title: Prognostic value of renal vein and inferior vena cava involvement in renal cell carcinoma.
abstract: BACKGROUND
  The prognostic significance of venous tumor thrombus extension in patients with renal cell carcinoma (RCC) is a matter of many controversies in the current literature.
  
  
  OBJECTIVE
  To evaluate the prognostic role of inferior vena cava (IVC) involvement in a large series of pT3b and pT3c RCCs.
  
  
  METHODS
  A total of 1192 patients from 13 European institutions underwent a radical nephrectomy for pT3b and pT3c RCC between 1982 and 2003. The patients were evaluated in a retrospective manner. Age, gender, clinical symptoms, Eastern Cooperative Oncology Group (ECOG) performance status, TNM stage, tumor size, adrenal invasion, perinephric fat invasion, histological type, and Fuhrman grade were reviewed. The log-rank and Cox uni- and multivariate regression analyses were used to evaluate prognostic factors for overall survival.
  
  
  METHODS
  Overall survival and prognostic factors for overall survival in patients with RCC extending to the renal vein (RV) or to the IVC.
  
  
  CONCLUSIONS
  The median follow-up was 61.4 mo (56.3-66.5 mo). The mean age was 63.2 yr. The mean tumor size was 8.9 cm. Group 1 (Gr 1) included 933 patients with a renal vein tumor thrombus (78.3%), Group 2 (Gr 2) included 196 patients with a subdiaphragmatic IVC tumor thrombus (16.4%), and Group 3 (Gr 3) included 63 patients with a supradiaphragmatic IVC tumor thrombus (5.3%). Median survival was 52 mo for Gr 1, 25.8 mo for Gr 2, and 18 mo for Gr 3. In univariate analysis, Gr 1 had a significantly better overall survival than Gr 2 (p<0.001) and Gr 3 (p<or=0.001). No significant difference in survival was noted between Gr 2 and Gr 3 (p=0.613). Prognostic factors for overall survival in univariate analysis were clinical symptoms (p<0.001), tumor size (p<0.001), perinephric fat invasion (p<0.001), Fuhrman grade (p<0.001), histological type (p=0.021), lymph node invasion (p<0.001), and distant metastasis (p<0.001). Independent prognostic factors in multivariate analysis were tumor size (p=0.013), perinephric fat invasion (p=0.003), lymph node invasion (p<0.001), distant metastasis (p<0.001), and IVC invasion (p=0.008).
  
  
  CONCLUSIONS
  The level of tumor thrombus in the IVC does not significantly affect long-term overall survival in patients with renal cell carcinoma. The overall survival was statistically different for patients with a tumor thrombus in the RV compared to those with IVC involvement. This has to be considered for the next revision of the TNM system, and the pT3b and pT3c stages have to be redesigned.
authors.affiliation: Department of Urology, Strasbourg University Hospital, Nouvel Hôpital Civil, Strasbourg, France. bernd.wagner@chru-strasbourg.fr
authors.forename: Bernd
authors.initials: B
authors.lastname: Wagner
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Arnaud
authors.initials: A
authors.lastname: Méjean
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Grégory
authors.initials: G
authors.lastname: Verhoest
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
authors.forename: Jacques
authors.initials: J
authors.lastname: Tostain
authors.forename: Peter
authors.initials: P
authors.lastname: Mulders
authors.forename: Denis
authors.initials: D
authors.lastname: Chautard
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Descotes
authors.forename: Alexandre
authors.initials: A
authors.lastname: de la Taille
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Tommaso
authors.initials: T
authors.lastname: Prayer-Galetti
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.forename: Antoine
authors.initials: A
authors.lastname: Valéri
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meyer
authors.forename: Didier
authors.initials: D
authors.lastname: Jacqmin
authors.forename: Hervé
authors.initials: H
authors.lastname: Lang
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009362:Neoplasm Metastasis / Q000473:pathology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D012044:Regression Analysis; D012082:Renal Veins / Q000473:pathology*; D016019:Survival Analysis; D017741:Survivors; D013927:Thrombosis / Q000150:complications; D013997:Time Factors; D014682:Vena Cava, Inferior / Q000473:pathology*