Derya Tilki1, Hao G Nguyen2, Marc A Dall'Era2, Roberto Bertini3, Joaquín A Carballido4, Thomas Chromecki5, Gaetano Ciancio6, Siamak Daneshmand7, Paolo Gontero8, Javier Gonzalez9, Axel Haferkamp10, Markus Hohenfellner11, William C Huang12, Theresa M Koppie13, C Adam Lorentz14, Philipp Mandel15, Juan I Martinez-Salamanca4, Viraj A Master14, Rayan Matloob3, James M McKiernan16, Carrie M Mlynarczyk16, Francesco Montorsi3, Giacomo Novara17, Sascha Pahernik11, Juan Palou18, Raj S Pruthi19, Krishna Ramaswamy12, Oscar Rodriguez Faba18, Paul Russo20, Shahrokh F Shariat21, Martin Spahn22, Carlo Terrone23, Daniel Vergho22, Eric M Wallen19, Evanguelos Xylinas24, Richard Zigeuner5, John A Libertino25, Christopher P Evans2. 1. Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA, USA. Electronic address: derya.tilki@ucdmc.ucdavis.edu. 2. Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA, USA. 3. Department of Urology, Hospital San Raffaele, University Vita-Salute, Milan, Italy. 4. Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain. 5. Department of Urology, Medical University of Graz, Graz, Austria. 6. Miami Transplant Institute, University of Miami, Miami, FL, USA. 7. USC/Norris Comprehensive Cancer Center, Los Angeles, CA, USA. 8. Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy. 9. Department of Urology, Getafe University Hospital, Madrid, Spain. 10. Department of Urology, University of Frankfurt, Frankfurt, Germany. 11. Department of Urology, University of Heidelberg, Heidelberg, Germany. 12. Department of Urology, New York University School of Medicine, New York, NY, USA. 13. Department of Urology, Oregon Health & Science University, Portland, OR, USA. 14. Department of Urology, Emory University, Atlanta, GA, USA. 15. Institute of Empirical Economic Research, University of Leipzig, Leipzig, Germany. 16. Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY, USA. 17. University of Padua, Padua, Italy. 18. Department of Urology, Fundació Puigvert, Barcelona, Spain. 19. Department of Urology, UNC at Chapel Hill, Chapel Hill, NC, USA. 20. Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 21. Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. 22. University of Würzburg, Würzburg, Germany. 23. Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy. 24. Department of Urology, Weill Cornell Medical Center, New York, NY, USA. 25. Department of Urology, Lahey Clinic, Burlington, MA, USA.
Abstract
BACKGROUND: Although different prognostic factors for patients with renal cell carcinoma (RCC) and vena cava tumor thrombus (TT) have been studied, the prognostic value of histologic subtype in these patients remains unclear. OBJECTIVE: We analyzed the impact of histologic subtype on cancer-specific survival (CSS). DESIGN, SETTINGS, AND PARTICIPANTS: We retrospectively analyzed the records of 1774 patients with RCC and TT who underwent radical nephrectomy and tumor thrombectomy from 1971 to 2012 at 22 US and European centers. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable ordered logistic and Cox regression models were used to quantify the impact of tumor histology on CSS. RESULTS AND LIMITATIONS: Overall 5-yr CSS was 53.4% (confidence interval [CI], 50.5-56.2) in the entire group. TT level (according to the Mayo classification of macroscopic venous invasion in RCC) was I in 38.5% of patients, II in 30.6%, III in 17.3%, and IV in 13.5%. Histologic subtypes were clear cell renal cell carcinoma (cRCC) in 89.9% of patients, papillary renal cell carcinoma (pRCC) in 8.5%, and chromophobe RCC in 1.6%. In univariable analysis, pRCC was associated with a significantly worse CSS (p<0.001) compared with cRCC. In multivariable analysis, the presence of pRCC was independently associated with CSS (hazard ratio: 1.62; CI, 1.01-2.61; p<0.05). Higher TT level, positive lymph node status, distant metastasis, and fat invasion were also independently associated with CSS. CONCLUSIONS: In our multi-institutional series, we found that patients with pRCC and vena cava TT who underwent radical nephrectomy and tumor thrombectomy had significantly worse cancer-specific outcomes when compared with patients with other histologic subtypes of RCC. We confirmed that higher TT level and fat invasion were independently associated with reduced CSS.
BACKGROUND: Although different prognostic factors for patients with renal cell carcinoma (RCC) and vena cava tumor thrombus (TT) have been studied, the prognostic value of histologic subtype in these patients remains unclear. OBJECTIVE: We analyzed the impact of histologic subtype on cancer-specific survival (CSS). DESIGN, SETTINGS, AND PARTICIPANTS: We retrospectively analyzed the records of 1774 patients with RCC and TT who underwent radical nephrectomy and tumor thrombectomy from 1971 to 2012 at 22 US and European centers. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable ordered logistic and Cox regression models were used to quantify the impact of tumor histology on CSS. RESULTS AND LIMITATIONS: Overall 5-yr CSS was 53.4% (confidence interval [CI], 50.5-56.2) in the entire group. TT level (according to the Mayo classification of macroscopic venous invasion in RCC) was I in 38.5% of patients, II in 30.6%, III in 17.3%, and IV in 13.5%. Histologic subtypes were clear cell renal cell carcinoma (cRCC) in 89.9% of patients, papillary renal cell carcinoma (pRCC) in 8.5%, and chromophobe RCC in 1.6%. In univariable analysis, pRCC was associated with a significantly worse CSS (p<0.001) compared with cRCC. In multivariable analysis, the presence of pRCC was independently associated with CSS (hazard ratio: 1.62; CI, 1.01-2.61; p<0.05). Higher TT level, positive lymph node status, distant metastasis, and fat invasion were also independently associated with CSS. CONCLUSIONS: In our multi-institutional series, we found that patients with pRCC and vena cava TT who underwent radical nephrectomy and tumor thrombectomy had significantly worse cancer-specific outcomes when compared with patients with other histologic subtypes of RCC. We confirmed that higher TT level and fat invasion were independently associated with reduced CSS.
Authors: Hao G Nguyen; Derya Tilki; Marc A Dall'Era; Blythe Durbin-Johnson; Joaquín A Carballido; Thenappan Chandrasekar; Thomas Chromecki; Gaetano Ciancio; Siamak Daneshmand; Paolo Gontero; Javier Gonzalez; Axel Haferkamp; Markus Hohenfellner; William C Huang; Estefania Linares Espinós; Philipp Mandel; Juan I Martinez-Salamanca; Viraj A Master; James M McKiernan; Francesco Montorsi; Giacomo Novara; Sascha Pahernik; Juan Palou; Raj S Pruthi; Oscar Rodriguez-Faba; Paul Russo; Douglas S Scherr; Shahrokh F Shariat; Martin Spahn; Carlo Terrone; Daniel Vergho; Eric M Wallen; Evanguelos Xylinas; Richard Zigeuner; John A Libertino; Christopher P Evans Journal: J Urol Date: 2015-03-19 Impact factor: 7.450
Authors: Rene Mager; Siamak Daneshmand; Christopher P Evans; Joan Palou; Juan I Martínez-Salamanca; Viraj A Master; James M McKiernan; John A Libertino; Axel Haferkamp; Axel Haferkamp; Umberto Capitanio; Joaquín A Carballido; Venancio Chantada; Thomas Chromecki; Gaetano Ciancio; Siamak Daneshmand; Christopher P Evans; Paolo Gontero; Javier González; Markus Hohenfellner; William C Huang; Theresa M Koppie; John A Libertino; Estefanía Linares Espinós; Adam Lorentz; Juan I Martínez-Salamanca; Viraj A Master; James M McKiernan; Francesco Montorsi; Giacomo Novara; Padraic O'Malley; Sascha Pahernik; Joan Palou; José Luis Pontones Moreno; Raj S Pruthi; Oscar Rodriguez Faba; Paul Russo; Douglas S Scherr; Shahrokh F Shariat; Martin Spahn; Carlo Terrone; Derya Tilki; Dario Vázquez-Martul; Cesar Vera Donoso; Daniel Vergho; Eric M Wallen; Richard Zigeuner Journal: J Surg Oncol Date: 2016-08-26 Impact factor: 3.454
Authors: Daniel Claudius Vergho; Susanne Kneitz; Charis Kalogirou; Maximilian Burger; Markus Krebs; Andreas Rosenwald; Martin Spahn; Andreas Löser; Arkadius Kocot; Hubertus Riedmiller; Burkhard Kneitz Journal: PLoS One Date: 2014-10-03 Impact factor: 3.240