TITLE:
Risk Factors That Affect Survival in Patients with Renal Cell Carcinoma Invading the Vena Cava
AUTHORS:
Marissa Kent, Drew Palmer, John Libertino
KEYWORDS:
Renal Cell Carcinoma, Venous Tumor Thrombus, Vena Cava
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.8 No.1,
December
23,
2016
ABSTRACT: Objectives:
To determine which risk factors are associated with overall survival in
patients with T3b or T3c renal cell carcinoma. Materials and Methods: Retrospective
chart review was performed on all patients who underwent a nephrectomy at Lahey
Hospital from 1971-2014 and had a diagnosis of pathologic T3b or T3c renal cell
carcinoma. Twenty-one potential risk factors were examined and analyzed using
Cox Proportional Hazard Survival models. Additional factors examined in this cohort
included rate of complications, tumor recurrence, intra-operative death rate,
and 30-day mortality rate. Results: One-hundred eighty-two patients with stage
T3b or T3c renal cell carcinoma met inclusion criteria. Of these, 124 (68%)
were stage T3b and 58 (32%) were stage T3c. Median follow-up was 18.5 months.
One-hundred and six (58%) patients experienced a complication from surgery. The
intra-operative death rate was 1.1% (2 patients). The 30-day mortality rate was
7.1% (13 patients). Seventy-one (39%)
patients had disease recurrence at a median of 7 months (range 1 - 232
months). The 5-year disease-specific survival was 40% and the 5-year overall
survival was 32%. Of the 21 risk factors analyzed, clear cell histology,
positive lymph nodes, and peri-nephric fat involvement were all significant at
the p 0.05 level using unadjusted modeling. On
multivariable analysis, fully adjusting for all three significant variables,
only positive lymph nodes and peri-nephric fat involvement remained
significant. Conclusions: In
patients with T3b or T3c renal cell carcinoma overall survival is associated
with lymph node positivity and peri-nephric fat involvement and not tumor
thrombus level.