Management of renal cell carcinoma with inferior vena cava tumor thrombus.
OBJECTIVE
The prognostic implication of radical nephrectomy with inferior vena cava tumor thrombectomy for renal cell carcinoma is still controversial. We investigated the type of renal cell carcinoma with vena cava tumor thrombus for which surgical resection was beneficial.


METHODS
We retrospectively reviewed the records of 16 patients with renal cell carcinoma and inferior vena cava tumor thrombus. Of these, 10 received surgical treatment and 6 did not. We evaluated the association between the pretreatment serum C-reactive protein (CRP) level and the efficacy of surgery.


RESULTS
Among the 8 patients with an elevated pretreatment serum CRP level (CRP > or = 1.0 ng/ml), there was no significant difference of the median disease-specific survival between those who did (20.2 months) and did not undergo surgery (8.2 months; p = 0.1946). On the other hand, among the 8 patients who had a pretreatment serum CRP level within normal limits (CRP < 1.0 ng/ml), the median disease-specific survival of those who did not undergo surgery (80.6 months) was significantly better than that of those who did (50.2 months; p = 0.0136).


CONCLUSIONS
This study suggested that conservative treatment can be recommended for patients with renal cell carcinoma and inferior vena cava tumor thrombus when the pretreatment serum CRP level is normal because tumor progression is usually slow and surgical treatment may actually worsen the prognosis.
Matsui
Y
Y
Department of Urology, Kobe City General Hospital, Kobe City, Japan. Pujima@aol.com
Fujikawa
K
K
Oka
H
H
Fukuzawa
S
S
Takeuchi
H
H
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods / Q000401:mortality; D011336:Probability; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D017131:Thrombectomy / Q000379:methods / Q000401:mortality; D013923:Thromboembolism / Q000150:complications / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome; D014682:Vena Cava, Inferior
D002097:C-Reactive Protein