Risk Factors That Affect Survival in Patients with Renal Cell Carcinoma Invading the Vena Cava

Abstract

Objectives: To determine which risk factors are associated with overall survival in patients with T3b or T3c renal cell carcinoma. Materials and Methods: Retrospective chart review was performed on all patients who underwent a nephrectomy at Lahey Hospital from 1971-2014 and had a diagnosis of pathologic T3b or T3c renal cell carcinoma. Twenty-one potential risk factors were examined and analyzed using Cox Proportional Hazard Survival models. Additional factors examined in this cohort included rate of complications, tumor recurrence, intra-operative death rate, and 30-day mortality rate. Results: One-hundred eighty-two patients with stage T3b or T3c renal cell carcinoma met inclusion criteria. Of these, 124 (68%) were stage T3b and 58 (32%) were stage T3c. Median follow-up was 18.5 months. One-hundred and six (58%) patients experienced a complication from surgery. The intra-operative death rate was 1.1% (2 patients). The 30-day mortality rate was 7.1% (13 patients). Seventy-one (39%) patients had disease recurrence at a median of 7 months (range 1 - 232 months). The 5-year disease-specific survival was 40% and the 5-year overall survival was 32%. Of the 21 risk factors analyzed, clear cell histology, positive lymph nodes, and peri-nephric fat involvement were all significant at the p < 0 .05 level using unadjusted modeling. On multivariable analysis, fully adjusting for all three significant variables, only positive lymph nodes and peri-nephric fat involvement remained significant. Conclusions: In patients with T3b or T3c renal cell carcinoma overall survival is associated with lymph node positivity and peri-nephric fat involvement and not tumor thrombus level.