title: Surgical treatment of renal cell carcinoma: Can morphological features of inferior vena cava tumor thrombus on computed tomography or magnetic resonance imaging be a prognostic factor?
abstract: To evaluate the impact of morphological features of inferior vena cava thrombus on the overall survival and cancer-specific survival (cancer-specific survival of patients with renal cell carcinoma).
  
  
  
  We retrospectively analyzed the records of 156 renal cell carcinoma patients with inferior vena cava thrombus who underwent radical nephrectomy and thrombectomy from 1998 to 2013 at five tertiary centers. Inferior vena cava thrombi were classified as spherical (type I) and spiculated (type II) according to morphological features on computed tomography or magnetic resonance imaging. Multivariate cox regression models were used to quantify the impact of prognostic factors on overall survival and cancer-specific survival.
  
  
  
  Type I was found in 29 patients (18.6%), and type II in 127 patients (81.4%). Median follow up was 38.2 months (interquartile range 12-57). Demographic characteristics were not significantly different, except for the cranial thrombus height (P = 0.003). On multivariate analysis, Eastern Cooperative Oncology Group performance score, clinical tumor size, distant metastasis, histologic subtype, thrombus morphology and remnant venous thrombus significantly affected overall survival in pNanyManypatients (all P < 0.05). Among the pNO/XMOpatients, clinical tumor size, histologic subtype, thrombus morphology and remnant venous thrombus significantly affected overall survival (all P < 0.05). In terms of cancer-specific survival, Eastern Cooperative Oncology Group performance score, clinical tumor size, distant metastasis, histologic subtype and thrombus morphology significantly affected cancer-specific survival in pNanyManypatients (all P < 0.05). In patients with pNO/XMO, body mass index, clinical tumor size, histological subtype, thrombus morphology and remnant venous thrombus significantly affected cancer-specific survival (all P < 0.05).
  
  
  
  Clinical tumor size, histological subtype, and thrombus morphology are independent predictors of overall survival and cancer-specific survival in renal cell carcinoma patients with inferior vena cava thrombus. These factors might be helpful for the surgeon's determination to improve therapeutic efficacy.
authors.affiliation: Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea.
authors.forename: Don Kyoung
authors.initials: DK
authors.lastname: Choi
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Hwang Gyun
authors.initials: HG
authors.lastname: Jeon
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul National University of Medicine, Seoul, Korea.
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Jeong
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul National University of Medicine, Seoul, Korea.
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.affiliation: Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Cheryn
authors.initials: C
authors.lastname: Song
authors.affiliation: Department of Urology, National Cancer Center, Goyang, Korea.
authors.forename: Jinsoo
authors.initials: J
authors.lastname: Chung
authors.affiliation: Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Sung Kyu
authors.initials: SK
authors.lastname: Hong
authors.affiliation: Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sung-Hoo
authors.initials: SH
authors.lastname: Hong
authors.affiliation: Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Seong Il
authors.initials: SI
authors.lastname: Seo
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging / Q000473:pathology; D009392:Nephrectomy; D011379:Prognosis; D012189:Retrospective Studies; D017131:Thrombectomy; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D020246:Venous Thrombosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery
keywords: carcinoma; magnetic resonance imaging; nephrectomy; renal cell; thrombectomy; tomography