Population based analysis of survival in patients with renal cell carcinoma and venous tumor thrombus

Urol Oncol. 2013 Feb;31(2):259-63. doi: 10.1016/j.urolonc.2010.11.017. Epub 2011 Jul 27.

Abstract

Objectives: To identify prognostic factors for renal cell carcinoma (RCC) with venous tumor thrombus (VTT) and determine the significance of thrombus level on survival.

Materials and methods: Patients within the Surveillance, Epidemiology, and End Results (SEER) database with RCC and VTT were identified and included if managed surgically. The Kaplan-Meier method and Cox regression analyses were performed to identify factors associated with disease-specific survival.

Results: A total of 1,875 patients met the inclusion criteria. One-year survival for patients undergoing surgery was 60% for patients with metastases and 90% for those without. Factors associated with worse survival included larger tumor size (HR 1.2, 95% CI 1.0-1.4), medullary, collecting duct, or sarcomatoid histology (HR 2.2, 95% CI 1.5-3.3), Fuhrman grade 3 (HR 2.2, 95% CI 1.5-3.3) or grade 4 (HR 2.9, 95% CI 1.8-4.5) tumors, positive lymph nodes (HR 1.5, 95% CI 1.0-2.0), and metastases (HR 3.5, 95% CI 2.6-4.8). Thrombus level above the diaphragm (T3c) was not significantly associated with worse survival (HR 1.4, 95% CI 0.8-2.5).

Conclusions: In this large, population-based study of patients with RCC and VTT, we identify several disease-specific factors strongly associated with cancer-specific mortality. After controlling for adverse prognostic factors, thrombus level was not associated with worse outcome.

MeSH terms

  • Aged
  • Carcinoma, Renal Cell / complications
  • Carcinoma, Renal Cell / mortality*
  • Carcinoma, Renal Cell / pathology
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Kidney Neoplasms / complications
  • Kidney Neoplasms / mortality*
  • Kidney Neoplasms / pathology
  • Male
  • Middle Aged
  • Neoplastic Cells, Circulating / pathology*
  • Proportional Hazards Models
  • SEER Program
  • Venous Thrombosis / etiology
  • Venous Thrombosis / mortality*
  • Venous Thrombosis / pathology