MP40-05 EXTENT OF RENAL VEIN INVASION INFLUENCES PROGNOSIS IN PATIENTS WITH RENAL CELL CARCINOMA

Abstract

You have accessJournal of UrologyKidney Cancer; Evaluation/Staging IV1 Apr 2014MP40-05 EXTENT OF RENAL VEIN INVASION INFLUENCES PROGNOSIS IN PATIENTS WITH RENAL CELL CARCINOMA Mark Ball, Michael Gorin, Phillip Pierorazio, and Mohamad Allaf Mark BallMark Ball More articles by this author , Michael GorinMichael Gorin More articles by this author , Phillip PierorazioPhillip Pierorazio More articles by this author , and Mohamad AllafMohamad Allaf More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1340AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Renal cell carcinoma is associated with venous invasion in 4-10% of cases. The level of venous extension affects prognosis in cases of vena cava invasion as reflected in the American Joint Committee on Cancer (AJCC) staging system. Conversely, invasion of the both the main renal vein (RV) and segmental (muscle containing) RV branches invasion are classified as T3a. Therefore, we sought to clarify the significance of RV invasion in the main RV versus segmental branches. Methods Our institutional renal mass database was queried for patients with renal cell carcinoma and RV invasion. Patients were stratified into main RV invasion and segmental RV invasion. Cancer-specific survival was analyzed for each group. Results A total of 157 cases with RV invasion were identified; 79 had main RV invasion and 78 had segmental RV invasion. Baseline characteristics were similar between groups, but tumor size was larger for main RV compared to segmental RV invasion (9 v 5.9 cm, p < 0.0001). During a mean follow-up of 40.2 months, cancer-specific survival was better for segmental RV compared to main RV (log rank p=0.0133). The hazard ratio (HR) for main RV compared to segmental RV invasion was 3.33 (p = 0.02). Controlling for age, cytoreductive indication, approach and tumor diameter, main RV invasion remained an independent predictor of worse survival (HR=2.92, p=0.04) along with cytoreductive indication (HR 3.1, p value 0.039). Conclusions Main RV invasion is independently associated with worse cancer-specific survival than segmental RV in this single-institution cohort. Though these findings require external validation, they suggest that the current staging guidelines may require modification to stratify by extent of RV invasion. Table 1. Baseline Characteristics. Main RV (n=79) Segmental RV (n=78) P value Age 63.9 61.5 0.599 Male, n (%) 54 (68.4) 55 (73.3) 0.497 MIS Approach 53 (67.1) 63 (80.7) 0.051 Tumor Diameter 9 (6-11.5) 5.9 (4.5 - 8.55) < 0.0001 Cytoreductive, n (%) 13 (16.5) 8 (10.26) 0.254 Values are expressed in medians (inter-quartile range) unless otherwise specified. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e435-e436 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Mark Ball More articles by this author Michael Gorin More articles by this author Phillip Pierorazio More articles by this author Mohamad Allaf More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...