To compare oncologic outcomes for segmental versus main renal vein invasion (RVI) in patients with renal cell carcinoma.
Patients undergoing extirpative surgery for RCC at our institution from 2003-2013 were stratified into five groups: T2 (n=135), T3a with fat invasion (n=185), T3a with segmental RVI (n=87), T3a with main RVI (n=64), and T3b disease (n=40).
Kaplan-Meier survival analysis and multivariable Cox regression were performed to determine the impact of segmental RVI on recurrence-free survival (RFS) and cancer-specific survival (CSS). Harrell's C index was used to compare the prognostic accuracy of current and proposed staging models.
At a median follow-up of 37 months, both RFS and CSS were significantly worse for patients with main RVI as compared to segmental RVI (p = 0. 03, p = 0. 009, respectively). On multivariable analysis, main RVI had an increased risk of recurrence (HR 2. 3, 95% confidence interval [CI] 1. 1-4. 4, p = 0. 03) and CSS (HR 3. 5, 95%CI 1. 3-9. 9, p = 0. 02) compared to segmental RVI. Sub-stratifying T3a disease by separating segmental and main RVI improved prognostic accuracy compared to the current staging system for CSS (c indices 0. 66 vs 0. 59) and RFS (0. 70 vs 0. 60).
Main RVI is independently associated with worse RFS and CSS than segmental RVI. These findings may have significance for patient counseling and future staging guidelines. This article is protected by copyright. All rights reserved.
BJU international. 2015 Oct 11 [Epub ahead of print]
Mark W Ball, Michael A Gorin, Kelly T Harris, Kevin M Curtiss, George J Netto, Christian P Pavlovich, Phillip M Pierorazio, Mohamad E Allaf
The James Buchanan Brady Urological Institute & Department of Urology, The Johns Hopkins University School of Medicine. , The James Buchanan Brady Urological Institute & Department of Urology, The Johns Hopkins University School of Medicine. , The James Buchanan Brady Urological Institute & Department of Urology, The Johns Hopkins University School of Medicine. , The James Buchanan Brady Urological Institute & Department of Urology, The Johns Hopkins University School of Medicine. , The James Buchanan Brady Urological Institute & Department of Urology, The Johns Hopkins University School of Medicine. , The James Buchanan Brady Urological Institute & Department of Urology, The Johns Hopkins University School of Medicine. , The James Buchanan Brady Urological Institute & Department of Urology, The Johns Hopkins University School of Medicine. , The James Buchanan Brady Urological Institute & Department of Urology, The Johns Hopkins University School of Medicine.