title: Impact of histologic subtype on cancer-specific survival in patients with renal cell carcinoma and tumor thrombus.
abstract: BACKGROUND
  Although different prognostic factors for patients with renal cell carcinoma (RCC) and vena cava tumor thrombus (TT) have been studied, the prognostic value of histologic subtype in these patients remains unclear.
  
  
  OBJECTIVE
  We analyzed the impact of histologic subtype on cancer-specific survival (CSS).
  
  
  METHODS
  We retrospectively analyzed the records of 1774 patients with RCC and TT who underwent radical nephrectomy and tumor thrombectomy from 1971 to 2012 at 22 US and European centers.
  
  
  METHODS
  Multivariable ordered logistic and Cox regression models were used to quantify the impact of tumor histology on CSS.
  
  
  CONCLUSIONS
  Overall 5-yr CSS was 53.4% (confidence interval [CI], 50.5-56.2) in the entire group. TT level (according to the Mayo classification of macroscopic venous invasion in RCC) was I in 38.5% of patients, II in 30.6%, III in 17.3%, and IV in 13.5%. Histologic subtypes were clear cell renal cell carcinoma (cRCC) in 89.9% of patients, papillary renal cell carcinoma (pRCC) in 8.5%, and chromophobe RCC in 1.6%. In univariable analysis, pRCC was associated with a significantly worse CSS (p<0.001) compared with cRCC. In multivariable analysis, the presence of pRCC was independently associated with CSS (hazard ratio: 1.62; CI, 1.01-2.61; p<0.05). Higher TT level, positive lymph node status, distant metastasis, and fat invasion were also independently associated with CSS.
  
  
  CONCLUSIONS
  In our multi-institutional series, we found that patients with pRCC and vena cava TT who underwent radical nephrectomy and tumor thrombectomy had significantly worse cancer-specific outcomes when compared with patients with other histologic subtypes of RCC. We confirmed that higher TT level and fat invasion were independently associated with reduced CSS.
authors.affiliation: Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA, USA. Electronic address: derya.tilki@ucdmc.ucdavis.edu.
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
authors.affiliation: Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA, USA.
authors.forename: Hao G
authors.initials: HG
authors.lastname: Nguyen
authors.affiliation: Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Dall'Era
authors.affiliation: Department of Urology, Hospital San Raffaele, University Vita-Salute, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bertini
authors.affiliation: Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Joaquín A
authors.initials: JA
authors.lastname: Carballido
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Chromecki
authors.affiliation: Miami Transplant Institute, University of Miami, Miami, FL, USA.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ciancio
authors.affiliation: USC/Norris Comprehensive Cancer Center, Los Angeles, CA, USA.
authors.forename: Siamak
authors.initials: S
authors.lastname: Daneshmand
authors.affiliation: Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gontero
authors.affiliation: Department of Urology, Getafe University Hospital, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Gonzalez
authors.affiliation: Department of Urology, University of Frankfurt, Frankfurt, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haferkamp
authors.affiliation: Department of Urology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Hohenfellner
authors.affiliation: Department of Urology, New York University School of Medicine, New York, NY, USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Huang
authors.affiliation: Department of Urology, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Koppie
authors.affiliation: Department of Urology, Emory University, Atlanta, GA, USA.
authors.forename: C Adam
authors.initials: CA
authors.lastname: Lorentz
authors.affiliation: Institute of Empirical Economic Research, University of Leipzig, Leipzig, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Mandel
authors.affiliation: Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Juan I
authors.initials: JI
authors.lastname: Martinez-Salamanca
authors.affiliation: Department of Urology, Emory University, Atlanta, GA, USA.
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
authors.affiliation: Department of Urology, Hospital San Raffaele, University Vita-Salute, Milan, Italy.
authors.forename: Rayan
authors.initials: R
authors.lastname: Matloob
authors.affiliation: Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: McKiernan
authors.affiliation: Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Carrie M
authors.initials: CM
authors.lastname: Mlynarczyk
authors.affiliation: Department of Urology, Hospital San Raffaele, University Vita-Salute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: University of Padua, Padua, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.affiliation: Department of Urology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Pahernik
authors.affiliation: Department of Urology, Fundació Puigvert, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Palou
authors.affiliation: Department of Urology, UNC at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Raj S
authors.initials: RS
authors.lastname: Pruthi
authors.affiliation: Department of Urology, New York University School of Medicine, New York, NY, USA.
authors.forename: Krishna
authors.initials: K
authors.lastname: Ramaswamy
authors.affiliation: Department of Urology, Fundació Puigvert, Barcelona, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Rodriguez Faba
authors.affiliation: Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Russo
authors.affiliation: Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.affiliation: University of Würzburg, Würzburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Spahn
authors.affiliation: Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Terrone
authors.affiliation: University of Würzburg, Würzburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Vergho
authors.affiliation: Department of Urology, UNC at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Wallen
authors.affiliation: Department of Urology, Weill Cornell Medical Center, New York, NY, USA.
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.affiliation: Department of Urology, Medical University of Graz, Graz, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.affiliation: Department of Urology, Lahey Clinic, Burlington, MA, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Libertino
authors.affiliation: Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Evans
mesh_terms: D000273:Adipose Tissue / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009392:Nephrectomy; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014684:Venae Cavae / Q000473:pathology*; D020246:Venous Thrombosis / Q000473:pathology* / Q000601:surgery; D055815:Young Adult
keywords: Clear cell; Histology; Papillary; Prognosis; Renal cell carcinoma; Survival; Vena cava tumor thrombus