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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.

Hatakeyama S, Yoneyama T, Hamano I, Murasawa H, Narita T, Oikawa M, Hagiwara K, Noro D, Tanaka T, Tanaka Y, Hashimoto Y, Koie T, Ohyama C - BMC Urol (2013)

Bottom Line: The aim of this study was to evaluate the benefit of surgical management in such patients.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.In propensity score-matched patients, overall survival was significantly longer in those who received surgical management than those who did not.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, 036-8562 Hirosaki, Japan. coyama@cc.hirosaki-u.ac.jp.

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.

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Survival in the RV and IVC thrombus groups, according to surgical management and distant metastasis. (A) Overall survival in the RV thrombus and IVC thrombus groups. (B) In the RV thrombus group, survival was significantly longer in patients who received surgical management than those who did not. (C) In the RV thrombus group, distant metastasis was a powerful prognostic factor. (D) In the IVC thrombus group, thrombus level was not significantly correlated with overall survival. (E) In the IVC thrombus group, survival was significantly longer in patients who received surgical management than those who did not. (F) In the IVC thrombus group, distant metastasis was not a significant prognostic factor.
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Figure 3: Survival in the RV and IVC thrombus groups, according to surgical management and distant metastasis. (A) Overall survival in the RV thrombus and IVC thrombus groups. (B) In the RV thrombus group, survival was significantly longer in patients who received surgical management than those who did not. (C) In the RV thrombus group, distant metastasis was a powerful prognostic factor. (D) In the IVC thrombus group, thrombus level was not significantly correlated with overall survival. (E) In the IVC thrombus group, survival was significantly longer in patients who received surgical management than those who did not. (F) In the IVC thrombus group, distant metastasis was not a significant prognostic factor.

Mentions: Sixty-five patients (76%) underwent radical nephrectomy with thrombectomy, and 20 did not receive surgical management. None of the patients who received surgical management underwent preoperative renal artery embolization. The median follow-up period was 26 months in patients who received surgical management and 5 months in patients who did not. Among the patients who did not receive surgical management, eight received immunotherapy or interferon-α 6,000,000 IU three times/week, seven received molecular targeted therapy, one underwent tumor embolization, and four received best supportive care only. The reason for non-surgical management was multiple organ or unresectable metastasis in 14 patients (lung and lymph nodes, n = 6; lung and bone, n = 2; lung, n = 2; lung, bone, and brain, n = 1; lung and liver in a patient with duodenal invasion, n = 1; brain, n = 1; lymph nodes, n = 1), patient refusal in 4 patients, dementia in 1 patient, and ECOG-PS >3 in 1 patient. In the whole group of 85 patients, the estimated median overall survival time was 41 months and the estimated 5-year overall survival rate was 40% (Figure 3A, Table 2). At the time of this report, 43 patients (51%) had died of their disease, including 24 (43%) who received surgical management and 15 (75%) who did not (P = 0.003). In all patients who did not receive surgical management, the main cause of death was cachexia. In patients who received surgical management, the estimated median survival time was 60 months and the estimated 5-year overall survival rate was 54%. In patients who did not receive surgical management, the estimated median survival time was 8.2 months and the estimated 5-year survival rate was 0% (Table 2). Distant metastasis was present at the time of diagnosis in 45 patients (53%). In patients with distant metastasis at presentation, the median overall survival time was 11 months and the estimated 5-year survival rate was 21%. In patients without distant metastasis at presentation, the estimated median survival time was 24 months and the estimated 5-year survival rate was 80% (Table 2). The independent prognostic factors identified by multivariate analysis using the Cox proportional hazards model were thrombus level, presence of distant metastasis, surgical management, serum albumin concentration, serum choline esterase concentration, neutrophil-lymphocyte ratio, and Charlson comorbidity index (Table 3).


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.

Hatakeyama S, Yoneyama T, Hamano I, Murasawa H, Narita T, Oikawa M, Hagiwara K, Noro D, Tanaka T, Tanaka Y, Hashimoto Y, Koie T, Ohyama C - BMC Urol (2013)

Survival in the RV and IVC thrombus groups, according to surgical management and distant metastasis. (A) Overall survival in the RV thrombus and IVC thrombus groups. (B) In the RV thrombus group, survival was significantly longer in patients who received surgical management than those who did not. (C) In the RV thrombus group, distant metastasis was a powerful prognostic factor. (D) In the IVC thrombus group, thrombus level was not significantly correlated with overall survival. (E) In the IVC thrombus group, survival was significantly longer in patients who received surgical management than those who did not. (F) In the IVC thrombus group, distant metastasis was not a significant prognostic factor.
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Figure 3: Survival in the RV and IVC thrombus groups, according to surgical management and distant metastasis. (A) Overall survival in the RV thrombus and IVC thrombus groups. (B) In the RV thrombus group, survival was significantly longer in patients who received surgical management than those who did not. (C) In the RV thrombus group, distant metastasis was a powerful prognostic factor. (D) In the IVC thrombus group, thrombus level was not significantly correlated with overall survival. (E) In the IVC thrombus group, survival was significantly longer in patients who received surgical management than those who did not. (F) In the IVC thrombus group, distant metastasis was not a significant prognostic factor.
Mentions: Sixty-five patients (76%) underwent radical nephrectomy with thrombectomy, and 20 did not receive surgical management. None of the patients who received surgical management underwent preoperative renal artery embolization. The median follow-up period was 26 months in patients who received surgical management and 5 months in patients who did not. Among the patients who did not receive surgical management, eight received immunotherapy or interferon-α 6,000,000 IU three times/week, seven received molecular targeted therapy, one underwent tumor embolization, and four received best supportive care only. The reason for non-surgical management was multiple organ or unresectable metastasis in 14 patients (lung and lymph nodes, n = 6; lung and bone, n = 2; lung, n = 2; lung, bone, and brain, n = 1; lung and liver in a patient with duodenal invasion, n = 1; brain, n = 1; lymph nodes, n = 1), patient refusal in 4 patients, dementia in 1 patient, and ECOG-PS >3 in 1 patient. In the whole group of 85 patients, the estimated median overall survival time was 41 months and the estimated 5-year overall survival rate was 40% (Figure 3A, Table 2). At the time of this report, 43 patients (51%) had died of their disease, including 24 (43%) who received surgical management and 15 (75%) who did not (P = 0.003). In all patients who did not receive surgical management, the main cause of death was cachexia. In patients who received surgical management, the estimated median survival time was 60 months and the estimated 5-year overall survival rate was 54%. In patients who did not receive surgical management, the estimated median survival time was 8.2 months and the estimated 5-year survival rate was 0% (Table 2). Distant metastasis was present at the time of diagnosis in 45 patients (53%). In patients with distant metastasis at presentation, the median overall survival time was 11 months and the estimated 5-year survival rate was 21%. In patients without distant metastasis at presentation, the estimated median survival time was 24 months and the estimated 5-year survival rate was 80% (Table 2). The independent prognostic factors identified by multivariate analysis using the Cox proportional hazards model were thrombus level, presence of distant metastasis, surgical management, serum albumin concentration, serum choline esterase concentration, neutrophil-lymphocyte ratio, and Charlson comorbidity index (Table 3).

Bottom Line: The aim of this study was to evaluate the benefit of surgical management in such patients.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.In propensity score-matched patients, overall survival was significantly longer in those who received surgical management than those who did not.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, 036-8562 Hirosaki, Japan. coyama@cc.hirosaki-u.ac.jp.

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.

Show MeSH
Related in: MedlinePlus