title: Prognostic value of microvascular invasion in predicting the cancer specific survival and risk of metastatic disease in renal cell carcinoma: a multicenter investigation.
abstract: OBJECTIVE
  While microvascular invasion is an accepted risk factor in various cancers, its prognostic role in renal cell carcinoma is still unclear. Therefore, a large multicenter study examining the experience of 5 international institutions was performed to evaluate the prognostic value of microvascular invasion in the occurrence of metastases and cancer specific survival.
  
  
  METHODS
  A total of 2,596 patients (475 with microvascular invasion and 2,121 without microvascular invasion) having up to 212 (median 22.4) months of followup were compared for differences in clinicopathological features, occurrence of metastases and cancer specific survival.
  
  
  RESULTS
  Patients with microvascular invasion presented with higher age (p = 0.001) and a worse Eastern Cooperative Oncology Group performance status (p <0.0001). Microvascular invasion was associated with larger tumor diameter (p <0.0001), higher Fuhrman grade (p <0.0001), more advanced pT stage (p <0.0001), and the presence of lymph node and distant metastases (p <0.0001). In particular, in nonmetastatic cases worse survival was associated with microvascular invasion (p <0.0001, HR 2.38). Univariate analysis demonstrated a strong correlation between microvascular invasion and cancer specific survival (p <0.0001). However, after controlling for gender, Eastern Cooperative Oncology Group performance status, Fuhrman grade and TNM stage statistical significance was lost. Of interest, low stage tumors with microvascular invasion were strongly correlated with the occurrence of metastases (p <0.0001).
  
  
  CONCLUSIONS
  Microvascular invasion occurs in nearly 1 of 5 patients with renal cell carcinoma, is tightly correlated with adverse clinicopathological features and is an independent predictor of metastatic spread including in those presenting with low stage tumors.
authors.affiliation: UCLA Institute of Urologic Oncology, David Geffen School of Medicine, Los Angeles, CA, USA.
authors.forename: Nils
authors.initials: N
authors.lastname: Kroeger
authors.forename: Edward N
authors.initials: EN
authors.lastname: Rampersaud
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.forename: Tobias
authors.initials: T
authors.lastname: Klatte
authors.forename: Frédéric D
authors.initials: FD
authors.lastname: Birkhäuser
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Hervé
authors.initials: H
authors.lastname: Lang
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rioux-Leclerq
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.forename: Nazy
authors.initials: N
authors.lastname: Zomorodian
authors.forename: Fairooz F
authors.initials: FF
authors.lastname: Kabbinavar
authors.forename: Arie S
authors.initials: AS
authors.lastname: Belldegrun
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Pantuck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology* / Q000556:secondary; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology*; D008297:Male; D055806:Microvessels; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D019043:Vascular Neoplasms / Q000401:mortality* / Q000473:pathology*; D055815:Young Adult