Published in:
01-08-2012 | Urology - Original Paper
Does left side renal cell carcinoma (RCC) with renal vein/vena cava thrombus predict worse prognosis than equivalent right side RCC tumor thrombus?
Published in: International Urology and Nephrology | Issue 4/2012
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Purpose
To determine whether renal cell carcinoma (RCC) thrombi that reach the vena cava from the left kidney are associated with a greater risk of RCC death than equivalent thrombi from the right kidney.
Methods
Two hundred and fifty-nine patients treated with radical nephrectomy (1970–2006) for unilateral, sporadic RCC with level 1–4 RCC tumor thrombus were identified. Clinicopathologic features between patients with right-sided (N = 183) and left-sided (N = 76) thrombus were compared utilizing Wilcoxon rank sum and Fisher’s exact tests. Associations with RCC-specific death using hazard ratios (HR) and 95 % confidence intervals (CIs) from Cox proportional hazards models were evaluated.
Results
Left-sided RCC patients with thrombus are less likely to be clear cell subtype (85 % vs. 93 %; p = 0.013) and more likely to have nodal involvement (28 % vs. 16 %; p = 0.018) compared to right side RCC patients with thrombus. Overall, there is little evidence that the risk of RCC death is higher for left versus right-sided RCC thrombus (HR = 1.11; 95 % CI 0.81–1.53; p = 0.52). However, among those patients with a thrombus that has reached the vena cava (level III/IV), we observe evidence after multivariate adjustment that the risk of RCC death is higher for left versus right side patients (HR = 2.02; 95 % CI 0.91–4.47; p = 0.08).
Conclusions
Left side RCC with tumor thrombus is not associated with worse prognosis than right-sided tumors (all tumor thrombi levels). Our data suggest that among RCC patients with advanced tumor thrombi (level III/IV), a left side thrombus may be associated with worse prognosis compared to a right side thrombus.