Prognostic value of venous tumor thrombus in renal cell carcinoma

Fadrique, G. García; Budía-Alba, A.; Ruiz-Cerdá, J.L.; Morales-Solchaga, G.; Pontones, J.L.; Jiménez-Cruz, J.F.

doi:10.1016/j.acuroe.2011.06.012

Cited by 3 publications

(4 citation statements)

References 32 publications

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“…In our analysis, we could further confirm the influence of previously reported clinico‐pathological variables on the patients' prognoses, such as pathological stage , perinephric fat invasion , tumour size , Fuhrman grade , tumour necrosis and sarcomatoid features . Somewhat surprising was the finding that even patients with low grade (grade 1) RCC developed VTT; it should be noted, however, that Fuhrman classification of low grade tumours may be difficult, a fact that is supported by low interobserver agreement in the classification of grade 1 and 2 tumours .…”

Section: Discussionsupporting

confidence: 81%

“…Improved diagnostics have led to a stage migration in RCC, but a third of patients are diagnosed at an advanced stage, which is still highly lethal . Venous tumour thrombus (VTT) is observed in 12–19% of patients with RCC , and is associated with a poor prognosis . The clinical variables tumour size, Fuhrman grade, nodal/distant metastases and VTT level are predictive of a patient's outcome , but the clinical course of patients with similar characteristics is still heterogeneous, and additional variables to guide patient counselling are warranted.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic significance of venous tumour thrombus consistency in patients with renal cell carcinoma (RCC)

Weiss

Braun²,

Perner³

et al. 2013

BJU International

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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.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Prognostic significance of venous tumour thrombus consistency in patients with renal cell carcinoma (RCC)

Weiss

Braun²,

Perner³

et al. 2013

BJU International

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“…Reported mortality rates for radical nephrectomy with concomitant IVC thrombectomy range between 5% and 12.5% for higher level thrombus depending on patient comorbidities and tumour characteristics [3,6–11]. Selection for nephrectomy and IVC thrombectomy with or without caval reconstruction should be limited to patients with an anticipated good performance status, as this patient cohort has a significantly shorter cancer‐specific survival than do patients with RCC without IVC involvement [3,12,13].…”

Section: Introductionmentioning

confidence: 99%

Important surgical considerations in the management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumour thrombus

Lawindy,

Kurian,

Kim

et al. 2012

BJU International

110

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What ' s known on the subject? and What does the study add? Historically, the surgical management of renal tumours with intravascular tumour thrombus has been associated with high morbidity and mortality. In addition, few cases are treated, and typically at tertiary care referral centres, hence little is known and published about the ideal surgical management of such complex cases.The present comprehensive review details how a multidisciplinary surgical approach to renal tumours with intravascular tumour thrombus can optimise patient outcomes. Similarly, we have developed a treatment algorithm in this review that can be used in the surgical planning of such cases. • Recent surgical and perioperative advances have for the most part optimized the clinical outcome of such patients. MATERIALS AND METHODS • A comprehensive review of the scientifi c literature was conducted using MEDLINE from 1990 to present using as the keywords ' renal cell carcinoma ' and ' IVC tumor thrombus ' .• In all, 62 manuscripts were reviewed, 58 of which were in English. Of these, 25 peerreviewed articles were deemed of scientifi c merit and were assessed in detail as part of this comprehensive review.• These articles consist of medium to large ( ≥ 25 patients) peer-reviewed studies containing contemporary data pertaining to the surgical management of RCC and IVC tumour thrombus.• Many of these studies highlight important surgical techniques and considerations in the management of such patients and report on their respective clinical outcomes. RESULTS • Careful preoperative planning is essential to optimising the outcomes within this patient cohort. High quality and detailed preoperative imaging studies help delineate the proximal extension of the IVC tumour thrombus and possible caval wall direct invasion while determining the potential necessity for intraoperative vascular bypass.• The surgical management of RCC and IVC tumour thrombus (particularly for level III or IV) often requires the commitment of a multidisciplinary surgical team to optimise patient surgical outcomes.• Despite signifi cant improvements in surgical techniques and perioperative care, the 5-year overall survival remains only between 32% and 69%, highlighting the adverse prognosis of such locally advanced tumours.

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“…The radical treatment of these patients -whenever feasible -consists of radical nephrectomy with thrombectomy with or without caval reconstruction [5][6][7]. As this kind of surgery bears a high mortality rate between 5 and 12.5% depending on the level of the thrombus, patient selection is crucial [5].…”

Section: Impact Of E-cadherin and β-Catenin As Prognostic Factor In Rmentioning

confidence: 99%

Impact of E-Cadherin and β-Catenin as Prognostic Factor in Renal Cell Carcinoma with Tumor Thrombus of the Vena Cava

et al. 2019

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Purpose: Renal cell carcinoma (RCC) forming tumor thrombus (TT) of vena cava (VC) is characterized by poor prognosis. Nevertheless, the outcome of patients after radical surgery varies. To date only limited data concerning prognostic biomarkers in this RCC subgroup are available. Methods: Out of 159 patients with pT3b/c RCC, 95 patients without synchronous distant metastases at time of diagnosis were included in the study cohort. After immunohistochemical (IHC) evaluation of E-cadherin and β-Catenin expression, association with clinical, histopathological and survival was assessed by univariate analysis, multivariate analysis, and Kaplan-Meier-analysis. Cancer-specific survival (CSS) rates and overall survival (OS) rates were estimated using Kaplan-Meier analysis and compared using Log rank test. Results: We found a significant correlation between E-cadherin overexpression and initial lymph node metastasis (ρ = 0.300, p = 0.003), positive surgical margins (ρ = 0.210, p = 0.043), and the development of distant metastases (ρ = 0.258, p = 0.012). Furthermore, we observed a significant correlation of β-Catenin overexpression with higher tumor stage pT3c (ρ = 0.230, p = 0.028) and initial lymph node metastases (ρ = 0.236, p = 0.025). Survival analysis revealed a statistically significant association of both E-cadherin and β-Catenin overexpression with worse CSS (p < 0.001 and p = 0.007, respectively) and OS (p < 0.001 and p = 0.041, respectively). Multivariate analysis revealed initial lymph node metastasis as the only predictive factor for worse OS (HR 4.54, 95% CI 2.30–8.93; p < 0.001). E-Cadherin and β-Catenin expression failed to be significant in multivariable analysis for OS and CSS. Conclusions: In a large series of RCC with TT of VC high IHC expression of E-cadherin and β-Catenin was associated with initial lymph node metastasis and with both worse OS and worse CSS. This might help to identify patients at risk for recurrence who might benefit from adjuvant therapy or stricter follow-up.

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Prognostic value of venous tumor thrombus in renal cell carcinoma

Cited by 3 publications

References 32 publications

Prognostic significance of venous tumour thrombus consistency in patients with renal cell carcinoma (RCC)

Prognostic significance of venous tumour thrombus consistency in patients with renal cell carcinoma (RCC)

Important surgical considerations in the management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumour thrombus

Impact of E-Cadherin and β-Catenin as Prognostic Factor in Renal Cell Carcinoma with Tumor Thrombus of the Vena Cava

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