1.362, 2.738) < 0.001 1.432 (0.998, 2.056) 0.051
ASA grade
  1-2
  3-4 1.399 (0.939, 2.083) 0.098
Radical nephrectomy approach
  Open
  Laparoscopic 1.483 (1.067, 2.060) 0.019 0.872 (0.596, 1.276) 0.481
  Robotic 0.884 (0.512, 1.525) 0.657 0.614 (0.349, 1.081) 0.091

Figure 1

Kaplan-Meier survival curves for clear cell and non-clear cell renal cell carcinoma (ccRCC and nccRCC) patients with venous tumor thrombus compared with overall survival"

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