MP44-20 CAN MORPHOLOGIC FEATURES OF VENA CAVAL TUMOR THROMBUS ON CT OR MRI BE A PROGNOSTIC FACTOR AFTER SURGICAL TREATMENT OF RENAL CELL CARCINOMA WITH IVC THROMBUS?

Abstract

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging II1 Apr 2015MP44-20 CAN MORPHOLOGIC FEATURES OF VENA CAVAL TUMOR THROMBUS ON CT OR MRI BE A PROGNOSTIC FACTOR AFTER SURGICAL TREATMENT OF RENAL CELL CARCINOMA WITH IVC THROMBUS? Don kyoung Choi, Hwang Gyun Jeon, Byong Chang Jeong, Seong Soo Jeon, Hyun Moo Lee, Han-Yong Choi, Chang Wook Jeong, Cheol Kwak, Cheryn Song, Jinsoo Chung, Sung Kyu Hong, Sung-Hoo Hong, and Seong Il Seo Don kyoung ChoiDon kyoung Choi More articles by this author , Hwang Gyun JeonHwang Gyun Jeon More articles by this author , Byong Chang JeongByong Chang Jeong More articles by this author , Seong Soo JeonSeong Soo Jeon More articles by this author , Hyun Moo LeeHyun Moo Lee More articles by this author , Han-Yong ChoiHan-Yong Choi More articles by this author , Chang Wook JeongChang Wook Jeong More articles by this author , Cheol KwakCheol Kwak More articles by this author , Cheryn SongCheryn Song More articles by this author , Jinsoo ChungJinsoo Chung More articles by this author , Sung Kyu HongSung Kyu Hong More articles by this author , Sung-Hoo HongSung-Hoo Hong More articles by this author , and Seong Il SeoSeong Il Seo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1562AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although various prognostic factors have been studied for renal cell carcinoma (RCC) with IVC thrombus, the prognostic value of thrombus feature in these patients remains unclear. To analyze the effect of morphologic feature of IVC thrombus on overall survival (OS) and cancer-specific survival (CSS) after surgery. METHODS We retrospectively analyzed the records of 169 patients of RCC with IVC thrombus who underwent radical nephrectomy and thrombectomy from 1998 to 2013 at 5 centers. IVC thrombi were classified as spherical(smooth surfaced, type I) and spiculated (type II) according to their morphologic features on CT or MRI. The classification was carried out by 1 radiologist and 2 urologists in a blind fashion (without prior knowledge of patient characteristics). Multivariate ordered Cox regression models were used to quantify the impact of various prognostic factors on OS and CSS. RESULTS Type 1 was found in 30 patients (17.8%) and type 2 in 139 patients (82.2%). Mean follow-up was 38.0 months (IQR: 12-57). Demographic characteristics were not significantly different between type I and type II except for the cranial thrombus level (p=0.004). 5-yr OS was 77.4% in patients with type I and 33.0% in patients with type II. In cases of pN0/XM0, 22 (21.6%) had type 1, and 80 (78.4%) had type 2. On multivariate analysis, distant metastasis, thrombus morphology, and remnant venous thrombus significantly affected OS in pNanyMany patients (all p<0.05). Among the pN0/XM0 patients, thrombus morphology (p=0.016) significantly affected OS. In terms of CSS, ECOG performance score (p=0.034), distant metastasis, Furhman grade and thrombus morphology significantly affected CSS in pNanyMany patients (all p<0.05). In patients with pN0/XM0, only thrombus morphology (p=0.031) significantly affected CSS. CONCLUSIONS Thrombus morphology is an independent predictor of OS and CSS after surgical treatment of RCC with IVC thrombus. Furthermore, remnant venous thrombus also appears to be an independent predictor of OS. Multivariable Cox regression analysis predicting overall survival (any N any M) Variables Univariable Multivariable HR (95% CI) p-value Age 0.248 0.992 (0.972-1.012) 0.431 ECOG PS (0-1 vs 2-3) 0.023 1.786 (0.869-3.668) 0.115 Thrombus level (I-II-III vs. IV) 0.400 1.134 (0.533-2.412) 0.745 Distant metastasis <0.001 2.227 (1.426-3.478) <0.001 LN involvement (N0/X vs. N1) 0.090 1.224 (0.816-2.853) 0.185 Furhmann grade (I-II vs. III-IV) 0.074 2.161 (0.950-4.913) 0.066 Morphology of tumor thrombus 0.006 2.522 (1.191-5.343) 0.016 (Spherical vs. spiculated) Remnant Thrombus (post-operation) Venous thrombus <0.001 2.356 (1.283-4.325) 0.006 Pulmonary embolism 0.342 1.247 (0.607-2.562) 0.547 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e534 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Don kyoung Choi More articles by this author Hwang Gyun Jeon More articles by this author Byong Chang Jeong More articles by this author Seong Soo Jeon More articles by this author Hyun Moo Lee More articles by this author Han-Yong Choi More articles by this author Chang Wook Jeong More articles by this author Cheol Kwak More articles by this author Cheryn Song More articles by this author Jinsoo Chung More articles by this author Sung Kyu Hong More articles by this author Sung-Hoo Hong More articles by this author Seong Il Seo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...