title: Population based analysis of survival in patients with renal cell carcinoma and venous tumor thrombus.
abstract: OBJECTIVE
  To identify prognostic factors for renal cell carcinoma (RCC) with venous tumor thrombus (VTT) and determine the significance of thrombus level on survival.
  
  
  METHODS
  Patients within the Surveillance, Epidemiology, and End Results (SEER) database with RCC and VTT were identified and included if managed surgically. The Kaplan-Meier method and Cox regression analyses were performed to identify factors associated with disease-specific survival.
  
  
  RESULTS
  A total of 1,875 patients met the inclusion criteria. One-year survival for patients undergoing surgery was 60% for patients with metastases and 90% for those without. Factors associated with worse survival included larger tumor size (HR 1.2, 95% CI 1.0-1.4), medullary, collecting duct, or sarcomatoid histology (HR 2.2, 95% CI 1.5-3.3), Fuhrman grade 3 (HR 2.2, 95% CI 1.5-3.3) or grade 4 (HR 2.9, 95% CI 1.8-4.5) tumors, positive lymph nodes (HR 1.5, 95% CI 1.0-2.0), and metastases (HR 3.5, 95% CI 2.6-4.8). Thrombus level above the diaphragm (T3c) was not significantly associated with worse survival (HR 1.4, 95% CI 0.8-2.5).
  
  
  CONCLUSIONS
  In this large, population-based study of patients with RCC and VTT, we identify several disease-specific factors strongly associated with cancer-specific mortality. After controlling for adverse prognostic factors, thrombus level was not associated with worse outcome.
authors.affiliation: Department of Urology, University of California, San Francisco, CA 94143, USA. jwhitson@urology.ucsf.edu
authors.forename: Jared M
authors.initials: JM
authors.lastname: Whitson
authors.forename: Adam C
authors.initials: AC
authors.lastname: Reese
authors.forename: Maxwell V
authors.initials: MV
authors.lastname: Meng
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D016016:Proportional Hazards Models; D018426:SEER Program; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality* / Q000473:pathology