Even with curative surgery, renal cell carcinoma occasionally recurs in other organs, with fatal results. In this study, we identified independent prognostic factors for survival in patients with renal cell carcinoma after curative surgery.
The records of 482 patients (mean age, 61.0 years; range, 17-90 years) who underwent curative surgery for renal cell carcinoma at Gifu University Hospital and its affiliated hospitals between 1991 and 2000 were reviewed. The average follow-up period was 42 months (range, 10-140 months). Clinical characteristics of the 482 patients were divided into three categories: patient factors (sex, age, performance status, and mode of tumor discovery), tumor factors (T classification, N classification, mode of infiltration, histological grade, and venous invasion), and treatment factor (whether or not adjuvant therapy with interferon-alpha was used). Stepwise multivariate Cox proportional hazards regression modeling was performed to identify independent determinants of survival.
Of the patient factors, performance status and mode of tumor discovery were independent factors predicting survival. Of the tumor factors, venous invasion and mode of infiltration were independent factors predicting survival. Use or non-use of adjuvant therapy was not significantly associated with survival. Overall, performance status, venous invasion, mode of infiltration, and histological grade were shown to be independent prognostic factors, in descending order of importance.
Performance status, venous invasion, mode of infiltration, and histological grade, in descending order, were the most important factors predicting survival after curative surgery for renal cell carcinoma.
[Show abstract][Hide abstract] ABSTRACT: To retrospectively evaluate whether T2*-weighted imaging can be used to grade clear cell renal cell carcinomas (ccRCC) based on intratumoral susceptibility signals (ISSs).
MR imaging from 37 patients with pathologically-proven ccRCCs was evaluated. ISSs on T2*WI were classified as linear or conglomerated linear structures (type I) and dot-like or patchy foci (type II). Two radiologists assessed the likelihood of the presence of ISS, dominant structure of ISS and ratio of ISS area to tumor area. Results were analyzed by nonparametric Mann-Whitney test.
ISSs were seen in all patients except for four patients with low-grade ccRCCs and two patients with high-grade ccRCCs. There was no significant difference of the likelihood of the presence of ISS between low- and high-grade ccRCCs. More type I ISSs and less type II ISSs were predictive of low-grade tumors, whereas more conspicuity type II ISSs correlated with higher occurrence of high-grade tumors (P<0.05). The ratio of ISS area to tumor area was also significantly higher for the high-grade group (1.27±0.79) than that for the low-grade group (0.81±0.40) (P<0.05).
ISSs on T2*-weighted gradient-echo MR images can help grade ccRCCs before operations.
PLoS ONE 11/2013; 8(11):e79597. DOI:10.1371/journal.pone.0079597 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The prognostic significance of venous tumor thrombus extension in patients with renal cell carcinoma (RCC) is a matter of many controversies in the current literature.
To evaluate the prognostic role of inferior vena cava (IVC) involvement in a large series of pT3b and pT3c RCCs.
A total of 1192 patients from 13 European institutions underwent a radical nephrectomy for pT3b and pT3c RCC between 1982 and 2003. The patients were evaluated in a retrospective manner. Age, gender, clinical symptoms, Eastern Cooperative Oncology Group (ECOG) performance status, TNM stage, tumor size, adrenal invasion, perinephric fat invasion, histological type, and Fuhrman grade were reviewed. The log-rank and Cox uni- and multivariate regression analyses were used to evaluate prognostic factors for overall survival.
Overall survival and prognostic factors for overall survival in patients with RCC extending to the renal vein (RV) or to the IVC.
The median follow-up was 61.4 mo (56.3-66.5 mo). The mean age was 63.2 yr. The mean tumor size was 8.9 cm. Group 1 (Gr 1) included 933 patients with a renal vein tumor thrombus (78.3%), Group 2 (Gr 2) included 196 patients with a subdiaphragmatic IVC tumor thrombus (16.4%), and Group 3 (Gr 3) included 63 patients with a supradiaphragmatic IVC tumor thrombus (5.3%). Median survival was 52 mo for Gr 1, 25.8 mo for Gr 2, and 18 mo for Gr 3. In univariate analysis, Gr 1 had a significantly better overall survival than Gr 2 (p<0.001) and Gr 3 (p<or=0.001). No significant difference in survival was noted between Gr 2 and Gr 3 (p=0.613). Prognostic factors for overall survival in univariate analysis were clinical symptoms (p<0.001), tumor size (p<0.001), perinephric fat invasion (p<0.001), Fuhrman grade (p<0.001), histological type (p=0.021), lymph node invasion (p<0.001), and distant metastasis (p<0.001). Independent prognostic factors in multivariate analysis were tumor size (p=0.013), perinephric fat invasion (p=0.003), lymph node invasion (p<0.001), distant metastasis (p<0.001), and IVC invasion (p=0.008).
The level of tumor thrombus in the IVC does not significantly affect long-term overall survival in patients with renal cell carcinoma. The overall survival was statistically different for patients with a tumor thrombus in the RV compared to those with IVC involvement. This has to be considered for the next revision of the TNM system, and the pT3b and pT3c stages have to be redesigned.
European Urology 08/2008; 55(2):452-9. DOI:10.1016/j.eururo.2008.07.053 · 13.94 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.