title: The extent of tumour fat invasion affects survival in patients with renal cell carcinoma and venous tumour thrombosis.
abstract: OBJECTIVE
  • To investigate the effect of presence and extent of tumour fat invasion (TFI) - perinephric invasion (PFI), renal sinus fat invasion (RSFI) or both PFI and RSFI - on cancer-specific mortality (CSM) in patients with renal cell carcinoma (RCC) and venous tumour thrombus (VTT).
  
  
  METHODS
  • We examined 184 consecutive patients with RCC with VTT treated with nephrectomy between 1987 and 2007. Associations with CSM were evaluated by univariable and multivariable Cox proportional hazard models.
  
  
  RESULTS
  • Median follow up was 21 months. The 5-year CSM-free survival estimates were 75%, 36% and 20% in patients with VTT without TFI, those with VTT with PFI or RSFI, and those with VTT with both PFI and RSFI, respectively (P < 0.001). In multivariable analyses, presence of either PFI or RSFI was associated with a two-fold increased risk of CSM, whereas presence of both PFI and RSFI was associated with a three-fold increased risk of CSM, relative to VTT-only cases. • The inclusion of the variable describing the presence and extent of TFI in a base model including pT stage, Fuhrman grade and presence of nodal disease and metastatic disease significantly increased the accuracy in predicting CSM (+2.1%; P < 0.001) in patients with VTT.
  
  
  CONCLUSIONS
  • Patients affected by RCC with VTT and TFI have a higher risk of CSM relative to cases with VTT only. Patients with both PFI and RSFI showed increased CSM compared with patients with either PFI or RSFI. • Our results suggest TFI should be accurately evaluated and included in routine pathological reports to provide better patient risk stratification.
authors.affiliation: Department of Urology, Vita-Salute University San Raffaele, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bertini
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Massimo
authors.initials: M
authors.lastname: Freschi
authors.forename: Diego
authors.initials: D
authors.lastname: Angiolilli
authors.forename: Elena
authors.initials: E
authors.lastname: Strada
authors.forename: Giovanni
authors.initials: G
authors.lastname: Petralia
authors.forename: Francesco
authors.initials: F
authors.lastname: Sozzi
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Anna
authors.initials: A
authors.lastname: Cremonini
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology*; D018572:Disease-Free Survival; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D018205:Neoplasms, Adipose Tissue / Q000401:mortality / Q000473:pathology*; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors; D020246:Venous Thrombosis / Q000401:mortality / Q000473:pathology*