Prognostic Value of Renal Vein and Inferior Vena Cava Involvement in Renal Cell Carcinoma

被引:176
作者
Wagner, Bernd [1 ]
Patard, Jean-Jacques [2 ]
Mejean, Arnaud [2 ]
Bensalah, Karim [2 ]
Verhoest, Gregory [2 ]
Zigeuner, Richard [3 ]
Ficarra, Vincenzo [4 ]
Tostain, Jacques [5 ]
Mulders, Peter [6 ]
Chautard, Denis [7 ]
Descotes, Jean-Luc [2 ]
de la Taille, Alexandre [8 ]
Salomon, Laurent [8 ]
Prayer-Galetti, Tommaso [9 ]
Cindolo, Luca [10 ]
Valeri, Antoine [2 ]
Meyer, Nicolas [1 ]
Jacqmin, Didier [1 ]
Lang, Herve [1 ,2 ]
机构
[1] Strasbourg Univ Hosp, Nouvel Hop Civil, Dept Urol, F-67091 Strasbourg, France
[2] CCAFU, Strasbourg, France
[3] Graz Univ Hosp, Dept Urol, Graz, Austria
[4] Verona Univ Hosp, Dept Urol, Verona, Italy
[5] St Etienne Univ Hosp, Hop Nord, Dept Urol, St Etienne, France
[6] Univ Nijmegen Hosp, Dept Urol, NL-6500 HB Nijmegen, Netherlands
[7] Angers Univ Hosp, Dept Urol, Angers, France
[8] Hop Henri Mondor, Dept Urol, Creteil, France
[9] Padua Univ Hosp, Dept Urol, Padua, Italy
[10] Benevento Univ Hosp, Dept Urol, Benevento, Italy
关键词
Kidney cancer; Renal cell carcinoma; Prognosis; Venous thrombus; Renal vein involvement; Inferior vena cava involvement; TUMOR THROMBUS EXTENSION; SURGICAL-MANAGEMENT; STAGING SYSTEM; CANCER; EXPERIENCE; SURVIVAL; INVASION; SURGERY; IMPACT;
D O I
10.1016/j.eururo.2008.07.053
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: The prognostic significance of venous tumor thrombus extension in patients with renal cell carcinoma (RCC) is a matter of many controversies in the current literature. Objective: To evaluate the prognostic role of inferior vena cava (IVC) involvement in a large series of pT3b and pT3c RCCs. Design, setting, and participants: A total of 1192 patients from 13 European institutions underwent a radical nephrectomy for pT3b and pT3c RCC between 1982 and 2003. The patients were evaluated in a retrospective manner. Age, gender, clinical symptoms, Eastern Cooperative Oncology Group (ECOG) performance status, TNM stage, tumor size, adrenal invasion, perinephric fat invasion, histological type, and Fuhrman grade were reviewed. The log-rank and Cox uni- and multivariate regression analyses were used to evaluate prognostic factors for overall survival. Measurements: Overall survival and prognostic factors for overall survival in patients with RCC extending to the renal vein (RV) or to the IVC. Results and limitations: The median follow-up was 61.4 mo (56.3-66.5 mo). The. mean age was 63.2 yr. The mean tumor size was 8.9 cm. Group 1 (Gr 1) included 933 patients with a renal vein tumor thrombus (78.3%), Group 2 (Gr 2) included 196 patients with a subdiaphragmatic IVC tumor thrombus (16.4%), and Group 3 (Gr 3) included 63 patients with a supradiaphragmatic IVC tumor thrombus (5.3%). Median survival was 52 mo for Gr 1, 25.8 mo for Gr 2, and 18 mo for Gr 3. In univariate analysis, Gr 1 had a significantly better overall survival than Gr 2 (p < 0.001) and Gr 3 (p < 0.001). No significant difference in survival was noted between Gr 2 and Gr 3 (p = 0.613). Prognostic factors for overall survival in univariate analysis were clinical symptoms (p < 0.001), tumor size (p < 0.001), perinephric fat invasion (p < 0.001), Fuhrman grade (p < 0.001), histological type (p = 0.021), lymph node invasion (p < 0.001), and distant metastasis (p < 0.001). Independent prognostic factors in multivariate analysis were tumor size (p = 0.013), perinephric fat invasion (p = 0.003), lymph node invasion (p < 0.001), distant metastasis (p < 0.001), and IVC invasion (p = 0.008). Conclusions: The level of tumor thrombus in the IVC does not significantly affect long-term overall survival in patients with renal cell carcinoma. The overall survival was statistically different for patients with a tumor thrombus in the RV compared to those with IVC involvement. This has to be considered for the next revision of the TNM system, and the pT3b and pT3c stages have to be redesigned. (C) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:452 / 460
页数:9
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