UT Southwestern-led researchers find new way to determine prognosis of invasive kidney cancer

The nationally recognized Kidney Cancer Program at UT Southwestern Medical Center's Harold C. Simmons Comprehensive Cancer Center led a team of investigators who identified a new way to help doctors determine the prognosis for patients with stage 3 kidney cancer, which has important implications for decisions about surgery and inclusion in clinical trials.

Patients with stage 3 kidney cancer have rates of recurrence after surgery that vary widely from 20 to 60 percent. To help identify factors that can affect recurrence, Dr. Vitaly Margulis, Associate Professor of Urology, and Dr. Michael Wait, Professor of Cardiovascular and Thoracic Surgery, led a research team of top-tier investigators from Mayo Clinic, MD Anderson Cancer Center, Emory University, Indiana University, and the University of Wisconsin.

Stage 3 kidney tumors are characterized by invasion, and the team focused on a subset of tumors that invaded the largest vein of the body, the inferior vena cava. In these patients, kidney cancer may travel along the vena cava all the way to the heart. In up to half of these patients, the tumor inside the vena cava can trigger the development of a blood clot, but it was previously unclear whether blood clot development impacts cancer survival rates.

The UT Southwestern-led team found that patients whose tumors triggered a blood clot had a fourfold higher chance of dying from their kidney cancer.

Published in Urology this year, the study followed 446 patients with kidney tumors that invaded the vena cava and who were treated with surgery to remove the affected kidney. The patients were split into two groups – those who developed a blood clot (174) and those who did not (272). The investigators found that the presence of a blood clot was associated with a more advanced stage of the disease, more complications during surgery, and increased risk of dying from the kidney cancer.

Because a blood clot can be easily identified by MRI, this study has revealed a useful and powerful marker that will help doctors better understand their patients' tumors.

"These important findings provide a new radiological marker for counseling patients and building the most effective, interdisciplinary treatment plans," said Dr. Margulis, corresponding author of the study. "The results will help patients in making decisions about surgery, as well as participation in advanced clinical trials available at UT Southwestern."

"The remarkable skill of our surgeons together with novel treatment approaches we pioneered using stereotactic radiation and the availability of clinical trials makes UT Southwestern an ideal place for patients with these challenging tumors," said Dr. James Brugarolas, Professor of Internal Medicine and Director of the Kidney Cancer Program, who holds the Sherry Wigley Crow Cancer Research Endowed Chair in Honor of Robert Lewis Kirby, M.D.​