title: Prognostic benefit of surgical management in renal cell carcinoma patients with thrombus extending to the renal vein and inferior vena cava: 17-year experience at a single center.
abstract: BACKGROUND
  Management of renal cell carcinoma (RCC) with tumor thrombus extending to the renal vein and inferior vena cava (IVC) is challenging. The aim of this study was to evaluate the benefit of surgical management in such patients.
  
  
  METHODS
  From February 1995 to February 2013, 520 patients were treated for RCC at Hirosaki University Hospital, Hirosaki, Japan. The RCC patients with tumor thrombus extending to the renal vein (n = 42) and IVC (n = 43) were included in this study. The records of these 85 patients were retrospectively reviewed to assess the relevant clinical and pathological variables and survival. Prognostic factors were identified by multivariate analysis. The benefit of surgical management was evaluated using propensity score matching to compare overall survival between patients who received surgical management and those who did not.
  
  
  RESULTS
  RCC was confirmed by pathological examination of surgical or biopsy specimens in 74 of the 85 patients (87%). Sixty-five patients (76%) received surgical management (radical nephrectomy with thrombectomy). Distant metastasis was identified in 45 patients (53%). The proportion of patients with tumor thrombus level 0 (renal vein only), I, II, III, and IV was 49%, 13%, 18%, 14%, and 5%, respectively. The estimated 5-year overall survival rate was 70% in patients with thrombus extending to the renal vein and 23% in patients with thrombus extending to the IVC. Multivariate analysis identified thrombus extending to the IVC, presence of distant metastasis, surgical management, serum albumin concentration, serum choline esterase concentration, neutrophil-lymphocyte ratio, and Carlson comorbidity index as independent prognostic factors. In propensity score-matched patients, overall survival was significantly longer in those who received surgical management than those who did not.
  
  
  CONCLUSIONS
  Surgical management may improve the prognosis of RCC patients with thrombus extending to the renal vein and IVC.
authors.affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, 036-8562 Hirosaki, Japan. coyama@cc.hirosaki-u.ac.jp.
authors.forename: Shingo
authors.initials: S
authors.lastname: Hatakeyama
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yoneyama
authors.forename: Itsuto
authors.initials: I
authors.lastname: Hamano
authors.forename: Hiromi
authors.initials: H
authors.lastname: Murasawa
authors.forename: Takuma
authors.initials: T
authors.lastname: Narita
authors.forename: Masaaki
authors.initials: M
authors.lastname: Oikawa
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Hagiwara
authors.forename: Daisuke
authors.initials: D
authors.lastname: Noro
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Tanaka
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Takuya
authors.initials: T
authors.lastname: Koie
authors.forename: Chikara
authors.initials: C
authors.lastname: Ohyama
mesh_terms: D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000401:mortality*; D015995:Prevalence; D011379:Prognosis; D012082:Renal Veins / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D017131:Thrombectomy / Q000401:mortality*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*; D020246:Venous Thrombosis / Q000401:mortality / Q000601:surgery*