title: Renal cell carcinoma with vena caval involvement: a contemporary clinicopathologic analysis of 53 cases.
abstract: A clinicopathologic analysis of patients with renal cell carcinoma (RCC) and vena caval involvement diagnosed at our institution was performed. Multiple clinicopathologic parameters were examined. Fifty-three cases were identified. Mean patient age was 62 years (range, 40-82 years). The cohort comprised 36 of 53 (68%) men and 17 of 53 (32%) women. Mean primary tumor size was 10.4 cm (range, 3.1-21.0 cm). The breakdown of tumor stage was as follows: 37 of 53 (70%) were pT3b, 14 of 53 (26%) were pT3c, and 2 of 53 (4%) were pT4. Most of the tumors were clear cell RCC (45/53, 84.6%), although other variants were also represented. All cases were Fuhrman nuclear grade 3 (34/53, 64%) or 4 (19/53, 36%). Tumor necrosis was present in 41 of 53 (77%) cases. At the time of the initial tumor resection, 11 of 53 (21%) cases were staged pM1. Of the 42 patients staged as pMX at the time of primary tumor resection, 12 of 42 (29%) later developed metastasis, most commonly to the lungs. Of all 53 cases with these very advanced tumors, only 6 of 53 (11.3%) had positive surgical margins: 4 of 53 (7.5%) had positive vascular resection margins, and 2 of 53 (3.8%) had focally positive perinephric fat margins. The mean 5-year survival in our cohort was 50%. Our findings suggest that a select group of patients with RCC with vena caval involvement may benefit from radical nephrectomy, although some tumors may have positive vascular and/or nonvascular surgical resection margins even in the best surgical hands. Multi-institutional studies are needed to further characterize these advanced tumors from the molecular standpoint.
authors.affiliation: Department of Pathology, Emory University School of Medicine, Atlanta, GA, 30322.
authors.forename: Ifeoma U
authors.initials: IU
authors.lastname: Nwadei
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, GA, 30322.
authors.forename: Adam
authors.initials: A
authors.lastname: Lorentz
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, GA, 30322.
authors.forename: Dattatraya
authors.initials: D
authors.lastname: Patil
authors.affiliation: Department of Pathology, Emory University School of Medicine, Atlanta, GA, 30322.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Dimarco
authors.affiliation: Department of Urology, Emory University School of Medicine, Atlanta, GA, 30322; Emory Winship Cancer Institute, Atlanta, GA, 30322.
authors.forename: Viraj A
authors.initials: VA
authors.lastname: Master
authors.affiliation: Department of Pathology, Emory University School of Medicine, Atlanta, GA, 30322; Department of Urology, Emory University School of Medicine, Atlanta, GA, 30322; Emory Winship Cancer Institute, Atlanta, GA, 30322; Department of Pathology, Veterans Affairs Medical Center, Atlanta, GA, 30033. Electronic address: adeboye.osunkoya@emory.edu.
authors.forename: Adeboye O
authors.initials: AO
authors.lastname: Osunkoya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D009392:Nephrectomy; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D014682:Vena Cava, Inferior / Q000473:pathology*
keywords: Margin status; Pathologic stage; Radical nephrectomy; Renal cell carcinoma; Tumor necrosis; Vena cava invasion