Prognostic Factors for Survival in the Renal Cell Carcinoma with Tumor Thrombus

Baek, Seung Hyun; Ahn, Han Jong; Kim, Choung Soo

Abstract

Purpose
To analyze various prognostic factors and surgical outcomes in patients who underwent radical nephrectomy and thrombectomy of a renal cell carcinoma with renal vein or inferior vena caval thrombosis.
Materials and Methods
Among 44 patients with confirmed renal cell carcinomas and renal vein or inferior vena caval thrombosis, between December 1993 and June 2000, 42 having undergone radical nephrectomy and thrombectomy were retrospectively studied. 2 patients were excluded due to no operation performance. The 5-year disease-specific survival rates were analyzed according to various prognostic factors, including age, gender, clinical symptoms, tumor side (Rt. vs. Lt.), thrombus position (renal vein vs. IVC), histopathological cell type, lymph node involvement, pT stage irrespective of thrombus, Fuhrmann nuclear grade and invasion to perinephric fat, vessel, renal pelvis or adrenal gland.
Results
The overall 5-year disease-specific survival rate of all the patients was 55%. A univariate analysis of the 42 patients showed that the position of the tumor thrombus, histopathological cell type and invasion to the adrenal gland had a significant impact on the survival. On multivariate analysis, the tumor thrombus location and histopathological cell type were independent prognostic factors for the survival. The 5-year disease-specific survival rates of the patients with a renal vein thrombus (n=23) and with IVC (inferior vena cava, n=20) were 75 and 20%, respectively. The 5-year disease-specific survival rate of the patients with a conventional cell type (n=32) was 68%, and patients with other pathologic cell types had no significant follow-up periods.
Conclusions
The tumor thrombosis position, histopathological cell type and invasion to the adrenal gland are considered as clinically significant prognostic factors in patients with a renal cell carcinoma with vein thrombosis after radical nephrectomy with a thrombectomy. Meticulous radical nephrectomy with thrombectomy will be beneficial to the survival of patients with a renal cell carcinoma and vein thrombus.