Renal cell carcinoma: Survival and prognostic factors

Golimbu, Mircea; Tessler, Arthur N.; Joshi, Prashant; Al‐Askari, Salah; Sperber, A.; Morales, Pablo

doi:10.1016/0090-4295(86)90300-6

Cited by 299 publications

(152 citation statements)

References 25 publications

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“…In our series we had about 10% patients above 70 years and oldest was 94 years. Secondly patients with metastasis were generally not operated because of poor survival rates [5] but now with advent of immunotherapy those who have resectable solitary metastasis [6,7] or those who are symptomatic for caval thrombi can be operated with good results. We have operated only non metastatic patients but we believe patients with solitary metastasis could be benefited by surgery but cost of adjuvant therapy is an issue.…”

Section: Patient Selection Criteriamentioning

confidence: 99%

“…The major causes of deaths reported to be are pulmonary embolism and myocardial infarction or due to complications related to the bypass procedures [3,5,6,9,20,22,25]. The complication rates increase with the higher extension of the caval thrombus.…”

Section: Mortality and Morbiditymentioning

confidence: 99%

“…Several pathologic prognostic factors are mentioned in the literature [6,11,[40][41][42][43], including mainly the local stage of the tumor, histological type and grade of tumor and presence of vascular invasion, vessel wall invasion, adrenal and pelvicalyceal involvement.…”

Section: Five Year Survival and Pathological Variablesmentioning

confidence: 99%

“…The incidence of asymptomatic patients of RCC with venous involvement is rising steadily as well. Further in the past patients with IVC invasion with metastasis were not operated because of poor survival [5], However some series have reported that patients with solitary metastasis can be operated with good results [6,7],especially if one is planning for immunotherapy.…”

Section: Introductionmentioning

confidence: 99%

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IVC Thrombectomy in Renal Cell Carcinoma—Analysis of Out Come Data of 100 Patients and Review of Literature

Kulkarni

Jadhav

Valsangkar

2011

Indian J Surg Oncol

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To review our experience of RCC with IVC thrombus in terms of clinical presentation, principles of surgical management in contemporary era, also an impact of clinico-pathological factors on prognosis. Total 100 patients who underwent radical nephrectomy and IVC thrombectomy between 1991-2008 were included in this retrospective analysis. Data was analysed in terms of clinical pathological factors, survivals and compared with contemporary literature. The extent tumour thrombus was infrahepatic in 58 retro hepatic in 28 and suprahepatic in 14 patients including 6 with right atrial thrombus. The immediate postoperative mortality was 2% and incidence of major postoperative non fatal complications was 38%, which were managed conservatively. The overall and disease free 5 year survival was 63% and 55%. Further amongst the histological types, patients with clear cell tumours had the best (DFS-71.42%), and those with papillary had the poor (DFS-30.76%) outcome. Grade II tumors had better survivals as compared to grade IV (DFS 75.39% vs 23.52%, p<0.05). Loco-regional extent wise 74% patients without perinephric fat invasion were free from disease at 5 years as compared to 30% of those who had perinephric fat invasion (p<0.01). Similarly 5 year DFS was 76.11% in patients with negative nodes as compared to 12% in positive nodes (p<0.01). In conclusion radical nephrectomy with IVC thrombectomy still remains the most effective therapeutic option in management in this clinical setting. Although this is complicated surgery success with multi disciplinary approach excellent survival outcome can be obtained. Further pathological factors, such as locoregional spread and grade of tumor, rather than clinical factors influence long term survival.

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Section: Patient Selection Criteriamentioning

confidence: 99%

Section: Mortality and Morbiditymentioning

confidence: 99%

Section: Five Year Survival and Pathological Variablesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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IVC Thrombectomy in Renal Cell Carcinoma—Analysis of Out Come Data of 100 Patients and Review of Literature

Kulkarni

Jadhav

Valsangkar

2011

Indian J Surg Oncol

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“…The fairly indolent chromophobe renal cell carcinoma and the unclassified category account for approximately 5% each, while the rarest and most aggressive type is collecting duct carcinoma (Kovacs et al, 1997). Clinical stage and nuclear grade are the most important prognostic factors in RCC (Fuhrman et al, 1982), but within a given disease stage the outcome is highly variable, and other prognostic indicators are needed to identify patients with high risk of progressive disease (Golimbu et al, 1986). Cell proliferation markers, p53 mutations, growth factor expression, and intratumoural microvessel density have been investigated as prognostic indicators, with partly contradicting results (Gelb et al, 1997;Grignon et al, 1995).…”

mentioning

confidence: 99%

The free β-subunit of human chorionic gonadotropin as a prognostic factor in renal cell carcinoma

et al. 2002

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The free b-subunit of human chorionic gonadotropin b is expressed in several nontrophoblastic tumours and this is usually associated with aggressive disease. Little is known about human chorionic gonadotropin b expression in renal cancer. We determined the pretreatment levels of human chorionic gonadotropin b in serum of patients with renal cell carcinoma, and studied whether elevated levels predicted the clinical outcome. Serum samples were collected before surgery from 177 patients with renal cell carcinoma and from 84 apparently healthy controls. Human chorionic gonadotropin b in serum was measured by a highly sensitive time-resolved immunofluorometric assay. The prognostic value of human chorionic gonadotropin b, and of usual clinical and pathological variables was analyzed by the Kaplan-Meier method, the log rank test and Cox multiple hazard regression. The serum concentrations of human chorionic gonadotropin b were increased in 23% of the renal cell carcinoma patients and they were significantly higher in patients with renal cell carcinoma than in controls (P50.0001). The concentrations did not correlate with clinical stage and histopathological grade, but patients with increased human chorionic gonadotropin b levels had significantly shorter survival time than those with levels below the median (cut-off 1.2 pmol l 71 , P=0.0029). In multivariate analysis human chorionic gonadotropin b, tumour stage and grade were independent prognostic variables. The serum concentration of human chorionic gonadotropin b is an independent prognostic variable in renal cell carcinoma. The preoperative value of human chorionic gonadotropin b in serum may be used to identify patents with increased risk of progressive disease.

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Surgical Resection Following Interleukin 2 Therapy for Metastatic Renal Cell Carcinoma Prolongs Remission

Kim

Louie²

1992

Arch Surg

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Records of 399 patients with metastatic renal cell carcinoma treated with interleukin 2 with or without lymphokine-activated killer cell immunotherapy enrolled in 14 separate clinical trials from multiple institutions were reviewed to determine whether patients with a partial response to interleukin 2 therapy would benefit from surgical resection of residual tumor. Sixty-two patients demonstrated objective responses (15.5%), 18 (4.5%) complete and 44 (11.0%) partial. Eleven patients underwent resection of residual tumor in the lung, kidney, retroperitoneum, or pelvis so that they had "surgically no evidence of disease" (SNED). Of these, 10 had partial responses, and one patient with progressive disease had a complete response. Comparison of response duration showed no difference between the complete response and SNED groups, but there was a significant difference between each of these groups and the partial response group. At this writing, all 11 patients in the SNED group remained alive without evidence of disease (median follow-up, 21 months). In contrast, only 14 patients (76%) with complete responses and 15 patients (35%) with partial responses remained free of disease progression. Enhanced survival of the complete response and SNED groups compared with the partial response group borders on significance and awaits longer follow-up. These data suggest that surgical resection, if technically feasible, may benefit patients who show a partial response to interleukin 2 treatment for metastatic renal cell carcinoma.

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Renal cell carcinoma: Survival and prognostic factors

Cited by 299 publications

References 25 publications

IVC Thrombectomy in Renal Cell Carcinoma—Analysis of Out Come Data of 100 Patients and Review of Literature

IVC Thrombectomy in Renal Cell Carcinoma—Analysis of Out Come Data of 100 Patients and Review of Literature

The free β-subunit of human chorionic gonadotropin as a prognostic factor in renal cell carcinoma

Surgical Resection Following Interleukin 2 Therapy for Metastatic Renal Cell Carcinoma Prolongs Remission

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