Extent of renal vein invasion influences prognosis in patients with renal cell carcinoma

Mark W. Ball, Michael Gorin, Kelly T. Harris, Kevin M. Curtiss, George J. Netto, Christian Pavlovich, Phillip Martin Pierorazio, Mohamad E Allaf

Research output: Contribution to journalArticle

Abstract

Objective: To compare oncological outcomes for segmental vs main renal vein invasion (RVI) in patients with renal cell carcinoma (RCC). Patients Methods: Patients undergoing extirpative surgery for RCC at our institution between 2003 and 2013 were stratified into five groups according to clinical stage: T2 (n = 135), T3a with fat invasion (n = 185), T3a with segmental RVI (n = 87), T3a with main RVI (n = 64) and T3b (n = 40). Kaplan–Meier survival analysis and multivariable Cox regression were performed to determine the impact of segmental RVI on recurrence-free survival (RFS) and cancer-specific survival (CSS). Harrell's c index was used to compare the prognostic accuracy of current and proposed staging models. Results: At a median follow-up of 37 months, both RFS and CSS were significantly worse for patients with main RVI as compared with segmental RVI (P = 0.03 and P = 0.009, respectively). On multivariable analysis, main RVI had inferior RFS (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.1–4.4; P = 0.03] and CSS (HR 3.5, 95% CI 1.3–9.9; P = 0.02) compared with segmental RVI. Sub-stratifying T3a disease by separating segmental and main RVI improved prognostic accuracy compared with the current staging system for CSS (c indices 0.66 vs 0.59) and RFS (0.70 vs 0.60). Conclusions: Main RVI is independently associated with worse RFS and CSS than segmental RVI. These findings may have significance for patient counselling and future staging guidelines.

Original languageEnglish (US)
Pages (from-to)112-117
Number of pages6
JournalBJU International
Volume118
Issue number1
DOIs
StatePublished - Jul 1 2016

Fingerprint

Renal Veins
Renal Cell Carcinoma
Survival
Recurrence
Neoplasms
Confidence Intervals
Neoplasm Staging
Survival Analysis
Counseling
Fats
Guidelines

Keywords

  • kidney cancer
  • renal cell carcinoma
  • risk stratification
  • venous invasion

ASJC Scopus subject areas

  • Urology

Cite this

Extent of renal vein invasion influences prognosis in patients with renal cell carcinoma. / Ball, Mark W.; Gorin, Michael; Harris, Kelly T.; Curtiss, Kevin M.; Netto, George J.; Pavlovich, Christian; Pierorazio, Phillip Martin; Allaf, Mohamad E.

In: BJU International, Vol. 118, No. 1, 01.07.2016, p. 112-117.

Research output: Contribution to journalArticle

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title = "Extent of renal vein invasion influences prognosis in patients with renal cell carcinoma",
abstract = "Objective: To compare oncological outcomes for segmental vs main renal vein invasion (RVI) in patients with renal cell carcinoma (RCC). Patients Methods: Patients undergoing extirpative surgery for RCC at our institution between 2003 and 2013 were stratified into five groups according to clinical stage: T2 (n = 135), T3a with fat invasion (n = 185), T3a with segmental RVI (n = 87), T3a with main RVI (n = 64) and T3b (n = 40). Kaplan–Meier survival analysis and multivariable Cox regression were performed to determine the impact of segmental RVI on recurrence-free survival (RFS) and cancer-specific survival (CSS). Harrell's c index was used to compare the prognostic accuracy of current and proposed staging models. Results: At a median follow-up of 37 months, both RFS and CSS were significantly worse for patients with main RVI as compared with segmental RVI (P = 0.03 and P = 0.009, respectively). On multivariable analysis, main RVI had inferior RFS (hazard ratio [HR] 2.3, 95{\%} confidence interval [CI] 1.1–4.4; P = 0.03] and CSS (HR 3.5, 95{\%} CI 1.3–9.9; P = 0.02) compared with segmental RVI. Sub-stratifying T3a disease by separating segmental and main RVI improved prognostic accuracy compared with the current staging system for CSS (c indices 0.66 vs 0.59) and RFS (0.70 vs 0.60). Conclusions: Main RVI is independently associated with worse RFS and CSS than segmental RVI. These findings may have significance for patient counselling and future staging guidelines.",
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T1 - Extent of renal vein invasion influences prognosis in patients with renal cell carcinoma

AU - Ball, Mark W.

AU - Gorin, Michael

AU - Harris, Kelly T.

AU - Curtiss, Kevin M.

AU - Netto, George J.

AU - Pavlovich, Christian

AU - Pierorazio, Phillip Martin

AU - Allaf, Mohamad E

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N2 - Objective: To compare oncological outcomes for segmental vs main renal vein invasion (RVI) in patients with renal cell carcinoma (RCC). Patients Methods: Patients undergoing extirpative surgery for RCC at our institution between 2003 and 2013 were stratified into five groups according to clinical stage: T2 (n = 135), T3a with fat invasion (n = 185), T3a with segmental RVI (n = 87), T3a with main RVI (n = 64) and T3b (n = 40). Kaplan–Meier survival analysis and multivariable Cox regression were performed to determine the impact of segmental RVI on recurrence-free survival (RFS) and cancer-specific survival (CSS). Harrell's c index was used to compare the prognostic accuracy of current and proposed staging models. Results: At a median follow-up of 37 months, both RFS and CSS were significantly worse for patients with main RVI as compared with segmental RVI (P = 0.03 and P = 0.009, respectively). On multivariable analysis, main RVI had inferior RFS (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.1–4.4; P = 0.03] and CSS (HR 3.5, 95% CI 1.3–9.9; P = 0.02) compared with segmental RVI. Sub-stratifying T3a disease by separating segmental and main RVI improved prognostic accuracy compared with the current staging system for CSS (c indices 0.66 vs 0.59) and RFS (0.70 vs 0.60). Conclusions: Main RVI is independently associated with worse RFS and CSS than segmental RVI. These findings may have significance for patient counselling and future staging guidelines.

AB - Objective: To compare oncological outcomes for segmental vs main renal vein invasion (RVI) in patients with renal cell carcinoma (RCC). Patients Methods: Patients undergoing extirpative surgery for RCC at our institution between 2003 and 2013 were stratified into five groups according to clinical stage: T2 (n = 135), T3a with fat invasion (n = 185), T3a with segmental RVI (n = 87), T3a with main RVI (n = 64) and T3b (n = 40). Kaplan–Meier survival analysis and multivariable Cox regression were performed to determine the impact of segmental RVI on recurrence-free survival (RFS) and cancer-specific survival (CSS). Harrell's c index was used to compare the prognostic accuracy of current and proposed staging models. Results: At a median follow-up of 37 months, both RFS and CSS were significantly worse for patients with main RVI as compared with segmental RVI (P = 0.03 and P = 0.009, respectively). On multivariable analysis, main RVI had inferior RFS (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.1–4.4; P = 0.03] and CSS (HR 3.5, 95% CI 1.3–9.9; P = 0.02) compared with segmental RVI. Sub-stratifying T3a disease by separating segmental and main RVI improved prognostic accuracy compared with the current staging system for CSS (c indices 0.66 vs 0.59) and RFS (0.70 vs 0.60). Conclusions: Main RVI is independently associated with worse RFS and CSS than segmental RVI. These findings may have significance for patient counselling and future staging guidelines.

KW - kidney cancer

KW - renal cell carcinoma

KW - risk stratification

KW - venous invasion

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