Analysis Of Survival And Correlative Factors On Renal Cell Carcinoma With Renal Vein Tumor Thrombus

ObjectiveTo discuss and analyze the long-term survival and to find correlative factors of renal cell carcinoma with renal vein tumor thrombus without distant metastasis.Methods128 cases of renal cell carcinoma with renal vein tumor thrombus treated by urology department of Cancer Hospital Chinese Academy of Medical Sciences from January 2000 to September 2015, which were no distant metastasis before operations and confirmed by postoperatively pathological examinations, were retrospectively analyzed, including clinical informations, preoperative diagnosis, treatments and survival situations. Survival analysis was estimated with Kaplan-Meier method. Univariable and multivariable suvival analyses were performed by using the COX proportional hazard regression model to seek the prognostic factors of renal cell carcinoma with renal vein tumor thrombus. Define the risk groups of high, middle and low groups according to the prognostic factors in order to analyze the survivals of different groups and guide clinical strategies.Results128 cases accounted for 2.89% of renal cell carcinoma admitted during the same period (128/4426), including 103 male and 25 female patients. The median age was 61 years old (34-87).89 tumor thrombus were detected by preoperative image’s while 39 detected during operations. Patients were all grade 0 tumor thrombus by using Mayo classificaton system. All patients underwent retroperitoneal radical nephrectomy plus embolectomy, and 2 of which were laparoscopic operations. No tumor thrombus fell out during operations.60 accepted adjuvant therapies such as cytokine and targeted drugs and 68 were followed by active surveillance.121 cases (94.5%) were followed up with a median time of 47 months (7-194).59 occured metastasis or recurrence postoperaticely with a median time of 40 months (2-108).37 cases died. The median survival time was 127 months (95%CI:100.8-153.2). Cancer-specific survival (CSS) for 5 years was 65.1%. Cox indicated that Paraneoplasitc Syndrome, Fuhrman grade(G3/4), perirenal fat invasion, blood tranfusion, tumor diameter, tumor necrosis, BMI and lymphatic metastasis influenced prognosis, and Paraneoplasitc Syndrome, Fuhrman grade(G3/4), perirenal fat invasion were independent prognostic fators (p<0.05). The 5-year CSS of low-risk group was 100%, however, the 5-year CSS of high-risk group was just 24.9%.ConclusionsRenal cell carcinoma with renal vein tumor thrombus without distant metastasis had low incidence. No tumor thrombus fell out during operations. There was good prognosis after radical surgeries. Patients with Paraneoplasitc Syndrome, higher Fuhrman grade(G3/4) and perirenal fat invasion had worse prognosis.