Prognostic relevance of intracaval neoplastic extension for patients with renal cell cancer

Abstract

Objective: To assess the diagnosis of vena caval thrombosis (VCT) in patients with renal cell carcinoma (RCC) as an independent indicator of prognostic importance and when combined with additional tumour characteristics in a controlled multivariate analysis.

Patients and methods: The clinical course of 53 patients (41 men and 12 women, mean age 60 years, range 35-79) with RCC and VCT was compared with that of a control group of 47 patients (37 men and 10 women, mean age 57 years, range 32-76) with RCC but no neoplastic extension into the vena cava.

Results: With a follow-up of 1-154 months and a mean long-term survival of 32 and 35 months, respectively, for patients with and without VCT, neither the propagation of the tumour into the vena cava (P = 0.391) nor the cranial extension of the thrombosis (P = 0.158) were identified as having any prognostic value during univariate or multivariate statistical analysis. The presence of regional lymph node (P < 0.001) or distant metastases (P = 0.009) was an independent prognostic variable for patients with RCC, with a significant decrease in long-term survival (13 and 14 months for patients with lymph node and distant metastases, respectively).

Conclusion: A radical surgical approach is essential as standard therapy for the treatment of patients with RCC and neoplastic extension into the vena cava. Because they have a significantly decreased life expectancy, asymptomatic patients with lymph node or distant metastases should be treated conservatively.