Renal vein and vena cava involvement does not affect prognosis in patientswith renal cell carcinoma

Objectives:The prognostic value of tumor extension into the renal vein or v ena cava is still a controversial issue. The aim of this study is to report our experience with radical surgery in patients with renal cell carcinoma (RCC) extending into the renal vein or subdiaphragmatic vena cava. Methods: We evaluated 142 patients with RCC involving the renal vein or inferior su bdiaphragmatic vena cava. RCC had extended into the renal vein in 118 patie nts and into the inferior vena cava in the remaining 24. Radical nephrectom y was performed in all cases with renal vein invasion. Radical nephrectomy with cavotomy and tumor thrombus removal was carried out in all cases with inferior subdiaphragmatic vena caval invasion. Cause-specific survival was calculated by means of the Kaplan-Meier method. The log rank test was used for survival comparisons and univariate analysis. Results: The 5- and 10-ye ar cause-specific survival rates were 51.5 and 39%, respectively, in the gr oup of patients with tumor extension into the renal vein and 33.4% in those with inferior vena caval involvement. In 52 patients (44%), RCC extended o nly into the renal vein. In the remaining 66 patients, renal vein invasion was associated with other adverse prognostic factors. Life expectancy was l ower for patients with other concurrent adverse prognostic factors than for those affected by renal vein involvement alone (p < 0.0001). In the latter group, survival expectancy was similar to those with stage T2N0M0 tumor. I n 7 cases (29%), inferior vena caval invasion was not associated with other adverse prognostic factors. In the remaining 15 patients (71 %), vena cava l involvement was associated with other adverse prognostic factors. Concurr ence of other adverse prognostic factors with vena caval invasion significa ntly decreased the disease-specific survival expectancy in comparison with the patients in whom vena caval involvement was the main prognostic factor (p = 0.008). In these patients, disease-specific survival was similar to th ose with stage T2N0M0 tumor. Conclusion: Renal vein or inferior subdiaphrag matic vena caval involvement does not significantly affect prognosis in pat ients with RCC. Copyright (C) 2001 S. Karger AG, Basel.