INTRODUCTION: The objectives were to: (1) analyze clinical and pathological features of renal cell carcinoma (RCC) with caval thrombosis in order to indentify independent prognostic factors, and (2) analyze perioperative morbidity and mortality.
METHODS: The authors retrospectively analyzed clinical and pathological data of 56 patients treated for RCC with caval thrombosis during a 20-year period. The surgical procedure was essentially unchanged. Independent variables were: TNM, creatinine value, age, histological extent, histological type, adjuvant treatment, and surgical technique; the dependent variable was overall survival. Contingency and logistic regression tables were used. Kaplan-Meier method, log-rank, and Cox models were used to analyze survival rates.
RESULTS: There were complications in 15 patients and 2 perioperative deaths. Overall mean (SD) survival rates were 32% (7%) and 24% (6%) at 3 and 5 years, respectively. Multivariate results showed that the significant prognostic indicators of survival were: the size of the tumor > 8 cm (P < .01), the presence of metastasis (P < .04), and lymph node invasion (P < .009). These were also regarded as the relevant variables, independent of patient survival.
CONCLUSION: The surgical approach for this disorder is challenging and not exempt of complications. Nodal involvement, tumor size, and distant metastases are the most important prognostic factors; thrombus extension has a clear impact on surgical planning and performance.
Jorge Rioja, Anibal Rincón Mayans, Juan Javier Zudaire Bergera, David Rosell Costa, Jose Enrique Robles García, Gregorio Rabago, Jose Maria Berian Polo
Submitted April 2, 2010 - Accepted for Publication July 13, 2010
KEYWORDS: Kidney cancer; Vena cava thrombus; Extracorporeal circulation, Prognostic factors; Multivariate analysis.
CORRESPONDENCE: Dr. Jorge Rioja, AMC University Hospital, Meibergdreef 9. 1105 AZ Amsterdam, The Netherlands ( ).
CITATION: UroToday Int J. 2010 Aug;3(4).
doi:10.3834/uij.1944-5784.2010.08.18