Preoperative metastatic status, level of thrombus and body mass index predict overall survival in patients undergoing nephrectomy and inferior vena cava thrombectomy

Departments of Genitourinary Oncology Biostatistics, Moffitt Cancer Center, Tampa, FL, USA.
BJU International (Impact Factor: 3.53). 04/2012; 110(11B). DOI: 10.1111/j.1464-410X.2012.11155.x
Source: PubMed


Study Type – Prognosis (case series)
Level of Evidence 4
What's known on the subject? and What does the study add?
Little is known about the prognostic impact of body mass index (BMI) and obesity on patients with locally advanced kidney cancer. Previous studies suggest that clinical/pathological stage, the proximal extent of the tumour thrombus, direct vascular wall invasion, and preoperative performance status may all constitute important prognostic factors within this patient population.
The present study shows that a patient's metastatic status, higher level of tumour thrombus, and lower BMI all constitute adverse predictors of overall survival in patients who have RCC with inferior vena cava tumour thrombus.

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Available from: Philippe Spiess, Oct 03, 2014
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    ABSTRACT: Objectives To investigate the impact of histological subtypes on the survival of patients presenting with renal cell carcinoma extending into the inferior vena cava. Methods From January 1985 until October 2011, 68 patients with renal cell carcinoma extending into the inferior vena cava underwent radical nephrectomy and inferior vena cava thrombectomy at Tokyo Women's Medical University, Tokyo, Japan. Their clinical and pathological parameters were reviewed from the medical charts. ResultsThe median follow up was 19 months (range 0.1-144 months). The tumor thrombus level was I in four patients (6%), II in 38 patients (56%), III in 12 patients (18%) and IV in 14 patients (20%). Papillary histological subtype was found in seven patients (10%), and clear cell in 61 patients (90%). Patients with a papillary subtype had a significantly worse survival outcome than the patients with the clear cell subtype (median survival time 9.0 vs 36.1 months, P<0.001). Multivariate analysis also showed that the papillary subtype was the only independent prognostic factor for unfavorable cancer-specific survival (P=0.03). When the patients presented with metastases to lymph nodes or distant metastases, the median survival of the patients with a papillary subtype was extremely short, at just 5.2 months compared with those with a clear cell subtype (24.0 months, P=0.001). Conclusions Patients with renal cell carcinoma extending into the inferior vena cava with a papillary subtype show a considerably shorter survival compared with those with a clear cell subtype. The papillary renal cell carcinoma extending into the inferior vena cava patient might be an inappropriate candidate for extensive surgery when metastases to nodes or distant organs are found.
    International Journal of Urology 02/2013; 20(11). DOI:10.1111/iju.12123 · 2.41 Impact Factor
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    ABSTRACT: Objectives: To identify the prognostic impact of venous tumour thrombus (VTT) in locally advanced renal cell carcinomas (RCCs). To further differentiate the clinical course of patients with VTT who have similar clinicopathological characteristics. Patients and methods: We determined the VTT consistency (solid vs friable) in a retrospective cohort of 200 patients with RCC who had undergone nephrectomy between 1994 and 2011. We examined the correlation of VTT consistency in these patients with clinical and pathological variables. Results: A total of 65% of the patients had solid VTT and 35% had friable VTT, which has a significantly lower amount of cell-cell adhesion molecules and connective tissue than solid VTT. We found that friable VTT was associated with advanced pT stage, higher VTT level, papillary RCC subtype and a lower age. Patients with friable VTT had a significantly shorter median overall survival than those with solid VTT (29 vs 89 months), but VTT consistency was not found to be an independent predictor of patients' survival in the multivariate Cox analysis. We found that VTT consistency was an independent significant predictor of overall survival in patients without evidence of distant and nodal metastases (N = 119). Conclusions: The VTT consistency is caused by the tumour and not by different surgical handling. Friable VTT is an important adverse prognostic predictor of overall survival in patients with non-metastatic RCC.
    BJU International 06/2013; 113(2). DOI:10.1111/bju.12322 · 3.53 Impact Factor
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    ABSTRACT: Inferior vena cava tumor thrombectomy requires experienced surgical teams due to complex hemodynamic considerations, often utilizing vascular bypass techniques that introduce additional risk. Control of the IVC within the pericardium obviates the need for cardiopulmonary bypass (CPB). We reviewed our experience with intrapericardial control during IVC tumor thrombectomy to evaluate perioperative outcomes and determine factors associated with overall survival. We completed a retrospective review of 87 patients who underwent nephrectomy with IVC tumor thrombectomy using intrapericardial IVC control from 1978-2012. This technique was performed in all cases of intrahepatic (n=43) and supradiaphragmatic (n=35) thrombi, and select cases of intra-atrial (n=9) thrombi. Patient demographics, operative variables, and post-operative outcomes were examined. Multivariate regression analysis was used to determine associations between clinical variables and overall survival. Perioperative mortality (30-day) was 9.2% and incidence of high-grade complications was 19.5%. Median survival was 3.1 years and 2.5 years for pT3bN0 and pT3cN0 patients, respectively. Extended regional lymphadenectomy, performed in all cases revealed nodal metastasis in 36% of patients. On multivariate analysis, ECOG >2 and pT3c stage were associated with worse survival. Histologic grade, perinephric fat invasion and presence of lymph node involvement were not associated with worse survival. Intrapericardial control of the IVC allows a single surgical team to safely perform tumor thrombectomy for intrahepatic and supradiaphragmatic thrombi, eliminating risk and morbidity related to CPB. Though supradiaphragmatic extent and ECOG >2 are associated with worse survival, complete resection with lymphadenectomy can allow long-term survival in patients with locally advanced disease.
    The Journal of urology 04/2014; 192(3). DOI:10.1016/j.juro.2014.03.112 · 4.47 Impact Factor
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