title: Microvascular tumour invasion in renal cell carcinoma: the most important prognostic factor.
abstract: OBJECTIVE
  To evaluate the role of microvascular invasion (MVI) in the primary lesion for predicting tumour behaviour in patients with renal cell carcinoma (RCC), as reliable clinical prognostic factors would be very valuable.
  
  
  METHODS
  MVI was assessed in 230 patients with clinically localized RCC (stages T1-4NxM0) who had a radical nephrectomy and/or nephron-sparing surgery. The median (range) follow-up was 48 (3-130) months. The impact of MVI on disease progression and its correlation with clinical and histopathological factors was analysed, including whether patients were symptomatic or not at presentation, Fuhrman nuclear grade, tumour size, pathological stage and lymph node metastasis. Regression analyses and survival curves were used to determine if MVI was associated with the prognosis of RCC.
  
  
  RESULTS
  There was MVI in 59 patients (26%); of these, 46% developed disease recurrence. Among the 171 patients with no MVI, only 11 (6%) had tumour recurrence. MVI was associated with tumour diameter, nuclear grade, pathological stage, lymph node metastasis and the presence of sarcomatous elements in the tumour. Multivariate analysis showed that MVI was an independent predictor of disease recurrence and the most important factor related to death.
  
  
  CONCLUSIONS
  MVI is an independent predictor of prognosis in patients with RCC.
authors.affiliation: Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil. marcosdallogliouro@terra.com.br
authors.forename: Marcos F
authors.initials: MF
authors.lastname: Dall'Oglio
authors.forename: Alberto A
authors.initials: AA
authors.lastname: Antunes
authors.forename: Alvaro S
authors.initials: AS
authors.lastname: Sarkis
authors.forename: Alexandre
authors.initials: A
authors.lastname: Crippa
authors.forename: Kátia R
authors.initials: KR
authors.lastname: Leite
authors.forename: Antonio Marmo
authors.initials: AM
authors.lastname: Lucon
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000098:blood supply / Q000473:pathology* / Q000601:surgery; D008297:Male; D008833:Microcirculation / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000098:blood supply / Q000473:pathology*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D019043:Vascular Neoplasms / Q000473:pathology* / Q000556:secondary