Ten-year cancer-specific survival was significantly higher for patients with tumor thrombus in the renal vein compared to level I inferior vena cava involvement (66% vs 29%, p=0.0001).
Cohort (n=153)
Does the level of venous tumor thrombus extension (renal vein vs IVC) impact long-term cancer specific survival in patients with renal cell carcinoma undergoing surgical resection?
Survival in renal cell carcinoma is significantly better for patients with renal vein tumor thrombus compared to those with IVC involvement, challenging their combined grouping as T3b in the 1997 TNM staging.
Absolute Event Rate: 66% vs 29%
p-value: p=0.0001
PURPOSE: We investigated the prognostic significance of venous tumor thrombus extension in patients with renal cell carcinoma with particular emphasis on 2 questions. Does the level of thrombus in the inferior vena cava (IVC) impact long-term survival? Is there a difference in long-term survival when tumor thrombus is in the renal vein versus the IVC for patients classified as T3b by 1997 TNM staging? MATERIALS AND METHODS: Between July 1970 and July 2000, 153 patients underwent surgical resection. Cancer specific survival was determined for different tumor thrombus levels in a retrospective fashion. RESULTS: Mean followup was 60 months with a range of 12 to 221. Level of tumor thrombus was renal vein (in 46), level I (in 68), level II (in 17) and level III (in 22). No demographic differences existed between the different levels including gender, age, perinephric extension, Fuhrman grade, percentage of metastatic disease and tumor size (Fisher's exact test). Patients with evidence of nodal disease or metastasis at surgery were eliminated from cancer specific survival analysis. The overall 10-year cancer specific survival for patients was 30%, 19% and 29% for level I, II and III, respectively. Patient survival at 5 and 10 years was not significantly different between the 3 IVC levels (p = 0.48). Ten-year survival of patients with renal vein involvement (66%) versus level I (29%) was significantly different (p = 0.0001). CONCLUSIONS: The level of tumor thrombus in the IVC does not significantly effect long-term survival. Ten-year survival of patients classified as T3b is statistically different for patients having tumor thrombus in the renal vein compared to level I. Combining these 2 groups as T3b by the 1997 TNM staging may need to be reevaluated.
Moinzadeh et al. (Sun,) conducted a cohort in Renal cell carcinoma with venous tumor thrombus extension (n=153). Tumor thrombus in the renal vein vs. Tumor thrombus in the inferior vena cava (Level I) was evaluated on 10-year cancer specific survival (p=0.0001). Ten-year cancer-specific survival was significantly higher for patients with tumor thrombus in the renal vein compared to level I inferior vena cava involvement (66% vs 29%, p=0.0001).