title: [Prognostic value of venous tumor thrombus in renal cell carcinoma].
abstract: OBJECTIVE
  To evaluate the prognostic value of venous tumor thrombus in renal cell carcinoma.
  
  
  METHODS
  A retrospective study of 167 patients with renal cell carcinoma and stage pT3 who underwent radical nephrectomy and extended lymphadenectomy from July 1969 to May 2008 was conducted. Patients with any kind of venous involvement were selected for the analysis (73 patients; 43.7%). The Kaplan Meier survival curves and log-rank test for comparisons were used for the survival analysis. Multivariate analysis was done by Cox regression.
  
  
  RESULTS
  Lymph node involvement was present in 30 patients (41.1%) and metastatic disease in 9 patients (12.3%). The most frequent histologic renal cell carcinoma subtype was 50 (68.5%) conventional carcinoma, followed by nondifferentiated in 11 (15.5%), and chromophobe in 9 (12.3%). High grade tumors (Furhman 3-4) were present in 57% of the cases. Venous thrombus level extended to renal vein in 61 patients (83.6%), to inferior vena cava in 9 patients (12.3%) and to the cardiac right atrium in 3 cases (4.1%). The survival analysis showed worse survival in those patients with venous tumor thrombosis (p=.001) and with vein wall invasion (p=.0042), but not in function on the level of the thrombus (p=.12). The multivariate analysis identified the Furhman grade and venous tumor thrombosis as independent survival prognostic factors.
  
  
  CONCLUSIONS
  In our series, venous tumor thrombosis, together with the Furhman nuclear grade, is an independent survival prognostic factor. However, neither cephalic extension of the thrombus nor the invasion of the vein wall showed independent prognostic value.
authors.affiliation: Servicio de Urología, Hospital Universitario y Politécnico La Fe, Valencia, España. gonzag1@hotmail.com
authors.forename: G
authors.initials: G
authors.lastname: García-Fadrique
authors.forename: A
authors.initials: A
authors.lastname: Budía-Alba
authors.forename: J L
authors.initials: JL
authors.lastname: Ruiz-Cerdá
authors.forename: G
authors.initials: G
authors.lastname: Morales-Solchaga
authors.forename: J L
authors.initials: JL
authors.lastname: Pontones
authors.forename: J F
authors.initials: JF
authors.lastname: Jiménez-Cruz
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000145:classification / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007167:Immunotherapy; D007431:Intraoperative Complications / Q000209:etiology / Q000401:mortality; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009392:Nephrectomy; D011379:Prognosis; D016016:Proportional Hazards Models; D011655:Pulmonary Embolism / Q000209:etiology / Q000401:mortality; D012082:Renal Veins / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D017131:Thrombectomy; D014682:Vena Cava, Inferior / Q000473:pathology* / Q000601:surgery; D020246:Venous Thrombosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery