Impacts of clinicopathologic and operative factors on short-term and long-term survival in renal cell carcinoma with venous tumor thrombus extension: a multi-institutional retrospective study in Japan

Abstract

BackgroundAlthough the percentage of patients with renal cell carcinoma (RCC) extending into venous systems is unexpectedly high, the prognostic impact and independency of venous tumor thrombus-related factors on overall survival (OS) remain controversial. Furthermore, the prognostic impact of various clinicopathologic factors including tumor thrombus-related factors on OS may change with elapsed years after the intervention and also with follow-up duration of participants. The aim of the study is to explore independent and universal predictive preoperative and intraoperative clinicopathologic factors on OS in patients with RCC extending into venous systems using subgroup analysis in terms of restricted follow-up duration and yearly-based survivors.MethodsBetween 1980 and 2009, 292 patients diagnosed with RCC with venous tumor thrombus were retrospectively registered for this study. The prognostic impacts of various clinicopathologic and surgical treatment factors including levels of venous thrombus, venous wall invasion status and likelihood of aggressive cytoreductive operation, were investigated using Kaplan-Meier method and following multivariate Cox proportional hazards model for all patients and those still alive at 1, 2, and 3 years of follow-up. To investigate the impact of follow-up duration on the statistical analyses, multivariate logistic regression analyses were used to explore prognostic factors using restricted data until 1, 2, and 3 years of follow-up.ResultsThe median follow-up duration was 40.4 months. The 5-year OS was 47.6%. Several independent predictive factors were identified in each subgroup analysis in terms of yearly-based survival and restricted follow-up duration. The presence of tumor thrombus invading to venous wall was independently related to OS in the full-range follow-up data and in survivors at 2 and 3 years of follow-up. Using restricted follow-up data until 1, 2, and 3 years of follow-up, many independent predictive factors changed with follow-up duration, but surgical category could be universal and independent predictive factors.ConclusionThe most universal factors affecting improvement both in short-term and long-term survivals could be cytoreductive surgery and absence of venous wall invasion. It may mean that feasible aggressive cytoreductive operation following more reliable preoperative imaging for predicting venous wall invasion status would improve OS for patients with RCC extending into venous systems.

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

“…In the present study, the 1-, 3-, and 5-year CSS rates were 93.0%, 70.9%, and 58.1%, respectively, in all these patients, and were 95.3%, 82.6%, and 68.6%, respectively, in those without metastasis on diagnosis of the cancer. These figures were better than those reported previously [ 3 , 9 , 20 ]. Such differences may arise from the fact that more patients with renal venous tumor thrombus only were included in our study, and the proportion of patients who underwent surgery within the past 3 years was relatively high in the present study.…”

“…Perinephric fat invasion usually suggests a greater invasiveness of tumor. Although some studies have not shown perinephric fat invasion to be an independent prognostic predictor [ 9 , 22 ], two multicenter, large-scale studies have demonstrated that perinephric fat invasion correlated significantly with a poor prognosis and was an independent prognostic predictor for CSS in all patients [ 6 , 25 ]. The present study suggested perinephric fat invasion to be an independent prognostic predictor in Chinese patients with RCC and VTT but without metastasis; however, perinephric fat invasion was a statistically significant predictor for CSS of all patients in univariate but not in multivariate analysis (Table 2 ).…”

“…Although there have been successful cases in which neoadjuvant-targeted molecular therapies have succeeded in lowering the level of tumor thrombus, making surgical treatment possible [ 7 ], the issue of whether such therapies are indicated for patients with Level III and IV tumor thrombus remains controversial [ 8 ]. Most studies on the prognosis (and its influencing factors) of patients with RCC and VTT have been conducted in Western countries, and there have been only a few studies conducted in Asian populations [ 3 , 9 ], in particular in Chinese populations [ 10 ]. In the present study, therefore, we retrospectively analyzed the clinicopathological data of patients with RCC and VTT who underwent surgical treatment at our center and assessed the effect and significance of each prognostic factor on these patients.…”

The establishment of KORCC (KOrean Renal Cell Carcinoma) database

“…Some international groups have performed RCC studies based on multi-institutional RCC DBs. Examples include the renal mass study of CROES (Clinical Research Office of the Endourological Society) [ 3 4 ], CORONA (Collaborative Research On Renal Neoplasms Association) Project [ 5 6 7 8 9 ], SATURN (Surveillance and Treatment Update Renal Neoplasms) Projects [ 8 9 ] and Japanese multicenter studies [ 10 11 ], which have reported high-quality research results. Some multi-institutional retrospective studies on RCC have also been conducted in Korea [ 12 13 14 ], but there have been no large DB systems to collect data on Korean RCC.…”

A Predictive Model for Tumor Invasion of the Inferior Vena Cava Wall Using Multimodal Imaging in Patients with Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus

“…Therefore, it is necessary to remove the vascular wall infiltrated by IVCTT. However, IVC infiltrated by IVCTT is a risk factor for poor prognosis [ 23 ] and an important factor for IVC resection. Thus, a comprehensive preoperative imaging evaluation may allow surgical urologists to more effectively treat the IVC [ 19 , 21 ].…”