Cytoreductive nephrectomy for pT3b-T4 M1 renal cell carcinoma in 39 patients: single center analysis.

We reviewed cytoreductive nephrectomy for pT3b-T4 renal cell carcinoma with metastasis and evaluated the prognostic factors for cancer-specific survival. A total of 39 patients who underwent cytoreductive nephrectomy for renal cell carcinoma with pathological T3b-T4 (2009 Union for International Cancer Control consensus) from 1986 to 2011 in our hospital were the participants in this study. Prognostic factors for cancer-specific survival were analyzed. The median patient age was 64 years (range 31-84). Pathological T3b, T3c and T4 were found in 24 (61%), one (3%) and 14 (36%) patients, respectively. The distribution of the histological type was clear cell type in 34 (87%), papillary type in two (5%) and any type of renal cell carcinoma with a sarcomatoid component in three patients (8%). The median overall and cancer-specific survival was 7.5 and 7.6 months, respectively. Low-grade performance status, regional lymph node metastasis, higher pT stage and histological type were prognostic factors for cancer-specific survival on univariate analysis. On multivariate analysis, lymph node metastasis, higher pT stage and histological type (non-clear cell or sarcomatoid component) were significant predictors for cancer-specific survival. With cytoreductive nephrectomy for patients with pT4, lymph node metastasis and non-clear cell histology, we have to be particularly careful in terms of cancer control.