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Open Access 01-12-2013 | Research article

Prognostic benefit of surgical management in renal cell carcinoma patients with thrombus extending to the renal vein and inferior vena cava: 17-year experience at a single center

Authors: Shingo Hatakeyama, Takahiro Yoneyama, Itsuto Hamano, Hiromi Murasawa, Takuma Narita, Masaaki Oikawa, Kazuhisa Hagiwara, Daisuke Noro, Toshikazu Tanaka, Yoshimi Tanaka, Yasuhiro Hashimoto, Takuya Koie, Chikara Ohyama

Published in: BMC Urology | Issue 1/2013

Abstract

Background

Management of renal cell carcinoma (RCC) with tumor thrombus extending to the renal vein and inferior vena cava (IVC) is challenging. The aim of this study was to evaluate the benefit of surgical management in such patients.

Methods

From February 1995 to February 2013, 520 patients were treated for RCC at Hirosaki University Hospital, Hirosaki, Japan. The RCC patients with tumor thrombus extending to the renal vein (n = 42) and IVC (n = 43) were included in this study. The records of these 85 patients were retrospectively reviewed to assess the relevant clinical and pathological variables and survival. Prognostic factors were identified by multivariate analysis. The benefit of surgical management was evaluated using propensity score matching to compare overall survival between patients who received surgical management and those who did not.

Results

RCC was confirmed by pathological examination of surgical or biopsy specimens in 74 of the 85 patients (87%). Sixty-five patients (76%) received surgical management (radical nephrectomy with thrombectomy). Distant metastasis was identified in 45 patients (53%). The proportion of patients with tumor thrombus level 0 (renal vein only), I, II, III, and IV was 49%, 13%, 18%, 14%, and 5%, respectively. The estimated 5-year overall survival rate was 70% in patients with thrombus extending to the renal vein and 23% in patients with thrombus extending to the IVC. Multivariate analysis identified thrombus extending to the IVC, presence of distant metastasis, surgical management, serum albumin concentration, serum choline esterase concentration, neutrophil-lymphocyte ratio, and Carlson comorbidity index as independent prognostic factors. In propensity score-matched patients, overall survival was significantly longer in those who received surgical management than those who did not.

Conclusions

Surgical management may improve the prognosis of RCC patients with thrombus extending to the renal vein and IVC.

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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2490/13/47/prepub

Title: Prognostic benefit of surgical management in renal cell carcinoma patients with thrombus extending to the renal vein and inferior vena cava: 17-year experience at a single center
Authors: Shingo Hatakeyama
Takahiro Yoneyama
Itsuto Hamano
Hiromi Murasawa
Takuma Narita
Masaaki Oikawa
Kazuhisa Hagiwara
Daisuke Noro
Toshikazu Tanaka
Yoshimi Tanaka
Yasuhiro Hashimoto
Takuya Koie
Chikara Ohyama
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: BMC Urology / Issue 1/2013
Electronic ISSN: 1471-2490
DOI: https://doi.org/10.1186/1471-2490-13-47

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Prognostic benefit of surgical management in renal cell carcinoma patients with thrombus extending to the renal vein and inferior vena cava: 17-year experience at a single center

Abstract

Background

Methods

Results

Conclusions

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Abstract

Background

Methods

Results

Conclusions

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