Prognostic benefit of surgical management in renal cell carcinoma patients with thrombus extending to the renal vein and inferior vena cava: 17-year experience at a single centerReport as inadecuate




Prognostic benefit of surgical management in renal cell carcinoma patients with thrombus extending to the renal vein and inferior vena cava: 17-year experience at a single center - Download this document for free, or read online. Document in PDF available to download.

BMC Urology

, 13:47

Urological oncology

Abstract

BackgroundManagement of renal cell carcinoma RCC with tumor thrombus extending to the renal vein and inferior vena cava IVC is challenging. The aim of this study was to evaluate the benefit of surgical management in such patients.

MethodsFrom February 1995 to February 2013, 520 patients were treated for RCC at Hirosaki University Hospital, Hirosaki, Japan. The RCC patients with tumor thrombus extending to the renal vein n = 42 and IVC n = 43 were included in this study. The records of these 85 patients were retrospectively reviewed to assess the relevant clinical and pathological variables and survival. Prognostic factors were identified by multivariate analysis. The benefit of surgical management was evaluated using propensity score matching to compare overall survival between patients who received surgical management and those who did not.

ResultsRCC was confirmed by pathological examination of surgical or biopsy specimens in 74 of the 85 patients 87%. Sixty-five patients 76% received surgical management radical nephrectomy with thrombectomy. Distant metastasis was identified in 45 patients 53%. The proportion of patients with tumor thrombus level 0 renal vein only, I, II, III, and IV was 49%, 13%, 18%, 14%, and 5%, respectively. The estimated 5-year overall survival rate was 70% in patients with thrombus extending to the renal vein and 23% in patients with thrombus extending to the IVC. Multivariate analysis identified thrombus extending to the IVC, presence of distant metastasis, surgical management, serum albumin concentration, serum choline esterase concentration, neutrophil-lymphocyte ratio, and Carlson comorbidity index as independent prognostic factors. In propensity score-matched patients, overall survival was significantly longer in those who received surgical management than those who did not.

ConclusionsSurgical management may improve the prognosis of RCC patients with thrombus extending to the renal vein and IVC.

KeywordsRenal cell carcinoma Radical nephrectomy with thrombectomy Tumor thrombus Prognostic factors AbbreviationsCTComputed tomography

ECOG-PSEastern cooperative oncology group performance status

IVCInferior vena cava

RCCRenal cell carcinoma

RVRenal vein.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2490-13-47 contains supplementary material, which is available to authorized users.

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Author: Shingo Hatakeyama - Takahiro Yoneyama - Itsuto Hamano - Hiromi Murasawa - Takuma Narita - Masaaki Oikawa - Kazuhisa Hagiwar

Source: https://link.springer.com/







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