Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

Abstract

Purpose: To study the surgical outcomes of radical nephrectomy with thrombectomy and to determine prognostic factors for survival of Korean patients with renal cell carcinoma (RCC) and venous tumor thrombus. Materials and Methods: A total of 124 patients with RCC and venous tumor thrombus who underwent radical nephrectomy and thrombectomy were included in this retrospective study. Cancer-specific survival (CSS) and recurrence-free survival (RFS) rates were analyzed retrospectively according to various prognostic factors. Results: The median overall follow-up period for all patients was 29.0 months; the median survival period was 50.0 months. The 2-, 5-and 10-year CSS rates for all patients were 64.2%, 47.1% and 31.7%, respectively. Those for 76 patients (pN0/xM0) without metastasis at presentation were 80.9%, 64.5% and 44.9%, respectively. For all patients, lower body mass index (BMI), higher Fuhrman grade, presence of symptoms, perinephric fat invasion, invasion of inferior vena cava (IVC) wall, lymph node (LN) involvement and distant metastasis at presentation were independent predictors for decreased CSS on multivariate analysis, while thrombus level was not. For non-metastatic patients, lower BMI, presence of symptoms and tumor size were independently associated with decreased CSS. In terms of RFS, lower BMI, presence of perinephric fat invasion were prognostic factors for recurrence. Conclusions: Our data suggest that obesity is independently associated with better survival or lower risk of tumor recurrence in Korean patients undergoing radical nephrectomy with tumor thrombectomy. Also, our results indicate that Fuhrman grade, presence of symptoms, perinephric fat invasion and invasion of IVC wall, LN involvement and distant metastasis at presentation are independent predictors for survival.

Renal cell carcinoma and tumour thrombus in the inferior vena cava: clinical outcome of 98 consecutive patients and the prognostic value of preoperative parameters

“…This can be explained by differences in the applied inclusion criteria and/or patients' characteristics (e.g. higher proportion of patients with metastatic disease in other studies) [3,5,6,11,12]. The presence of metastasis, lymph node-positive status and lymphovascular invasion, high Fuhrman grade and high ASA performance status were negative predictors for DSS.…”

“…Bertini et al [15] showed reduced survival of patients with friable thrombus consistency compared with solid IVC thrombi. Also, a low body mass index (BMI) and the presence of symptoms at initial diagnosis are independent risk factors for survival as shown by Cho et al [12], whereas higher BMI was shown to be associated with better post-operative performance, at least for OS. Further, independent risk factors for survival were positive surgical margin and the presence of necrosis in the gross pathology specimen as Coons et al [16] could show in a study of 128 patients with a T3b disease.…”

“…Several clinicopathological risk factors increasing disease-associated mortality are described. Diverse studies showed metastatic disease [3,5,6,8,10,12,15,16], lymph node-positive disease [3,5,10,12,15], poor Eastern Cooperative Oncology Group (ECOG) performance status [5], sarcomatoid histopathological features [5,15], advanced local tumour stage [8], concomitant perinephritic fat invasion [5,12] and Fuhrman grade [3,12] to be independent prognostic factors [5]. Bertini et al [15] showed reduced survival of patients with friable thrombus consistency compared with solid IVC thrombi.…”

“…The 90-day mortality rates are twice as high in cases of surgeons performing ≤1 nephrectomies with IVC involvement annually compared with those who perform ≥2 [17]. The impact of thrombus extent on survival is not clear [3,5,12,15].…”

Intraoperative and oncological results of treating patients with renal cell carcinoma and venous tumor thrombus

“…Последний благодаря быстроте, легкости выполнения и возможности работы на всех органах брюшной полости позволяет успешно осуществлять тромбэктомию при тромбах, исходящих из опухоли как правой, так и левой почки. У 1 (3,8 Атриотомия была расширена вверх, кровь аспирирована аппаратом Cell-Saver, из предсердия и грудного отдела НПВ удален плотный тромб. Попытки удалить опухолевый тромб из печеночного отдела НПВ оказались безрезультатны из-за плотной фиксации к интиме последней.…”