1656 IMPACT OF THE INVASION OF PERINEPHRIC OR RENAL SINUS FAT IN PATIENTS WITH RENAL CELL CARCINOMA AND VENOUS TUMOR THROMBUS

Abstract

You have accessJournal of UrologyKidney Cancer: Advanced1 Apr 20101656 IMPACT OF THE INVASION OF PERINEPHRIC OR RENAL SINUS FAT IN PATIENTS WITH RENAL CELL CARCINOMA AND VENOUS TUMOR THROMBUS Elena Strada, Marco Roscigno, Massimo Freschi, Giovanni Petralia, Francesco Sozzi, Anna Cremonini, Renzo Colombo, Alberto Briganti, Andrea Gallina, Valerio Di Girolamo, Francesco Montorsi, Patrizio Rigatti, and Roberto Bertini Elena StradaElena Strada More articles by this author , Marco RoscignoMarco Roscigno More articles by this author , Massimo FreschiMassimo Freschi More articles by this author , Giovanni PetraliaGiovanni Petralia More articles by this author , Francesco SozziFrancesco Sozzi More articles by this author , Anna CremoniniAnna Cremonini More articles by this author , Renzo ColomboRenzo Colombo More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Valerio Di GirolamoValerio Di Girolamo More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Patrizio RigattiPatrizio Rigatti More articles by this author , and Roberto BertiniRoberto Bertini More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1459AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the impact of perinephric fat invasion (PFI) or renal sinus fat invasion (RSFI) on cancer specific mortality (CSM), in patients with renal cell carcinoma (RCC) with neoplastic thrombus. METHODS From 1987 to 2008, 194 patients underwent radical nephrectomy for RCC with neoplastic thrombus. The microscopic slides from all tumor specimens were reviewed by a single experienced genitourinary pathologist. Ninety pts had either PFI (n=47) or RSFI (n=43). Of these, 60 pts had coexisting PFI and RSFI. Patient characteristics: median age 61 yrs (range 24-91), pT3b/pT3c/pT4: 161/18/15, pN0/pN1/pN2/pNx 119/13/43/19 (TNM 2002); G2/G3/G4: 41/102/51, M0/M+: 109/85. Associations with cancer specific mortality (CSM) were evaluated by univariate analysis (Kaplan-Meier model) and univariate and multivariate Cox proportional hazard model, including Fuhrman grade, metastatic and nodal status and involvement of tumor fat invasion (TFI). RESULTS Overall median follow-up was 20 months, while median follow-up for alive patients was 36 months. The 3-year actuarial cancer specific survival was significantly lower in pts with TFI (39%) than in pts without TFI (74%; p<0.001). Kaplan-Meier survival analysis showed no difference between pts with PFI alone and pts with RSFI alone, while the presence of coexisting PFI and RSFI was associated with a higher risk of CSM (p <0,001). Univariate Cox regression analysis confirmed that pts with PFI or RSFI had a poorer prognosis than pts without TFI (p<0,010), moreover pts with coexistent PFI and SFI had a reduced survival than patients with PFI or RSFI alone (p=0,026). At multivariate analysis, the presence of synchronous metastases (p<0,001), nodal involvement (p=0,002) and TFI (p<0,001) were associated with increased risk of dying from RCC. Specifically, coexisting PFI and RSFI had a significant poor prognosis (p =0,046 HR 1,78). CONCLUSIONS This study shows that, pts affected by RCC with neoplastic thrombus and TFI have a significant reduced prognosis compared with RCC with neoplastic thrombus alone. Especially, pts with coexistent PFI and RSFI have an increased mortality for RCC with neoplastic thrombus than pts with PFI or RSFI alone. Milan, Italy© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e639-e640 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elena Strada More articles by this author Marco Roscigno More articles by this author Massimo Freschi More articles by this author Giovanni Petralia More articles by this author Francesco Sozzi More articles by this author Anna Cremonini More articles by this author Renzo Colombo More articles by this author Alberto Briganti More articles by this author Andrea Gallina More articles by this author Valerio Di Girolamo More articles by this author Francesco Montorsi More articles by this author Patrizio Rigatti More articles by this author Roberto Bertini More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...