Prognostische Bedeutung des Vena-cava-Befalles bei Nierenzellkarzinom und Stellenwert der präoperativen Tumorembolisation

Wawersig, C.; Staehler, G.; Pomer, S.; Roeren, T; Möhring, K.

doi:10.1055/s-2008-1058312

Cited by 1 publication

(1 citation statement)

References 10 publications

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“…This is probably due to the fact that venous involvement is often associated with other unfavorable factors such as high local tumor stage, nodal and/or distant métastasés. In fact, according to other authors, survival of V+ patients free from distant or nodal métastasés, in our series is rela tively high and it is similar to that of patients with nodal métastasés alone [27][28][29], This fact further stresses the importance of regional lymphadenectomy in assessing patients prognosis. The level reached by the tumor throm bus is of lesser importance and no differences in survival can be found, depending on tumor thrombus level, al though a correlation exists between tumor thrombus level and the presence of nodal or distant métastasés.…”

Section: Discussionsupporting

confidence: 52%

Radical Nephrectomy for Renal Cell Carcinoma: Long-Term Results and Prognostic Factors on a Series of 328 Cases

Giberti¹,

Oneto²,

Martorana³

et al. 1997

Eur Urol

104

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Objectives: A series of 328 evaluable patients with renal cell carcinoma operated by radical transabdominal nephrectomy with regional lymphadenectomy was reviewed to assess the prognostic significance of various pathologic parameters (pT, N, M, G and venous involvement) and the value of lymphadenectomy and of surgery of venous tumor thrombus. Patients and Methods: The complete charts of 328 patients with renal cell carcinoma available to follow-up, who were operated between 1970 and 1993, were reviewed. All patients underwent transabdominal extrafascial nephrosurrenalectomy and in all but 14 metastatic ones a regional retroperitoneal lymphadenectomy was performed. Surgery of venous tumor thrombus was performed in 79 patients. Life expectancy according to pT stage, pN stage, M stage, nuclear grade and venous involvement was calculated by means of the life tables method and differences in survival were evaluated by means of the log rank test. Correlation analysis and multivariate data analysis according to the Cox model were also performed. Results: Overall survival of the 328 patients was 50.70% at 5 years, 35.10% at 10 years and 29% at 15 years. At multivariate data analysis the most important prognostic factors is the presence of metastases (8% survival at 5 years and no patient surviving more than 7 years after surgery); tumor grade was the second prognostic factor and statistically significant differences were also found at life tables analysis among Gl, G2 and G3 tumors. Local tumor stage was the third leading prognostic factor at multivariate data analysis and statistically significant differences were also found at life tables analysis. Nodal and venous involvement had only minor importance at multivariate data analysis although statistically significant differences were found at life tables analysis between the pN+ and the pNO patients, also in the absence of venous involvement and distant metastases. Anyway survival of the pN+M0V0 patients was satisfactorily high (53.20% at 5 years, 39.10% at 10 years and 16% at 15 and 20 years). In patients with venous involvement no differences in survival were observed depending on the level reached by the tumor thrombus; differences in survival were observed between patients with venous involvement alone (38% surviving at 5 and 10 years) and patients who also had nodal or distant metastases (5.20% at 5 years and 0% at 10 years). Conclusions: From the review of our series it seems that the most important prognostic factors are synchronous metastases, tumor grading and the completeness of tumor exeresis. In fact, the low impact on survival of nodal involvement by itself is probably due to the completeness of lymphadenectomy. The value of regional lymphadenectomy is sustained by the high long term survival of N+M0V0 patients. Regarding venous involvement, it seems that V+ patients free from nodal and distant metastases may benefit from radical surgery, which on the contrary has only minimal impact on survival of V+M+/N+ patients.

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Section: Discussionsupporting

confidence: 52%