Prognostic Significance of Renal Vein Invasion by Hypernephroma

Myers, George H.; Fehrenbaker, Lawrence G.; Kelalis, Panayotis P.

doi:10.1016/s0022-5347(17)62543-6

Cited by 83 publications

(19 citation statements)

References 13 publications

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“…However, some controversy exists regarding the rele vance of venous tumor thrombi to prognosis. While some investigators have revealed venous tumor thrombi to adversely affect patient survival [12, [24][25][26][27][28]. others have not [6,29,30].…”

Section: Discussionmentioning

confidence: 99%

Multivariate Evaluation of Prognostic Determinants for Renal Cell Carcinoma

Takashi

Nakano²,

Sakata³

et al. 1993

Urol Int

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To clarify the relative importance of clinicopathological factors affecting survival in patients with renal cell carcinoma, univariate and multivariate analyses by Cox’s proportional hazards model were performed for 121 patients undergoing nephrectomy between 1980 and 1991. The 5-year survival rate was 67% for all 121 patients. Univariate analysis revealed that distant metastasis, local invasion, venous involvement, infiltration pattern, grade, lymph node metastasis, sex, and tumor size were significantly associated with patient survival. Multivariate analysis using a method of stepwise selection revealed that presence or absence of distant metastasis is the most significant determinant (p < 0.0001) for survival, followed by venous involvement (p < 0.001), treatment period (p < 0.02) and local invasion (p < 0.02), in this order. A four-factor model of the above determinants yielded adjusted hazard ratios of 5.3 for distant metastasis (positive vs. negative), 3.7 for venous involvement (pV1a-pV2 vs. pV0), 3.9 for treatment period (1980–1984 vs. 1985–1991), and 3.1 for local invasion (pT3-pT4 vs. pT1-pT2). The present study revealed recent improvements in the patient survival and justified the clinical application of Robson’s staging system implying local invasion, venous thrombus formation and distant metastasis as prognostic determinants.

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Section: Discussionmentioning

confidence: 99%

Multivariate Evaluation of Prognostic Determinants for Renal Cell Carcinoma

Takashi

Nakano²,

Sakata³

et al. 1993

Urol Int

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“…Different methods are employed in England (9), in Scandinavia (2, 3, 7) and the USA (5,8), differentiating 3, even 4 grades of malignancy. In 1974, the UICC (11) rec ommended histologic grading of malignancy with 3 grades of malignancy within the TNM system for renal cell cancer, without specifying which system is to be used.…”

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confidence: 99%

Histological Grading of Renal Cell Carcinoma

Hermanek¹,

Sigel²,

Chlepas³

1976

Eur Urol

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“…Later, a few reports described discouraging surgical results and no survival advantage. 12 However, in 1972, it was recognized that venous extension was potentially curable when surgical resection was complete (5-year survival rate, 55%). 13 Other similarly favorable outcomes were subsequently reported.…”

Section: Discussionmentioning

confidence: 99%

Early Detection of a Cavopulmonary Tumor Embolus with the Use of Transesophageal Echocardiography

Ahmed¹,

Al-Najjar²,

Aftab³

et al. 2015

Texas Heart Institute Journal

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P ulmonary tumor embolization from renal cell carcinoma (RCC) is associated with severe cardiopulmonary morbidity and high perioperative mortality rates. In one study, 1 the direct extension of RCC into the inferior vena cava (IVC) was observed in 22 of 295 patients (7%). Massive pulmonary embolism (PE) can occur during surgical treatment for RCC, especially when the tumor extends into the IVC.2-6 Advantages of using transesophageal echocardiography (TEE) during RCC excision include evaluating the cephalic extension of tumor into the IVC, monitoring the tumor during surgical mobilization, and evaluating cardiac function. 7,8We report a case in which continuous TEE monitoring prevented a patient's death from PE, when RCC extended into the IVC. Case ReportIn January 2012, a 71-year-old woman presented with severe right-sided abdominal pain. The patient's medical history included hypertension, chronic obstructive pulmonary disease, osteoarthritis, peptic ulcer disease, glaucoma, aortic insufficiency, mitral regurgitation, and hyperlipidemia. Her surgical history was notable for a C-section and treatment of a perforated peptic ulcer. Her medications included amlodipine, digoxin, hydrochlorothiazide, lisinopril, omeprazole, pravastatin, spironolactone, and zolpidem. She had no known drug allergies. Until recently, she had smoked one pack of cigarettes per day for approximately 15 years. Magnetic resonance images of the patient's abdomen revealed a 9.5 × 6-cm mass in the right kidney with a 2-to 3-cm extension into the infrahepatic portion of the IVC (Figs. 1 and 2). Contrast computed tomograms (CT) of the chest revealed substantial mediastinal lymphadenopathy and multiple small lung nodules. Results of a bone scan were negative. We decided to perform radical nephrectomy and resection of the intracaval mass. The urology team informed the patient that, at worst, surgery would be palliative rather than curative and might extend her life only for months.The patient's preoperative blood pressure (BP) was 120/65 mmHg, and her heart rate was 80 beats/min. She was given 2 mg of midazolam, and general anesthesia was induced. The patient was monitored by means of electrocardiography (ECG), pulse oximetry, a radial arterial line, a central venous pressure line, end-tidal carbon dioxide measurement, and a rectal temperature probe. An iE33 xMATRIX Echocardiography System probe (Koninklijke Philips N.V.; Best, The Netherlands) was placed. Initially,

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Prognostic Significance of Renal Vein Invasion by Hypernephroma

Cited by 83 publications

References 13 publications

Multivariate Evaluation of Prognostic Determinants for Renal Cell Carcinoma

Multivariate Evaluation of Prognostic Determinants for Renal Cell Carcinoma

Histological Grading of Renal Cell Carcinoma

Early Detection of a Cavopulmonary Tumor Embolus with the Use of Transesophageal Echocardiography

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