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Determinants of outcomes after resection of renal cell carcinoma with venous involvement

  • Urology - Original Paper
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Abstract

Purpose

To determine the outcomes and to identify prognostic variables determining mortality and recurrence after surgery for renal cell cancer (RCC) with venous involvement.

Methods

Retrospective evaluation of the medical records of 132 patients with RCC and tumor thrombi treated at Johns Hopkins Hospital (1997–2008) was done. Kaplan–Meier analysis was used to determine survivals. Uni- and multivariate Cox proportional analysis was done to identify predictors for recurrence, all-cause mortality (ACM) and cancer-specific mortality (CSM).

Results

Mean follow-up was 30.3 (0.03–159.5) months. Sixty-four (48.5 %) patients had renal vein thrombus (Group 1), 55 (41.7 %) had subdiaphragmatic inferior vena cava (IVC) tumor thrombus (Group 2), while 13 (9.8 %) had involvement of IVC above diaphragm or atrial extension (Group 3). IVC thrombus was more common from the right-sided tumors. Patients with higher thrombus levels had more blood loss and complicated and longer hospital stay.

Thrombus level was not found to be a predictor of recurrence, ACM and CSM. One- and three-year recurrence-free survivals for non-metastatic patients were 69 and 53 %. Tumor size (p = 0.015), grade (p = 0.007) and venous wall invasion (p = 0.027) were predictors for recurrence. Five-year overall survival was 48, 35 and 13 % for 3 groups, respectively. Presence of distant metastasis (p = 0.032), size (p = 0.002), histology (p = 0.020) and grade (p = 0.013) were predictors of ACM. Five-year cancer-specific survival was 65, 43 and 36 for 3 groups, respectively. Tumor size (p = 0.001) and distant metastasis at presentation (p = 0.025) were the predictors of CSM.

Conclusions

Tumor thrombus level does not predict recurrence or mortality in RCC with venous involvement. Survival is determined by inherent aggressiveness of the cancer manifested by tumor size, grade and distant metastasis at presentation.

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Conflict of interest

The authors declare that there is no conflict of interest.

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Authors and Affiliations

  1. Division of Urology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Abhinav Sidana

  2. James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Abhinav Sidana, Jatinder Goyal, Piyush Aggarwal & Ronald Rodriguez

  3. Department of Public Health, Johns Hopkins School of Public Health, 600 North Wolfe Street Marburg 205A, Baltimore, MD, 21287, USA

    Payal Verma

Authors
  1. Abhinav Sidana
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  2. Jatinder Goyal
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  3. Piyush Aggarwal
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  4. Payal Verma
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  5. Ronald Rodriguez
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Correspondence to Ronald Rodriguez.

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Sidana, A., Goyal, J., Aggarwal, P. et al. Determinants of outcomes after resection of renal cell carcinoma with venous involvement. Int Urol Nephrol 44, 1671–1679 (2012). https://doi.org/10.1007/s11255-012-0314-x

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  • DOI: https://doi.org/10.1007/s11255-012-0314-x

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