Impacts of clinicopathologic and operative factors on short-term and long-term survival in renal cell carcinoma with venous tumor thrombus extension: a multi-institutional retrospective study in Japan

BMC Cancer

Masanori Hirono¹⁰  Mikio Kobayashi⁵  Tomoyasu Tsushima¹¹  Wataru Obara¹²  Nobuo Shinohara²  Keiichi Ito¹⁵  Masatoshi Eto⁸  Tatsuya Takayama⁴  Yasuhisa Fujii¹³  Masaharu Nishikido⁷  Go Kimura¹  Takeshi Kishida⁶  Masayuki Takahashi⁹  Noriomi Miyao¹⁴  Yukio Naya³  Takashige Abe²  Tomoaki Fujioka¹²  Kazuto Ito¹⁰  Seiji Naito⁸ 

[1] Department of Urology, Nippon Medical School, Tokyo, Japan

[2] Department of Renal and Genitourinary surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan

[3] Department of Urology, Teikyo University Chiba Medical Center, Ichihara, Japan

[4] Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan

[5] Division of Urology, Isesaki Municipal Hospital, 12-1, Tsunatori-hon-machi, 372-0817 Isesaki, Gunma, Japan

[6] Department of Urology, Kanagawa Prefectural Cancer Center, Yokohama, Japan

[7] Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

[8] Department of Urology, Kyushu University Faculty of Medicine, Fukuoka, Japan

[9] Department of Urology, Tokushima University School of Medicine, Tokushima, Japan

[10] Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Japan

[11] Division of Urology, Okayama Medical Center, Okayama, Japan

[12] Department of Urology, Iwate Medical University School of Medicine, Morioka, Japan

[13] Department of Urology, Tokyo Medical and Dental University, Graduate School of Medical and Dental Sciences, Tokyo, Japan

[14] Division of Urology, Muroran City General Hospital, Muroran, Japan

[15] Department of Urology, National Defense Medical College, Tokorozawa, Japan

关键词: Cause-specific survival;    Overall survival;    Prognostic factors;    Tumor thrombus;    Renal cell carcinoma;   

Others  :  1079544
DOI  :  10.1186/1471-2407-13-447

 received in 2013-04-11, accepted in 2013-09-26,  发布年份 2013

【 摘 要 】

Background

Although the percentage of patients with renal cell carcinoma (RCC) extending into venous systems is unexpectedly high, the prognostic impact and independency of venous tumor thrombus-related factors on overall survival (OS) remain controversial. Furthermore, the prognostic impact of various clinicopathologic factors including tumor thrombus-related factors on OS may change with elapsed years after the intervention and also with follow-up duration of participants. The aim of the study is to explore independent and universal predictive preoperative and intraoperative clinicopathologic factors on OS in patients with RCC extending into venous systems using subgroup analysis in terms of restricted follow-up duration and yearly-based survivors.

Methods

Between 1980 and 2009, 292 patients diagnosed with RCC with venous tumor thrombus were retrospectively registered for this study. The prognostic impacts of various clinicopathologic and surgical treatment factors including levels of venous thrombus, venous wall invasion status and likelihood of aggressive cytoreductive operation, were investigated using Kaplan-Meier method and following multivariate Cox proportional hazards model for all patients and those still alive at 1, 2, and 3 years of follow-up. To investigate the impact of follow-up duration on the statistical analyses, multivariate logistic regression analyses were used to explore prognostic factors using restricted data until 1, 2, and 3 years of follow-up.

Results

The median follow-up duration was 40.4 months. The 5-year OS was 47.6%. Several independent predictive factors were identified in each subgroup analysis in terms of yearly-based survival and restricted follow-up duration. The presence of tumor thrombus invading to venous wall was independently related to OS in the full-range follow-up data and in survivors at 2 and 3 years of follow-up. Using restricted follow-up data until 1, 2, and 3 years of follow-up, many independent predictive factors changed with follow-up duration, but surgical category could be universal and independent predictive factors.

Conclusion

The most universal factors affecting improvement both in short-term and long-term survivals could be cytoreductive surgery and absence of venous wall invasion. It may mean that feasible aggressive cytoreductive operation following more reliable preoperative imaging for predicting venous wall invasion status would improve OS for patients with RCC extending into venous systems.

【 授权许可】

   
2013 Hirono et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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