Management of renal cell carcinoma with tumor thrombus in renal vein and the inferior vena cava.

The article aims to sum up experience in the treatment of renal cell carcinoma complicated with tumor thrombus in renal vein and inferior vena cava. A retrospective review was made on the diagnosis, treatment, and prognosis of 15 cases of renal carcinoma complicated with venous tumor thrombus from July 1994 to July 2006. The diagnosis of 93% (14/15) cases was confirmed by preoperative computed tomography or magnetic resonance imaging. Of the 15 cases, two had simple renal vein tumor thrombus of left kidney and 13 had inferior vena cava tumor thrombus; of the latter, nine were type I (pararenal type), three type II (subhepatic type), and one type III (intrahepatic type). Of the 12 patients who received surgical treatment, 11 had the renal tumors completely resected, the venous tumor thrombus removed, and lymph nodes cleared. Palliative excision was performed in one patient with a left kidney tumor because of adjacent adhesion. All the three patients who did not receive surgical treatment died, with a mean survival period of 7 months. Of the 12 surgical patients who received surgical treatment, three were lost during follow-up, and the other nine were followed up for 4-72 months; of these 9 patients, three (25%) survived tumor-free for more than 5 years, three for 1-3 years, and the other three died of metastasis within 1 year. Computerized tomography and magnetic resonance imaging are the best choice for noninvasive diagnosis of renal cell carcinoma complicated with inferior vena cava tumor thrombus. For patients without metastasis, radical resection of both the tumor and the thrombus often offers a relatively satisfactory outcome.

Qi J ，Gu Z ，Chen F ，Shen H ，Chen J ，Zhang L ，Wang W ... -  《-》

Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: single-center experience.

Renal cell carcinoma (RCC) with a tumor thrombus extension into the inferior vena cava (IVC) demands aggressive surgical management. To evaluate the long-term survival in patients undergoing radical nephrectomy and IVC thrombectomy. We performed a retrospective analysis of 87 patients undergoing surgery between 1997 and 2008. The patients were grouped according to the extent of tumor thrombus, with level I involving the IVC at the level of the renal vein, level II being infrahepatic IVC, level III being intrahepatic IVC, and level IV being suprahepatic IVC or right atrium. Relevant clinical and pathologic data were analyzed. Disease-free survival (DFS) and disease-specific survival (DSS) were studied. The median follow-up was 22 mo, and 19, 14, 40, and 14 patients had level I, II, III, and IV IVC thrombus, respectively. Among patients with M0 disease, 22 developed metastases. The 5-yr DFS was 64% for all levels and 74%, 69.5%, 59.5%, and 58% for levels I, II, III, and IV, respectively. Of the level I group, 16% of patients died of disease compared to 57% of the level IV group. The 5-yr DSS for all levels was 46% and 71%, 48%, 40%, and 35% for levels I, II, III, and IV, respectively. Patients with level IV thrombus had a significantly lower 5-yr DSS compared to level I (p=0.03). However, when analyzed in two groups-supradiaphragmatic and infradiaphragmatic-there was no significant difference in DSS (P=0.14). On univariate analysis, metastasis at presentation, non-clear-cell histology, lymph node metastases, and higher nuclear grade were statistically significant prognostic factors influencing DSS. Only higher nuclear grade (p=0.03), metastasis at presentation (p<0.01), and non-clear-cell histology (p=0.03) were independent prognostic factors on multivariate analysis. Radical nephrectomy and IVC thrombectomy offer reasonable long-term survival. The level of tumor thrombus is not an independent prognostic factor. Distant metastasis at presentation, higher nuclear grade, and non-clear-clear cell histology are significant prognostic factors influencing DSS.

Ciancio G ，Manoharan M ，Katkoori D ，De Los Santos R ，Soloway MS ... -  《-》

[Outcome of surgical management of renal cell carcinoma with renal vein or inferior vena cava tumor thrombus].

Song Y ，He ZS ，Li NC ，Li M ，Zhou LQ ，Na YQ ... -  《-》

[Prognostic value of venous tumor thrombus in renal cell carcinoma].

To evaluate the prognostic value of venous tumor thrombus in renal cell carcinoma. A retrospective study of 167 patients with renal cell carcinoma and stage pT3 who underwent radical nephrectomy and extended lymphadenectomy from July 1969 to May 2008 was conducted. Patients with any kind of venous involvement were selected for the analysis (73 patients; 43.7%). The Kaplan Meier survival curves and log-rank test for comparisons were used for the survival analysis. Multivariate analysis was done by Cox regression. Lymph node involvement was present in 30 patients (41.1%) and metastatic disease in 9 patients (12.3%). The most frequent histologic renal cell carcinoma subtype was 50 (68.5%) conventional carcinoma, followed by nondifferentiated in 11 (15.5%), and chromophobe in 9 (12.3%). High grade tumors (Furhman 3-4) were present in 57% of the cases. Venous thrombus level extended to renal vein in 61 patients (83.6%), to inferior vena cava in 9 patients (12.3%) and to the cardiac right atrium in 3 cases (4.1%). The survival analysis showed worse survival in those patients with venous tumor thrombosis (p=.001) and with vein wall invasion (p=.0042), but not in function on the level of the thrombus (p=.12). The multivariate analysis identified the Furhman grade and venous tumor thrombosis as independent survival prognostic factors. In our series, venous tumor thrombosis, together with the Furhman nuclear grade, is an independent survival prognostic factor. However, neither cephalic extension of the thrombus nor the invasion of the vein wall showed independent prognostic value.

García-Fadrique G ，Budía-Alba A ，Ruiz-Cerdá JL ，Morales-Solchaga G ，Pontones JL ，Jiménez-Cruz JF ... -  《-》

Prognostic value of renal vein and inferior vena cava involvement in renal cell carcinoma.

Wagner B ，Patard JJ ，Méjean A ，Bensalah K ，Verhoest G ，Zigeuner R ，Ficarra V ，Tostain J ，Mulders P ，Chautard D ，Descotes JL ，de la Taille A ，Salomon L ，Prayer-Galetti T ，Cindolo L ，Valéri A ，Meyer N ，Jacqmin D ，Lang H ... -  《-》