BERKELEY, CA (UroToday.com) - The prognostic significance of microvascular invasion (MVI) in renal cell carcinoma (RCC) remains a subject of controversy. While some have demonstrated its presence to be a surrogate of biologic aggressiveness, others have questioned the reliability with which it is identified and reported, and still others have shown no relationship between the presence of MVI and outcome. Here, Dall’Oglio and colleagues examine a variety of clinical and pathologic variables, including MVI, as predictors of outcome in RCC.

The authors examined clinical (presence of symptoms) and pathologic (tumor size, histology, grade, MVI, lymph node involvement) variables in 230 patients treated with radical nephrectomy or partial nephrectomy over a 15 year period. Median follow-up was 36 months and median time to recurrence was 22 months. Mean overall survival for the group was 130 months. Local or metastatic recurrence was noted in 17.3% and 13.9% died of RCC during follow-up. The 5 year disease free survival (DFS) and cancer specific survival (CSS), as stratified by each variable, is shown in the table below.

In their univariate analysis, only the presence of lymph node metastases and the presence of MVI were predictive of outcome. In their multivariate analysis, only MVI retained independent prognostic significance.

The authors conclude that the presence of MVI is an important prognostic variable that should be reported in every patient with RCC to provide important information on outcomes.

Dall’Oglio MF, Arap MA, Antunes AA, Cury J, Leite KR, Srougi M

J Urol. 177(5):1687-1691, May 2007

UroToday.com Renal Cancer Section

Written by Christopher G. Wood, MD, a Contributing Editor with UroToday.

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