ORLANDO, FL USA (UroToday.com) - Through a large, international, multi-institutional series of patients with cT3b renal cell carcinoma (RCC) — characterized by subdiaphragmatic inferior vena cava tumor extension — the authors aimed to better describe the outcomes and predictors of cancer-specific survival (CSS). In this cohort, while radical nephrectomy is a commonly accepted surgical outcome in guidelines, lymphadenectomy and radiation therapy are less consistently advocated or performed.
Twenty-two institutions developed a central database of patients (N=2147) who underwent radical nephrectomy and tumor thrombectomy for RCC between 1971-2012. Of these, 761 cT3b patients had complete data, which were retrospectively analyzed. CSS was determined and evaluated through Kaplan-Meyer and log rank tests, with univariable and multivariable analyses performed by Cox proportional hazards regression.
Within this database, 65% of the patients were male, 19% had lymph node and 17% had distant metastases. 95% received open radical nephrectomy—but only 5% required caval resection, and 31% received extended lymph node dissection. Histologically, most had clear cell subtype (74%); pathologically, 16% were stage pT3a, 76% were pT3b, 4% were pT3c and pT4, each. At follow-up, 39% had died of cancer, while 5- and 10-year CSS was 52.9% and 40.8%, respectively. When adjusted for predictors, the following were independently associated with CSS: mode of presentation, histology, pathologic stage, nodal stage, metastatic stage, Fuhrman grade, and caval involvement.
The results of this analysis offer an increased understanding of the clinical outcomes of patients with cT3b RCC; 5-year CSS was as low as 50%, while caval involvement, TNM stage, and histology were associated with worse survival. Lymphadenectomy, nevertheless, was rarely performed; these findings suggest that this gap might be addressed.
Presented by Estefania Linares at the American Urological Association (AUA) Annual Meeting - May 16 - 21, 2014 - Orlando, Florida USA
IRCCVT International Consortium, Madrid, Spain
Written by Eric Ballon-Landa, BA, University of California (Irvine), and medical writer for UroToday.com