title: Impact of venous tumour thrombus consistency (solid vs friable) on cancer-specific survival in patients with renal cell carcinoma.
abstract: BACKGROUND
  To our knowledge, the impact of venous tumour thrombus (VTT) consistency in patients affected by renal cell carcinoma (RCC) has never been addressed.
  
  
  OBJECTIVE
  To analyse the effect of VTT consistency on cancer-specific survival (CSS).
  
  
  METHODS
  We retrospectively analysed 174 consecutive patients with RCC and renal vein or inferior vena cava (IVC) VTT who underwent surgical treatment between 1989 and 2007 at our institute.
  
  
  METHODS
  All patients underwent radical nephrectomy and thrombectomy.
  
  
  METHODS
  Pathologic specimens were reviewed by a single uropathologist. In addition to traditional pathologic features, the morphologic aspect of the tumour thrombus was evaluated to distinguish solid from friable patterns. The prognostic role of thrombus consistency (solid vs friable) on CSS was assessed by means of Cox regression models.
  
  
  CONCLUSIONS
  The VTT was solid in 107 patients (61.5%) and friable in 67 patients (38.5%). The presence of a friable VTT increased the risk of having synchronous nodal or distant metastases, higher tumour grade, higher pathologic stage, and simultaneous perinephric fat invasion (all p < 0.05). The median follow-up was 24 mo. The median CSS was 33 mo; the median CSS was 8 mo in patients with a friable VTT and 55 mo in patients with a solid VTT (p < 0.001). On multivariable analyses, the presence of a friable VTT was an independent predictor of CSS (p = 0.02). The power of our conclusion may be somewhat limited by the relatively small study population and the retrospective nature of the study.
  
  
  CONCLUSIONS
  In patients with RCC and VTT, the presence of a friable thrombus is an independent predictor of CSS. If our finding is confirmed by further studies, the consistency of the tumour thrombus should be introduced into routine pathologic 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: Elena
authors.initials: E
authors.lastname: Strada
authors.forename: Diego
authors.initials: D
authors.lastname: Angiolilli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Petralia
authors.forename: Rayan
authors.initials: R
authors.lastname: Matloob
authors.forename: Francesco
authors.initials: F
authors.lastname: Sozzi
authors.forename: Umberto
authors.initials: U
authors.lastname: Capitanio
authors.forename: Luigi Filippo
authors.initials: LF
authors.lastname: Da Pozzo
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
authors.forename: Anna
authors.initials: A
authors.lastname: Cremonini
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D016009:Chi-Square Distribution; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000401:mortality*; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012082:Renal Veins / Q000473:pathology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology*; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality* / Q000473:pathology