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

Abstract

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.

Renal epithelioid angiomyolipoma: a study of six cases and a meta‐analytic study. Development of criteria for screening the entity with prognostic significance

“…The latter is reported to show distant metastases and fatal outcome in >50%. [53][54][55] Compared with EAML with a favourable outcome, those with aggressive behaviour were of large size, with a high degree of cytological atypia and more extensive tumour necrosis. and predominantly occurred in men (male:female ratio 1:1).…”

Management of Renal Cell Carcinoma with Intracardiac Extension

“…The prognostic implication of the level of tumor thrombus is unclear and the presence of distant metastases did not significantly influence the long-term survival. 4,19,20 But, several reports confirmed that the lymph node involvement and incomplete resection were bad prognostic indicators for survival. [4][5][6]12 In conclusion, a well-planned combined surgical team approach and use of CPB with DHCA enable the complete resection of the tumor without any complication and therefore improves the long-term survival.…”

Cyst‐associated renal cell carcinoma: Clinicopathologic characteristics and evaluation of prognosis in 27 cases

“…5,6,13,15,16 Of the patients in the present study, only three died of cancer and the overall 5-year survival rate was 88.6%, whereas that for conventional clear-cell RCC is reported to be 50-60%. 17,18 A number of reasons why patients with CRCC show a favorable prognosis have been discussed in previous reports. 5,6,13,15,16 The recognition of these lesions as malignant relies on the findings concerning the appearance of the cells, which are mainly clear-cells, lining the cyst walls, 5 and, in cases of RCC originating in a cyst, involving a minute tumor, cell aggregates may represent multicystic nephroma with epithelial proliferation in the cystic wall.…”