title: Natural history of untreated renal cell carcinoma with venous tumor thrombus.
abstract: OBJECTIVE
  The natural history of untreated renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is poorly characterized. We aimed to describe the natural history of this disease, and to identify prognostic factors associated with disease-specific survival.
  
  
  METHODS
  We identified patients in the Surveillance, Epidemiology, and End Results (SEER) database with untreated renal cell carcinoma and venous tumor thrombi. Disease-specific median and 1-year survival rates were determined, and disease-free survival curves were plotted using the Kaplan-Meier method. Multivariable Cox regression analyses were performed to identify factors associated with disease-specific and overall survival in this patient group.
  
  
  RESULTS
  Of 2,265 patients with RCC and VTT, 390 (17%) underwent no treatment; 278 (71%) patients died during follow-up; of these, 243 deaths (87%) were due to RCC. Median and 1-year disease-specific survival for this group was 5 months and 29%, respectively. On multivariable analysis, the extent of tumor thrombus (HR 1.7 for T3c vs. T3b, 95% CI 1.0-2.7) and the presence of metastases (HR 3.1 for M+ vs. M0, 95% CI 1.7-5.5) were most strongly associated with disease-specific mortality.
  
  
  CONCLUSIONS
  Prognosis is poor for the majority of untreated patients with RCC and VTT. Supradiaphragmatic thrombi and distant metastases are adverse prognostic factors in this patient group. This information is important when counseling patients as to the risk and benefits of surgical vs. nonoperative management of RCC and VTT.
authors.affiliation: Department of Urology, University of California San Francisco, San Francisco, CA 94143, USA. Electronic address: areese11@jhmi.edu.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Reese
authors.forename: Jared M
authors.initials: JM
authors.lastname: Whitson
authors.forename: Maxwell V
authors.initials: MV
authors.lastname: Meng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D011379:Prognosis; D016016:Proportional Hazards Models; D018426:SEER Program / Q000706:statistics & numerical data; D015996:Survival Rate; D013927:Thrombosis / Q000473:pathology*; D014682:Vena Cava, Inferior / Q000473:pathology*