Presurgical molecular therapy for renal cell carcinoma with venous tumor thrombus: a systematic review and meta-analysis.

2025-11-28
Frontiers in immunology 16
- Kewei Chen
- Lin Zhuo
- Zhuo Liu
- Liyuan Ge
- Le Yu
- Shudong Zhang

PubMed: 41394875
DOI: 10.3389/fimmu.2025.1705494

Study Design

Type: Meta-Analysis
Sample size: n = 184
Population: RCC patients with TT
Methods: systematic literature search

Background

Presurgical molecular therapy (PMT) including tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) showed various outcomes for renal cell carcinoma (RCC) with tumor thrombus (TT). We aimed to evaluate the impact of PMT on Mayo level or TT height and the treatment-related adverse events (AEs).

Methods

A systematic literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science up to June 2023 to identify relevant studies investigating the impact of PMT on RCC patients with TT. The literature investigating the impact of PMT on RCC patients with venous TT, whether followed by surgery or not, was included.

Results

Overall, 184 patients were enrolled in this study. 30.7% (95% CI, 17.6-43.8%, I² = 79%, p<0.01) patients experienced a decrease in TT levels after receiving PMT, while only 1.5% (95% CI, 0-0.044%, I² = 0%, p=0.98) exhibited an increase in TT levels. An average decrease of 15.2mm (95% CI, 22.4-8.0, I² = 77%, p<0.01) of TT in 117 patients was observed after PMT. The most common AEs was hypertension (49.9%, 95% CI, 27.1-77.7, I² = 88%, p<0.01), diarrhea (20.2%, 95% CI, 2.7-37.6, I² = 83%, p<0.01), fatigue (25.3%, 95% CI, 6.1-44.4, I² = 84%, p<0.01) and hand-foot syndrome (25.5%, 95% CI, 5.6-45.5, I² = 86%, p<0.01).

Conclusion

PMT is available to assist in lowering the TT level in RCC patients aiming to simply the surgical procedures, particularly in patients with Mayo grade 3/4. The frequency and severity of AEs during PMT are tolerable.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD420234399128.