Prognostic Factors for Renal Cell Carcinoma With Tumor Thrombus Extension

Klatte, Tobias; Pantuck, Allan J.; Riggs, Stephen B.; Kleid, Mark D.; Shuch, Brian; Zomorodian, Nazy; Kabbinavar, Fairooz; Belldegrun, Arie S.

doi:10.1016/j.juro.2007.05.134

Cited by 145 publications

(127 citation statements)

References 17 publications

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“…Fuhrman grade is currently the most widely used grading protocol in North America and Europe, and higher grades are correlated with tumor aggressiveness and increased metastatic potential (23,24). The prognostic significance of histological grade in patients with RCC and venous tumor thrombus is controversial (4,(6)(7)(8)16,25). In our study, Fuhrrnan grade was found to be one of most important prognostic factors for survival and relapse in patients with RCC and venous tumor thrombus, supporting the role of histological grade as an important predictor of patient outcomes.…”

Section: Discussionsupporting

confidence: 64%

“…In our study, the 2-, 5-and, 10-year CSS rates of all patients and those with non-metastatic RCC were 64.2%, 47.1% and 31.7%, and 80.9%, 64.5% and 44.9%, respectively. These rates appear to be a little higher than those of most reports from Western countries (3)(4)(5)7,8,16). However, our patient population included a higher proportion of individuals with tumor thrombus extension into renal vein only than other studies except for the one by Wagner et al, and may explain these seemingly higher survival rates (16).…”

Section: Discussionmentioning

confidence: 61%

“…Despite advances in radiation, chemotherapy, and immunotherapy, surgical resection is still the standard treatment for RCC with tumor thrombus (2). However, the range of 5-year survival rates for RCC patients with venous tumor thrombus treated with radical nephrectomy and tumor thrombectomy is only 35% -45% despite the developments in surgical techniques and perioperative care (3)(4)(5). Furthermore, even the 5-year survival rate for patients without evidence of nodal or distant metastasis at presentation is just 45% -65% (4,(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

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Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

et al. 2013

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Purpose: To study the surgical outcomes of radical nephrectomy with thrombectomy and to determine prognostic factors for survival of Korean patients with renal cell carcinoma (RCC) and venous tumor thrombus. Materials and Methods: A total of 124 patients with RCC and venous tumor thrombus who underwent radical nephrectomy and thrombectomy were included in this retrospective study. Cancer-specific survival (CSS) and recurrence-free survival (RFS) rates were analyzed retrospectively according to various prognostic factors. Results: The median overall follow-up period for all patients was 29.0 months; the median survival period was 50.0 months. The 2-, 5-and 10-year CSS rates for all patients were 64.2%, 47.1% and 31.7%, respectively. Those for 76 patients (pN0/xM0) without metastasis at presentation were 80.9%, 64.5% and 44.9%, respectively. For all patients, lower body mass index (BMI), higher Fuhrman grade, presence of symptoms, perinephric fat invasion, invasion of inferior vena cava (IVC) wall, lymph node (LN) involvement and distant metastasis at presentation were independent predictors for decreased CSS on multivariate analysis, while thrombus level was not. For non-metastatic patients, lower BMI, presence of symptoms and tumor size were independently associated with decreased CSS. In terms of RFS, lower BMI, presence of perinephric fat invasion were prognostic factors for recurrence. Conclusions: Our data suggest that obesity is independently associated with better survival or lower risk of tumor recurrence in Korean patients undergoing radical nephrectomy with tumor thrombectomy. Also, our results indicate that Fuhrman grade, presence of symptoms, perinephric fat invasion and invasion of IVC wall, LN involvement and distant metastasis at presentation are independent predictors for survival.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 99%

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Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

et al. 2013

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“…98 In subsequent studies conflicting results as to the prognostic significance of this classification have been reported, with some studies validating the classification, [99][100] whereas others have shown that the level of tumor thrombus beyond the renal vein does not influence survival. [101][102][103][104][105] To predict the outcome more accurately in locally advanced disease, additional parameters have been proposed to further stratify tumors showing vascular invasion. In particular, the poor prognosis associated with perirenal fat, adrenal and Gerota's fascia infiltration has led to the incorporation of those features into a proposed modification of pT3-4 criteria.…”

Section: Regional Spread Of Tumor (Tnm Category T3)mentioning

confidence: 99%

“…In particular, the poor prognosis associated with perirenal fat, adrenal and Gerota's fascia infiltration has led to the incorporation of those features into a proposed modification of pT3-4 criteria. 92,101,106 In this modification, which is based on international multicenter studies, cases have been grouped according to the presence of tumor thrombus within the renal vein or infradiaphragmatic vena cava, or the presence of perirenal fat invasion (group 1), fat invasion with either renal vein or infradiaphragmatic vena cava thrombus, or adrenal gland invasion (group 2) and adrenal involvement with either renal vein or infradiaphragmatic vena cava thrombus, or supradiaphragmatic vena cava thrombus or Gerota's fascia invasion (group 3) with 5-year survivals for each group being shown to be 61, 35, and 12.9%, respectively. 106 Although this would seem to be a promising advance, further studies and necessary to validate this proposed modification of the TNM system.…”

Section: Regional Spread Of Tumor (Tnm Category T3)mentioning

confidence: 99%

Advances and controversies in grading and staging of renal cell carcinoma

2009

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Despite the considerable progress made in our understanding of the pathogenesis, genetics, and pathology of renal cell carcinoma (RCC), difficulties remain relating to the prediction of clinical outcome for individual cases. Although there is evidence to show that high-grade tumors have a poorer prognosis when compared to those of low grade, debate remains regarding the predictive value of grading, especially for those tumors classified into the intermediate grades. Numerous composite morphologic and nuclear grading systems have been proposed for RCC and although that of the Fuhrman classification have achieved widespread usage, the validity of the grading criteria of this classification has been questioned. In addition, there are few studies that have attempted to validate the Fuhrman system for RCCs beyond that of the clear cell subtype. Recent studies have indicated that grading of papillary RCC should be based on nucleolar prominence alone and that the components of the Fuhrman grading classification do not provide prognostic information for chromophobe RCC. Independent of tumor grade, the prognostic importance of tumor stage for RCC is well recognized. The Union Internationale Contre le Cancer/American Joint Committee for Cancer Staging and End Results Reporting TNM staging system is now in its sixth edition (2002) and recent refinements have focused on defining size cut points that will identify apparently localized tumors that will develop recurrence and/or metastases despite attempted curative surgery. In parallel with these studies it has been shown that infiltration of the renal sinus is an important prognostic factor, being observed in almost all tumors 47 cm in diameter. Questions remain as to the appropriate stratification of regional extension of RCC, as defined in the T3 tumor-staging category. Recent modifications to this category have been suggested combining the level of infiltration of the venous outflow tract with the presence or absence of infiltration of the adrenal gland and/or perirenal fat. Similarly, the utility of classifying lymph node involvement by tumor is debated, although it is well recognized that lymph node infiltration is associated with a poor prognosis. Although the current TNM classification does provide useful prognostic information it would appear that further modifications are justified to enhance the predictive value of staging for RCC.

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Prognostic analysis of postoperative clinically nonmetastatic renal cell carcinoma

et al. 2019

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Objectives:To investigate the survival characteristics of postoperative nonmetastatic renal cell carcinoma (RCC) patients, and the predictive value of a prognostic model. Materials and Methods:We retrospectively evaluated data from 1202 postoperative nonmetastatic RCC patients who were treated between 1999 and 2012 at West China Hospital, Sichuan University (Chengdu, China). In addition, we also evaluated data relating to 53 205 cases acquired from the Surveillance, Epidemiology, and End Results (SEER) program. Survival analysis was performed on the cases, and subgroups, using the Kaplan-Meier and Cox regression methods. The concordance index of the Stage Size Grade Necrosis (SSIGN), Leibovich, and the UCLA integrated staging system, scores was determined to evaluate the accuracy of these outcome prediction models. Results:The 5-year overall survival rate for RCC cases in West China Hospital was 87.6%; this was higher than that observed for SEER cases. Survival analysis identified several factors that exerted significant influence over prognosis, including the time of surgery, Eastern Cooperative Oncology Group performance status, tumor stage, size, nuclear differentiation, pathological subtypes, along with necrotic and sarcomatoid differentiation. Moreover tumor stage, size, and nuclear grade were all identified as independent predictors for both our cases and those from the SEER program. Patient groups with advanced RCC, and poorly differentiated RCC subgroups, were both determined to have a poor prognosis. The SSIGN model yielded the best predictive value as a prognostic model, followed by the Leibovich, and UCLA integrated staging system; this was the case for our patients, and for sub-groups with a poor prognosis. Conclusion: The prognosis of RCC was mostly influenced by tumor stage, size, and nuclear differentiation. SSIGN may represent the most suitable prognostic model for the Chinese population. |SHAO et Al.

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Prognostic Factors for Renal Cell Carcinoma With Tumor Thrombus Extension

Cited by 145 publications

References 17 publications

Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

Prognostic factor for Korean patients with renal cell carcinoma and venous tumor thrombus extension: application of the new 2009 TNM staging system

Advances and controversies in grading and staging of renal cell carcinoma

Prognostic analysis of postoperative clinically nonmetastatic renal cell carcinoma

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