Clinical and oncological outcomes in Chinese patients with renal cell carcinoma and venous tumor thrombus extension: single-center experience

Abstract

BackgroundTo evaluate the clinical and oncological outcomes and to identify prognostic factors for survival in Chinese patients with renal cell carcinoma (RCC) and venous tumor thrombus (VTT).MethodsA total of 86 patients who underwent nephrectomy and tumor thrombectomy for RCC and venous tumor thrombus extension from 2003 to 2013 were included in this retrospective study. The records of these patients were reviewed. Kaplan-Meier analysis was used to determine cancer-specific survival (CSS). Prognostic factors for CSS were identified by univariate and multivariate analyses using the Cox proportional hazards regression mode.ResultsAll patients in this cohort received radical nephrectomy and tumor thrombectomy. Median follow-up period was 27.0 months (range 3–111). No patients died intraoperatively, and the complication rate was 36.0%. The 1-, 3-, and 5-year CSS rates for all patients were 93.0%, 70.9%, and 58.1%, respectively, and those for patients without distant metastasis at presentation were 95.3%, 82.6%, and 68.6%, respectively. Multivariate Cox regression analysis showed that lymph node invasion, distant metastasis at presentation, and invasion of the inferior vena cava (IVC) wall were the independent prognostic factors for CSS in all patients. For patients without distant metastasis, tumor grade, lymph node invasion, and perinephric fat invasion were significantly associated with CSS on multivariate analysis.ConclusionsSurvival rates for patients with RCC and VTT were still poor. Our results indicated that lymph node invasion, distant metastasis at presentation, and invasion of the IVC wall were independent negative prognostic factors.

Renal cell carcinoma with venous extension: prediction of inferior vena cava wall invasion by MRI

“…IVC wall invasion has recently been recognized as an independent prognostic factor for the survival of patients with IVC thrombi [ 16 , 18 – 20 ]. During surgery, IVC wall invasion requires a very challenging reconstruction beyond standard cavorrhaphy, that might include segmental resection or prosthetic replacement.…”

A proposal of post‐operative nomogram for overall survival in patients with renal cell carcinoma and venous tumor thrombus

“…Since single variable hardly accurately predict the prognosis of patients with RCC and VTT, several studies analyzed the predictive value of clinicopathological parameters in these patients. The significant predictors of long‐term survival include tumor thrombus level, tumor size, Fuhrman grade, lymph node invasion, metastasis at surgery, and adrenal gland invasion . However, no prognostic model has been established in these study which hinder the clinical application.…”

“…include tumor thrombus level, tumor size, Fuhrman grade, lymph node invasion, metastasis at surgery, and adrenal gland invasion. [8][9][10] However, no prognostic model has been established in these study which hinder the clinical application. Haddad et al 11 reported a preoperative nomogram for risk assessment in patients with RCC accompanying a suprahepatic IVC thrombus.…”

Prognostic effect of renal collecting system invasion on survival of patients with renal cell carcinoma and tumor thrombus

“…The authors did not perform a subgroup analysis of patients affected by both RCC and VTT versus patients without VTT. Chen et al also investigated the impact of renal pelvis invasion on survival in patients with RCC and VTT [ 20 ]. Fifty-three patients had level 0 VTT, 16 level I, 11 level II, and 6 level III.…”