[Surgical management and long-term outcomes of patients with renal cell carcinoma accompanied with venous tumor thrombus].
OBJECTIVE
To evaluate the surgical management and long-term outcomes of patients with renal cell carcinoma and venous tumor thrombus.


METHODS
From Aug. 2000 to Dec. 2011, 140 patients underwent radical nephrectomy and thrombectomy in our hospital, of whom, 80 were with renal vein tumor thrombus, 41 with inferior vena caval (IVC), level I tumor thrombus (below hepatic vein), 13 with IVC level II tumor thrombus (above hepatic vein but below diaphragm) and 6 with IVC level III tumor thrombus (above diaphragm). The overall and cancer-specific survival rates were analyzed with Kaplan-Meier survival curve method.


RESULTS
The follow-up information of the 114 patients was gained. The median follow-up period for all the patients was 20.5 months (1-96). In the last follow-up, 47 patients died. The median survival time for all the patients was 51 months. The median survival time for the patients with renal vein tumor thrombus and IVC level Ito III tumor thrombus were 57, 43, 40 and 27 months. The 5 year overall survival (OS) and cancer-specific survival (CSS) rates for all the patients were 40.1% and 47.2%, respectively. The survival time of the patients with early tumor thrombus (below hepatic vein) was significantly longer than that of the patients with advanced tumor thrombus (above hepatic vein) (54.1±4.8 months vs. 26.9±5.7 months, P=0.049).


CONCLUSIONS
Radical nephrectomy and thrombectomy are effective therapies for RCC patients with venous extension. The patients can obtain a relatively promising long-term outcome, which is comparable to previous western studies. Long-term outcome of the early tumor thrombus patients is significantly better than that of the advanced tumor thrombus patients.
Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034.
Qi
Q
Tang
Yi
Y
Song
Xue-song
XS
Li
Cui-jian
CJ
Zhang
Lin
L
Cai
Gang
G
Song
Qian
Q
Zhang
Jin
J
Wang
Zhi-song
ZS
He
Li-qun
LQ
Zhou
D002292:Carcinoma, Renal Cell / Q000150:complications / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000601:surgery*; D009392:Nephrectomy; D012189:Retrospective Studies; D015996:Survival Rate; D017131:Thrombectomy; D013927:Thrombosis / Q000150:complications*; D014682:Vena Cava, Inferior / Q000473:pathology