UroToday- Involvement of the renal vein or vena cava (IVC) occurs in approximately 14% of renal cell carcinoma (RCC) patients and represents an adverse prognostic feature that impacts patient outcome. Despite this surgical therapy can be curative in patients even those with locally advanced IVC involvement. One factor that has been debated in the literature is whether the height of the tumor thrombus at surgery is prognostic of patient outcome. Here, Haferkamp and colleagues weigh in with their experience in the management of patients with RCC and IVC involvement.

The authors report on 134 patients that presented with RCC and IVC involvement. Median patient age was 64 and with a median follow-up of 16.4 months there were 97 cancer specific deaths, 84% of patients had clear cell RCC histology. Of these 134 patients 23 were treated solely with tumor embolization and immunotherapy whereas 111 patients were treated with surgical extirpation of the tumor and thrombus. The median survival for those patients treated surgically (19.8 months) was significantly better than that for patients treated with embolization and immunotherapy (6.9 months). Interestingly, the 30 day mortality rate for the embolization group was 13% but was found to be 10% in the surgery group. Thirty patients had metastatic disease (nodal or distant) at the time of surgery. The median survival was significantly better for patients without metastatic disease at surgery (51.7 months) than those with metastases (6.9 months). In those patients with metastatic disease treated surgically, those that received immunotherapy after surgery had a significantly improved median survival (13.5 months) over those that did not (5.1 months). In their multivariate analysis the authors found that the presence of metastatic disease (p=0.0004) increased tumor grade (p=0.0228) and the height of the tumor thrombus (level III/IV, p=0.032) were all independent variables predictive of patient outcome. The 5 year overall survival for patients without metastatic disease with nodal metastases and with distant metastases was 45.8%, 19.1%, and 6.5%, respectively.

Unlike many other published series the authors in this study concluded that height of tumor thrombus was an important prognostic factor that predicted outcome and suggested that this feature should be considered in future RCC staging systems. Further, they demonstrated that even in the setting of metastatic disease, surgical control of the primary tumor is associated with the best patient outcomes.

Haferkamp A, Bastian PJ, Jakobi H, Pritsch M, Pfitzenmaier J, Albers P, Hallscheidt P, M??ller SC, Hohenfellner M

J Urol. 177(5):1703-1708, May 2007
doi:10.1016/j.juro.2007.01.039

Reported by UroToday Contributing Editor Christopher G. Wood, MD

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: urotoday

----------------------------
Copyright © 2007 - UroToday
Reproduced for blog with permission of UroToday.
----------------------------