INTRODUCTION: Surgical resection of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus is a complex procedure with significant morbidity. Patient selection is critical to determining whether the benefits of the procedure outweigh the risks. In this study, we identified and stratified the risk factors that were associated with overall survival (OS) and recurrence-free survival (RFS) in patients undergoing surgical resection of RCC with IVC thrombus. METHODS: We identified all patients with RCC with IVC tumor thrombus (stages cT3b and cT3c) who had undergone radical nephrectomy with tumor thrombectomy between December 1, 1993 and June 30, 2009. Kaplan-Meier method was used to estimate OS and RFS. Cox proportional hazards models were used to determine the association between risk factors and OS. Patients were stratified into 3 groups based on the number of risk factors present at diagnosis. RESULTS: Two hundred twenty-four patients were included in the study. A total of 45.3% of patients had metastasis at presentation, 84.5% had cT3b, and 90.2% had clear cell RCC. cT3c, cN1, and cM1 were significantly associated with the risk of death. Group 1 patients (0 risk factors) had a median OS duration of 77.6 months (95% CI 50.5-90.4), group 2 (1 risk factor) 26.0 months (95% CI 19.5-35.2), and group 3 (≥2 risk factors) 8.9 months (95% CI 5.2-12.9; P < .001). CONCLUSIONS: Stratification of patients with RCC and IVC thrombus by risk factors allowed us to predict survival duration. In patients with ≥2 risk factors, new treatment strategies with preoperative systemic therapy may improve survival.
INTRODUCTION: Surgical resection of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus is a complex procedure with significant morbidity. Patient selection is critical to determining whether the benefits of the procedure outweigh the risks. In this study, we identified and stratified the risk factors that were associated with overall survival (OS) and recurrence-free survival (RFS) in patients undergoing surgical resection of RCC with IVC thrombus. METHODS: We identified all patients with RCC with IVC tumor thrombus (stages cT3b and cT3c) who had undergone radical nephrectomy with tumor thrombectomy between December 1, 1993 and June 30, 2009. Kaplan-Meier method was used to estimate OS and RFS. Cox proportional hazards models were used to determine the association between risk factors and OS. Patients were stratified into 3 groups based on the number of risk factors present at diagnosis. RESULTS: Two hundred twenty-four patients were included in the study. A total of 45.3% of patients had metastasis at presentation, 84.5% had cT3b, and 90.2% had clear cell RCC. cT3c, cN1, and cM1 were significantly associated with the risk of death. Group 1 patients (0 risk factors) had a median OS duration of 77.6 months (95% CI 50.5-90.4), group 2 (1 risk factor) 26.0 months (95% CI 19.5-35.2), and group 3 (≥2 risk factors) 8.9 months (95% CI 5.2-12.9; P < .001). CONCLUSIONS: Stratification of patients with RCC and IVC thrombus by risk factors allowed us to predict survival duration. In patients with ≥2 risk factors, new treatment strategies with preoperative systemic therapy may improve survival.
Authors: Juan I Martínez-Salamanca; Estefania Linares; Javier González; Roberto Bertini; Joaquín A Carballido; Thomas Chromecki; Gaetano Ciancio; Sia Daneshmand; Christopher P Evans; Paolo Gontero; Axel Haferkamp; Markus Hohenfellner; William C Huang; Theresa M Koppie; Viraj A Master; Rayan Matloob; James M McKiernan; Carrie M Mlynarczyk; Francesco Montorsi; Hao G Nguyen; Giacomo Novara; Sascha Pahernik; Juan Palou; Raj S Pruthi; Krishna Ramaswamy; Oscar Rodriguez Faba; Paul Russo; Shahrokh F Shariat; Martin Spahn; Carlo Terrone; Derya Tilki; Daniel Vergho; Eric M Wallen; Evanguelos Xylinas; Richard Zigeuner; John A Libertino Journal: Curr Urol Rep Date: 2014-05 Impact factor: 3.092
Authors: Derya Tilki; Brian Hu; Hao G Nguyen; Marc A Dall'Era; Roberto Bertini; Joaquín A Carballido; Thenappan Chandrasekar; Thomas Chromecki; Gaetano Ciancio; Siamak Daneshmand; Paolo Gontero; Javier Gonzalez; Axel Haferkamp; Markus Hohenfellner; William C Huang; Theresa M Koppie; Estefania Linares; C Adam Lorentz; Philipp Mandel; Juan I Martinez-Salamanca; Viraj A Master; Rayan Matloob; James M McKiernan; Carrie M Mlynarczyk; Francesco Montorsi; Giacomo Novara; Sascha Pahernik; Juan Palou; Raj S Pruthi; Krishna Ramaswamy; Oscar Rodriguez Faba; Paul Russo; Shahrokh F Shariat; Martin Spahn; Carlo Terrone; William Thieu; Daniel Vergho; Eric M Wallen; Evanguelos Xylinas; Richard Zigeuner; John A Libertino; Christopher P Evans Journal: J Urol Date: 2014-07-22 Impact factor: 7.450
Authors: Robert J Motzer; Nizar M Tannir; David F McDermott; Osvaldo Arén Frontera; Bohuslav Melichar; Toni K Choueiri; Elizabeth R Plimack; Philippe Barthélémy; Camillo Porta; Saby George; Thomas Powles; Frede Donskov; Victoria Neiman; Christian K Kollmannsberger; Pamela Salman; Howard Gurney; Robert Hawkins; Alain Ravaud; Marc-Oliver Grimm; Sergio Bracarda; Carlos H Barrios; Yoshihiko Tomita; Daniel Castellano; Brian I Rini; Allen C Chen; Sabeen Mekan; M Brent McHenry; Megan Wind-Rotolo; Justin Doan; Padmanee Sharma; Hans J Hammers; Bernard Escudier Journal: N Engl J Med Date: 2018-03-21 Impact factor: 91.245
Authors: Samuel M Lawindy; Tony Kurian; Timothy Kim; Devanand Mangar; Paul A Armstrong; Angel E Alsina; Cedric Sheffield; Wade J Sexton; Philippe E Spiess Journal: BJU Int Date: 2012-04-30 Impact factor: 5.588
Authors: Charles C Peyton; E Jason Abel; Juan Chipollini; David C Boulware; Mounsif Azizi; Jose A Karam; Vitaly Margulis; Viraj A Master; Surena F Matin; Jay D Raman; Wade J Sexton; Christopher G Wood; Philippe E Spiess Journal: Eur Urol Focus Date: 2018-09-08