title: Analysis of renal cell carcinoma with subdiaphragmatic macroscopic venous invasion (T3b).
abstract: OBJECTIVE
  To review our institutional experience of surgery for renal cell carcinoma (RCC) with subdiaphragmatic macroscopic venous invasion (T3b) and to assess variables associated with cancer-specific survival (CSS), as the stratification of RCC with venous involvement (T3b and T3c) is subject to debate.
  
  
  METHODS
  We retrospectively reviewed the hospital records of patients who underwent a radical nephrectomy with resection of subdiaphragmatic tumour thrombus (T T) between October 1990 and May 2006. The log-rank and Cox uni- and multivariate regression analysis were used to evaluate predictive factors for CSS.
  
  
  RESULTS
  In all, 101 cases were identified. In the N0M0 group, univariate Cox regression analysis confirmed that ipsilateral adrenal gland invasion, Mayo Clinic level of T T, histological subtype and fat invasion were significantly associated with worse CSS. In multivariate Cox regression analysis, only Mayo Clinic level of T T was an independent predictor for CSS. In the subgroup with renal vein involvement only, the median CSS was not reached. In the subgroups with level I, II and III T T involvement, the median CSS was 69, 26 and 21 months, respectively. In the N+ and/or M+ group, only tumour size and type were independent predictors of CSS, while the level of T T was not. Radical nephrectomy yielded poor results with a median CSS of 13 months.
  
  
  CONCLUSIONS
  The Mayo Clinic level of T T is an independent prognostic predictor for CSS in non-metastatic T3b RCC. We strongly support the need for re-classification of the currently applied 2002 Tumour-Node-Metastasis staging system, which in its present form does not discriminate between levels of subdiaphragmatic venous invasion.
authors.affiliation: Department of Urology, University Hospital Gasthuisberg, KU Leuven, Belgium.
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Klaver
authors.forename: Steven
authors.initials: S
authors.lastname: Joniau
authors.forename: Raphael
authors.initials: R
authors.lastname: Suy
authors.forename: Raymond
authors.initials: R
authors.lastname: Oyen
authors.forename: Hein
authors.initials: H
authors.lastname: Van Poppel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D003964:Diaphragm / Q000098:blood supply*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009392:Nephrectomy; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000473:pathology / Q000601:surgery*