title: Pre-operative risk stratification for cancer-specific survival in patients with renal cell carcinoma with venous involvement who underwent nephrectomy.
abstract: OBJECTIVE
  The aim of this study is to identify the pre-operative prognostic factors and create a risk stratification model for patients with renal cell carcinoma with extension into the renal vein or inferior vena cava.
  
  
  METHODS
  The study cohort included 61 patients with renal cell carcinoma extending into the renal vein or inferior vena cava that underwent operations between 1993 and 2012. Cancer-specific survival rates were estimated, and univariate and multivariate analyses were carried out to determine the prognostic factors. A simple risk stratification model was developed for these patients.
  
  
  RESULTS
  The median follow-up period of the current patient cohort was 33.7 months. Their 1, 3 and 5-year cancer-specific survival were 89, 70 and 65%, respectively. On multivariate analysis, the level of tumor thrombus extension (extension into the supradiaphragm), presence of distant metastasis and elevation of lactate dehydrogenase and C-reactive protein were independent negative prognostic factors for cancer-specific survival. Cancer-specific survival rates were clearly discriminated by the stratification according to the scoring model (P < 0.001). The concordance index of the new model was 0.80.
  
  
  CONCLUSIONS
  We demonstrated a simple risk stratification model with four pre-operative independent prognostic factors for patients with renal cell carcinoma with venous involvement. This may be a useful decision-making model in the management of such patients.
authors.affiliation: Department of Urology, Tokyo Medical and Dental University.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nakayama
authors.affiliation: Department of Urology, Tokyo Medical and Dental University kz-saito.uro@tmd.ac.jp.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Saito
authors.affiliation: Department of Urology, Tokyo Medical and Dental University.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
authors.affiliation: Department of Human Pathology, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Shiho
authors.initials: S
authors.lastname: Abe-Suzuki
authors.affiliation: Department of Urology, Tokyo Medical and Dental University.
authors.forename: Yasukazu
authors.initials: Y
authors.lastname: Nakanishi
authors.affiliation: Department of Urology, Tokyo Medical and Dental University.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Kijima
authors.affiliation: Department of Urology, Tokyo Medical and Dental University.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Yoshida
authors.affiliation: Department of Urology, Tokyo Medical and Dental University.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Ishioka
authors.affiliation: Department of Urology, Tokyo Medical and Dental University.
authors.forename: Yoh
authors.initials: Y
authors.lastname: Matsuoka
authors.affiliation: Department of Urology, Tokyo Medical and Dental University.
authors.forename: Noboru
authors.initials: N
authors.lastname: Numao
authors.affiliation: Department of Urology, Tokyo Medical and Dental University.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Koga
authors.affiliation: Department of Urology, Tokyo Medical and Dental University.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kihara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D057234:Preoperative Period; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D015996:Survival Rate; D014682:Vena Cava, Inferior / Q000473:pathology
chemical_list: D002097:C-Reactive Protein; D007770:L-Lactate Dehydrogenase
keywords: prognostic factors; urologic surgery; urology