title: Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension.
abstract: BACKGROUND
  The prognostic significance of venous involvement and tumour thrombus level in renal cell carcinoma (RCC) remains highly controversial. In 2010, the American Joint Committee on Cancer (AJCC) and the Union International Centre le Cancer (UICC) revised the RCC staging system (7th edition) based on tumour thrombus level, differentiating the T stage of tumours limited to renal-vein-only involvement.
  
  
  OBJECTIVE
  We aimed to evaluate the impact of tumour thrombus extension in a multi-institutional cohort of patients.
  
  
  METHODS
  An international consortium of 11 institutions was established to retrospectively review a combined cohort of 1215 patients undergoing radical nephrectomy and tumour thrombectomy for RCC, including 585 patients with inferior vena cava (IVC) involvement or higher.
  
  
  METHODS
  Predictive factors of survival, including histology, tumour thrombus level, nodal status, Fuhrman grade, and tumour size, were analysed.
  
  
  CONCLUSIONS
  A total of 1122 patients with complete data were reviewed. The median follow-up for all patients was 24.7 mo, with a median survival of 33.8 mo. The 5-yr survival was 43.2% (renal vein involvement), 37% (IVC below the diaphragm), and 22% with caval involvement above the diaphragm. On multivariate analysis, tumour size (hazard ratio [HR]: 1.64 [range: 1.03-2.59]; p=0.036), Fuhrman grade (HR: 2.26 [range: 1.65-3.1]; p=0.000), nodal metastasis (HR: 1.32 [range: 1.09-1.67]; p=0.005), and tumour thrombus level (HR: 2.10 [range: 1.53-3.0]; p=0.00) correlated independently with survival.
  
  
  CONCLUSIONS
  Based on analysis of the largest known cohort of patients with RCC along with IVC and atrial thrombus involvement, tumour thrombus level is an independent predictor of survival. Our findings support the changes to the latest AJCC/UICC staging system.
authors.affiliation: Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain. msalamanca99@hotmail.com
authors.forename: Juan I
authors.initials: JI
authors.lastname: Martínez-Salamanca
authors.forename: William C
authors.initials: WC
authors.lastname: Huang
authors.forename: Isabel
authors.initials: I
authors.lastname: Millán
authors.forename: Roberto
authors.initials: R
authors.lastname: Bertini
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Bianco
authors.forename: Joaquin A
authors.initials: JA
authors.lastname: Carballido
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ciancio
authors.forename: Carlos
authors.initials: C
authors.lastname: Hernández
authors.forename: Felipe
authors.initials: F
authors.lastname: Herranz
authors.forename: Axel
authors.initials: A
authors.lastname: Haferkamp
authors.forename: Markus
authors.initials: M
authors.lastname: Hohenfellner
authors.forename: Brian
authors.initials: B
authors.lastname: Hu
authors.forename: Theresa
authors.initials: T
authors.lastname: Koppie
authors.forename: Claudio
authors.initials: C
authors.lastname: Martínez-Ballesteros
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Joan
authors.initials: J
authors.lastname: Palou
authors.forename: J Edson
authors.initials: JE
authors.lastname: Pontes
authors.forename: Paul
authors.initials: P
authors.lastname: Russo
authors.forename: Carlo
authors.initials: C
authors.lastname: Terrone
authors.forename: Humberto
authors.initials: H
authors.lastname: Villavicencio
authors.forename: Alessandro
authors.initials: A
authors.lastname: Volpe
authors.forename: John A
authors.initials: JA
authors.lastname: Libertino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016009:Chi-Square Distribution; D005060:Europe; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000379:methods*; D009392:Nephrectomy; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012082:Renal Veins / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D015996:Survival Rate; D017131:Thrombectomy; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014682:Vena Cava, Inferior / Q000473:pathology* / Q000601:surgery; D020246:Venous Thrombosis / Q000401:mortality / Q000473:pathology* / Q000601:surgery