Renal cell carcinoma with vena caval involvement: a contemporary clinicopathologic analysis of 53 cases

A clinicopathologic analysis of patients with renal cell carcinoma (RCC) and vena caval involvement diagnosed at our institution was performed. Multiple clinicopathologic parameters were examined. Fifty-three cases were identified.

Mean patient age was 62 years (range, 40-82 years). The cohort comprised 36 of 53 (68%) men and 17 of 53 (32%) women. Mean primary tumor size was 10. 4 cm (range, 3. 1-21. 0 cm). The breakdown of tumor stage was as follows: 37 of 53 (70%) were pT3b, 14 of 53 (26%) were pT3c, and 2 of 53 (4%) were pT4. Most of the tumors were clear cell RCC (45/53, 84. 6%), although other variants were also represented. All cases were Fuhrman nuclear grade 3 (34/53, 64%) or 4 (19/53, 36%). Tumor necrosis was present in 41 of 53 (77%) cases. At the time of the initial tumor resection, 11 of 53 (21%) cases were staged pM1. Of the 42 patients staged as pMX at the time of primary tumor resection, 12 of 42 (29%) later developed metastasis, most commonly to the lungs. Of all 53 cases with these very advanced tumors, only 6 of 53 (11. 3%) had positive surgical margins: 4 of 53 (7. 5%) had positive vascular resection margins, and 2 of 53 (3. 8%) had focally positive perinephric fat margins. The mean 5-year survival in our cohort was 50%. Our findings suggest that a select group of patients with RCC with vena caval involvement may benefit from radical nephrectomy, although some tumors may have positive vascular and/or nonvascular surgical resection margins even in the best surgical hands. Multi-institutional studies are needed to further characterize these advanced tumors from the molecular standpoint.

Human pathology. 2015 Nov 02 [Epub]

Ifeoma U Nwadei, Adam Lorentz, Dattatraya Patil, Michelle A Dimarco, Viraj A Master, Adeboye O Osunkoya

Department of Pathology, Emory University School of Medicine, Atlanta, GA, 30322. , Department of Urology, Emory University School of Medicine, Atlanta, GA, 30322. , Department of Urology, Emory University School of Medicine, Atlanta, GA, 30322. , Department of Pathology, Emory University School of Medicine, Atlanta, GA, 30322. , Department of Urology, Emory University School of Medicine, Atlanta, GA, 30322; Emory Winship Cancer Institute, Atlanta, GA, 30322. , Department of Pathology, Emory University School of Medicine, Atlanta, GA, 30322; Department of Urology, Emory University School of Medicine, Atlanta, GA, 30322; Emory Winship Cancer Institute, Atlanta, GA, 30322; Department of Pathology, Veterans Affairs Medical Center, Atlanta, GA, 30033. 

PubMed

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