Determinants and prognostic implications of malignant ascites in metastatic papillary renal cancer: Beyond the Abstract

Ascites has been known to be a significant prognostic indicator in various gynecological and gastrointestinal malignancies. However, its impact on prognosis in renal cell cancer (RCC) patients is not well known due to its rare incidence in RCC patients.

We investigated the incidence and prognostic impact of ascites in metastatic papillary type RCC (pRCC) patient population in our institute and inferred that malignant ascites is a relatively common manifestation in this cohort and the patients developing ascites had a grave prognosis compared to patients without this grim complication.1 We, further found  Platelet Lymphocyte Ratio (PLR) to be an independent predictor for the development of ascites in our patient population signifying the role of the host inflammatory response in the development of malignant ascites.

Paracentesis and drainage with a central venous catheter have remained the cornerstone of palliation in patients with malignant ascites.2,3 More recent modalities of treatment include cytoreductive surgery followed by different intraperitoneal therapeutic options like chemotherapy and other targeted immunotherapies. 4,5 These new emerging therapies have been promising in many cases of malignant ascites due to ovarian and gastrointestinal malignancies.6 However, there is a need of further research into the curative and palliative treatments in pRCC patients with ascites as currently there are no recommendations for its management.

Written by: Amit L Jain, MD1, Abhinav Sidana, MD1.

1Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA

References:
1. Sidana A, Kadakia M, Friend JC, et al: Determinants and prognostic implications of malignant ascites in metastatic papillary renal cancer, Urologic Oncology: Seminars and Original Investigations, Elsevier, 2016

2. Coupe NA, Cox K, Clark K, et al: Outcomes of permanent peritoneal ports for the management of recurrent malignant ascites. Journal of palliative medicine 16:938-940, 2013

3. Gu X, Zhang Y, Cheng M, et al: Management of non-ovarian cancer malignant ascites through indwelling catheter drainage. BMC palliative care 15:1, 2016

4. Garofalo A, Valle M, Garcia J, et al: Laparoscopic intraperitoneal hyperthermic chemotherapy for palliation of debilitating malignant ascites. European Journal of Surgical Oncology (EJSO) 32:682-685, 2006

5. Heiss MM, Murawa P, Koralewski P, et al: The trifunctional antibody catumaxomab for the treatment of malignant ascites due to epithelial cancer: results of a prospective randomized phase II/III trial. International journal of cancer 127:2209-2221, 2010

6. Al-Quteimat OM, Al-Badaineh MA: Intraperitoneal chemotherapy: Rationale, applications, and limitations. Journal of Oncology Pharmacy Practice:1078155213506244, 2013

7. Markman M, Walker JL: Intraperitoneal chemotherapy of ovarian cancer: a review, with a focus on practical aspects of treatment. Journal of Clinical Oncology 24:988-994, 2006

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