title: Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system.
abstract: OBJECTIVE
  To study the surgical outcomes of radical nephrectomy with thrombectomy and to determine prognostic factors for survival of Korean patients with renal cell carcinoma (RCC) and venous tumor thrombus.
  
  
  METHODS
  A total of 124 patients with RCC and venous tumor thrombus who underwent radical nephrectomy and thrombectomy were included in this retrospective study. Cancer-specific survival (CSS) and recurrence-free survival (RFS) rates were analyzed retrospectively according to various prognostic factors.
  
  
  RESULTS
  The median overall follow-up period for all patients was 29.0 months; the median survival period was 50.0 months. The 2-, 5- and 10-year CSS rates for all patients were 64.2%, 47.1% and 31.7%, respectively. Those for 76 patients (pN0/xM0) without metastasis at presentation were 80.9%, 64.5% and 44.9%, respectively. For all patients, lower body mass index (BMI), higher Fuhrman grade, presence of symptoms, perinephric fat invasion, invasion of inferior vena cava (IVC) wall, lymph node (LN) involvement and distant metastasis at presentation were independent predictors for decreased CSS on multivariate analysis, while thrombus level was not. For non-metastatic patients, lower BMI, presence of symptoms and tumor size were independently associated with decreased CSS. In terms of RFS, lower BMI, presence of perinephric fat invasion were prognostic factors for recurrence.
  
  
  CONCLUSIONS
  Our data suggest that obesity is independently associated with better survival or lower risk of tumor recurrence in Korean patients undergoing radical nephrectomy with tumor thrombectomy. Also, our results indicate that Fuhrman grade, presence of symptoms, perinephric fat invasion and invasion of IVC wall, LN involvement and distant metastasis at presentation are independent predictors for survival.
authors.affiliation: Department of Urology, Dongguk University, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Min Chul
authors.initials: MC
authors.lastname: Cho
authors.forename: Jung Kwon
authors.initials: JK
authors.lastname: Kim
authors.forename: Kyung Chul
authors.initials: KC
authors.lastname: Moon
authors.forename: Hyeon Hoe
authors.initials: HH
authors.lastname: Kim
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D056910:Republic of Korea; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D020246:Venous Thrombosis / Q000473:pathology* / Q000601:surgery