Introduction and Objectives
Venous extension is a particularity of RCC and is registered in 5–25% of the cases, 1% having atrial extension. Identification of the risk factors, especially the influence of the adherence and the level of the thrombus in patient's survival provides valuable informations for the treatment and prognosis of these patients.
Material and Methods
Two cohorts of patients were studied: Cohort A – 108 patients with RCC and subdiaphragmatic venous extension (renal vein – RV and subdiaphragmatic inferior vena cava – IVC) operated in our center between January 2000 – December 2006. Cohort B – 26 patients with RCC and supradiaphragmatic venous extension operated in our clinic between 1994 and 2007. Statistic significance of the potential risc factors was evaluated with several tests: chi2, Yates correction of chi2, Fisher test, relative risk and confidence interval. The confidence interval was 0.05
The main statistic significant survival risk factors were: sarcomatoid feature (p = 0,049), Fuhrman grade III and IV (p = 0,00003), tumoral stage T4 (significance only in cohort B – p = 0,033); lymph node metastases N (p = 0,0047), distant metastases M (p = 0,00005), tumoral stage IV (p = 0,00001). There were not validated as statistic significant risc factors: the sex of the patient (p = 0,668); left sided tumour (p = 0,420), tumour size >10 cm (p = 0,540), adherence of the thrombus (p = 0,214) and the level of the thrombus (subdiaphragmatic IVC vs RV p = 0,2834; supradiaphragmatic IVC vs RV – p = 0,2163; supradiaphragmatic IVC vs subdiaphragmatic IVC p = 0.36).
The statistic significant survival risc factors in RCC with venous extension were in our study: sarcomatoid feature, Führman grade III, IV, tumoral stage T4, lymph node metastases N+, distant metastases M+ and tumoral stage IV. The adherence and the level of the thrombus were not statistically significant risk factors.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.