Oscar Rodriguez Faba1, Estefania Linares2, Derya Tilki3, Umberto Capitanio4, Christopher P Evans3, Francesco Montorsi4, Juan I Martínez-Salamanca5, John Libertino6, Paolo Gontero7, Joan Palou8. 1. Fundació Puigvert, Barcelona, Spain. Electronic address: orodriguez@fundacio-puigvert.es. 2. Hospital Universitario Infanta Sofia, Madrid, Spain. 3. University of California, Davis, School of Medicine, Sacramento, CA, USA. 4. Department of Urology, Vita-Salute San Raffaele University, Milan, Italy; Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy. 5. Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain. 6. Department of Urology, Lahey Clinic, Burlington, MA, USA. 7. University of Torino, Turin, Italy. 8. Fundació Puigvert, Barcelona, Spain.
Abstract
BACKGROUND: Microscopic vein invasion (MVI), with local destruction and invasion of the endothelium by tumor, is of controversial predictive value in renal cell carcinoma (RCC). OBJECTIVE: To assess the impact of venous extension and wall invasion in RCC on survival. DESIGN, SETTING, AND PARTICIPANTS: Data for 1023 RCC patients with vena cava thrombus treated with radical nephrectomy and complete tumor thrombectomy were collected within a prospectively maintained international consortium (1995-2012). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The Kaplan-Meier method and univariable and multivariable Cox regression analyses were used to assess the impact of MVI on cancer-specific survival (CSS). The main two variables of interest were microscopic renal vein wall invasion (MRVI) and microscopic vena cava wall invasion (MVCI). RESULTS: MRVI was found in 725 cases (70.9%) and MVCI in 230 (22.5%). Patients with MRVI had larger tumors (p=0.005), longer hospital stay (p<0.001), higher clinical stage 0.039), higher Fuhrman grade (p=0.028), and more frequent fat invasion. Presence of MVCI was associated with larger tumors (p<0.001), longer hospital stay (p<0.001), higher clinical stage (p<0.001), lymph node involvement (p=0.045), higher Fuhrman grade (p<0.001), and higher thrombus level (p<0.001). With median follow-up of 52 mo, overall 5-yr CSS was 57.4%. Multivariable analysis showed that presence of MRVI was an independent factor related to CSS (hazard ratio 2.24, 95% confidence interval 1.24-3.59, p=0.006). The main limitation was the inability to report MVI percentages. CONCLUSIONS: Patients with MRVI experience significantly worse survival outcomes after radical nephrectomy and tumor thrombectomy. Consideration of MRVI at final pathology is appropriate to improve decision-making for risk-adapted follow-up. PATIENT SUMMARY: The behavior of locally advanced renal cell carcinoma (RCC) depends on clinical and pathologic factors. Analysis revealed that RCC patients with microscopic renal vein wall invasion experience significantly worse cancer-specific survival.
BACKGROUND: Microscopic vein invasion (MVI), with local destruction and invasion of the endothelium by tumor, is of controversial predictive value in renal cell carcinoma (RCC). OBJECTIVE: To assess the impact of venous extension and wall invasion in RCC on survival. DESIGN, SETTING, AND PARTICIPANTS: Data for 1023 RCCpatients with vena cava thrombus treated with radical nephrectomy and complete tumor thrombectomy were collected within a prospectively maintained international consortium (1995-2012). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The Kaplan-Meier method and univariable and multivariable Cox regression analyses were used to assess the impact of MVI on cancer-specific survival (CSS). The main two variables of interest were microscopic renal vein wall invasion (MRVI) and microscopic vena cava wall invasion (MVCI). RESULTS: MRVI was found in 725 cases (70.9%) and MVCI in 230 (22.5%). Patients with MRVI had larger tumors (p=0.005), longer hospital stay (p<0.001), higher clinical stage 0.039), higher Fuhrman grade (p=0.028), and more frequent fat invasion. Presence of MVCI was associated with larger tumors (p<0.001), longer hospital stay (p<0.001), higher clinical stage (p<0.001), lymph node involvement (p=0.045), higher Fuhrman grade (p<0.001), and higher thrombus level (p<0.001). With median follow-up of 52 mo, overall 5-yr CSS was 57.4%. Multivariable analysis showed that presence of MRVI was an independent factor related to CSS (hazard ratio 2.24, 95% confidence interval 1.24-3.59, p=0.006). The main limitation was the inability to report MVI percentages. CONCLUSIONS:Patients with MRVI experience significantly worse survival outcomes after radical nephrectomy and tumor thrombectomy. Consideration of MRVI at final pathology is appropriate to improve decision-making for risk-adapted follow-up. PATIENT SUMMARY: The behavior of locally advanced renal cell carcinoma (RCC) depends on clinical and pathologic factors. Analysis revealed that RCCpatients with microscopic renal vein wall invasion experience significantly worse cancer-specific survival.
Authors: Lisa C Adams; Bernhard Ralla; Yi-Na Y Bender; Keno Bressem; Bernd Hamm; Jonas Busch; Florian Fuller; Marcus R Makowski Journal: Cancer Imaging Date: 2018-05-03 Impact factor: 3.909