title: Prognostic factors in T3b renal cell carcinoma.
abstract: OBJECTIVE
  We reviewed our patients with pathologic T3b renal cell carcinoma (RCC) to determine which factors influenced survival in this high risk patient group.
  
  
  METHODS
  From April 1988 to August 2006, 722 patients underwent nephrectomy for RCC at Vanderbilt University. 128 patients (17%) had T3b disease by 2002 AJCC TNM staging criteria. 31 (24%) of these patients had known metastases at the time of nephrectomy. Patient demographics, clinical, and pathological characteristics were collected.
  
  
  RESULTS
  There were 95 men (74%) and 33 women (26%) whose median age was 64 years (range 35-87). Median follow-up was 25.2 months (0-124). Median follow-up among those still alive at last follow up was 45.8 months (2.4-114). For overall survival (OS), disease specific survival (DSS), and recurrence free survival (RFS), non-clear cell histology, grade, presence of sarcomatoid features, LN positive disease, presence of necrosis, positive margins, and metastasis present at the time of nephrectomy were all associated with worse outcomes. Race, gender, ASA class, age, and inferior vena cava (IVC) involvement were not associated with outcome. On multivariate analysis, metastasis at the time of nephrectomy, margin involvement, and the presence of necrosis were independently associated with decreased OS and DSS. The presence of necrosis and lymph node involvement were independent predictors of worse RFS.
  
  
  CONCLUSIONS
  Our data suggests that in patients with T3b RCC, the presence or absence of macroscopic necrosis should be included as part of the pathology report to help guide prognosis in this high risk patient group.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN, 37232-2765, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Coons
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Stec
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Stratton
authors.forename: Sam S
authors.initials: SS
authors.lastname: Chang
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.forename: S
authors.initials: S
authors.lastname: Duke Herrell
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
authors.forename: Peter E
authors.initials: PE
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate