Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension

Juan I. Martínez-Salamanca, William C. Huang, Isabel Millán, Roberto Bertini, Fernando J. Bianco, Joaquin A. Carballido, Gaetano Ciancio, Carlos Hernández, Felipe Herranz, Axel Haferkamp, Markus Hohenfellner, Brian Hu, Theresa Koppie, Claudio Martínez-Ballesteros, Francesco Montorsi, Joan Palou, J. Edson Pontes, Paul Russo, Carlo Terrone, Humberto VillavicencioAlessandro Volpe, John A. Libertino

Research output: Contribution to journalArticle

125 Citations (Scopus)

Abstract

Background: The prognostic significance of venous involvement and tumour thrombus level in renal cell carcinoma (RCC) remains highly controversial. In 2010, the American Joint Committee on Cancer (AJCC) and the Union International Centre le Cancer (UICC) revised the RCC staging system (7th edition) based on tumour thrombus level, differentiating the T stage of tumours limited to renal-vein-only involvement. Objective: We aimed to evaluate the impact of tumour thrombus extension in a multi-institutional cohort of patients. Design, setting, and participants: An international consortium of 11 institutions was established to retrospectively review a combined cohort of 1215 patients undergoing radical nephrectomy and tumour thrombectomy for RCC, including 585 patients with inferior vena cava (IVC) involvement or higher. Measurements: Predictive factors of survival, including histology, tumour thrombus level, nodal status, Fuhrman grade, and tumour size, were analysed. Results and limitations: A total of 1122 patients with complete data were reviewed. The median follow-up for all patients was 24.7 mo, with a median survival of 33.8 mo. The 5-yr survival was 43.2% (renal vein involvement), 37% (IVC below the diaphragm), and 22% with caval involvement above the diaphragm. On multivariate analysis, tumour size (hazard ratio [HR]: 1.64 [range: 1.03-2.59]; p = 0.036), Fuhrman grade (HR: 2.26 [range: 1.65-3.1]; p = 0.000), nodal metastasis (HR: 1.32 [range: 1.09-1.67]; p = 0.005), and tumour thrombus level (HR: 2.10 [range: 1.53-3.0]; p = 0.00) correlated independently with survival. Conclusions: Based on analysis of the largest known cohort of patients with RCC along with IVC and atrial thrombus involvement, tumour thrombus level is an independent predictor of survival. Our findings support the changes to the latest AJCC/UICC staging system.

Original languageEnglish
Pages (from-to)120-127
Number of pages8
JournalEuropean Urology
Volume59
Issue number1
DOIs
StatePublished - Jan 1 2011

Fingerprint

Neoplasm Staging
Renal Cell Carcinoma
Thrombosis
Neoplasms
Inferior Vena Cava
Survival
Renal Veins
Diaphragm
Thrombectomy
Venae Cavae
Nephrectomy
Histology
Multivariate Analysis

Keywords

  • 2009 TNM
  • Prognostic factors
  • Renal cell carcinoma
  • Survival
  • Venous extension
  • Venous thrombus

ASJC Scopus subject areas

  • Urology

Cite this

Martínez-Salamanca, J. I., Huang, W. C., Millán, I., Bertini, R., Bianco, F. J., Carballido, J. A., ... Libertino, J. A. (2011). Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension. European Urology, 59(1), 120-127. https://doi.org/10.1016/j.eururo.2010.10.001

Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension. / Martínez-Salamanca, Juan I.; Huang, William C.; Millán, Isabel; Bertini, Roberto; Bianco, Fernando J.; Carballido, Joaquin A.; Ciancio, Gaetano; Hernández, Carlos; Herranz, Felipe; Haferkamp, Axel; Hohenfellner, Markus; Hu, Brian; Koppie, Theresa; Martínez-Ballesteros, Claudio; Montorsi, Francesco; Palou, Joan; Pontes, J. Edson; Russo, Paul; Terrone, Carlo; Villavicencio, Humberto; Volpe, Alessandro; Libertino, John A.

In: European Urology, Vol. 59, No. 1, 01.01.2011, p. 120-127.

Research output: Contribution to journalArticle

Martínez-Salamanca, JI, Huang, WC, Millán, I, Bertini, R, Bianco, FJ, Carballido, JA, Ciancio, G, Hernández, C, Herranz, F, Haferkamp, A, Hohenfellner, M, Hu, B, Koppie, T, Martínez-Ballesteros, C, Montorsi, F, Palou, J, Pontes, JE, Russo, P, Terrone, C, Villavicencio, H, Volpe, A & Libertino, JA 2011, 'Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension', European Urology, vol. 59, no. 1, pp. 120-127. https://doi.org/10.1016/j.eururo.2010.10.001
Martínez-Salamanca JI, Huang WC, Millán I, Bertini R, Bianco FJ, Carballido JA et al. Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension. European Urology. 2011 Jan 1;59(1):120-127. https://doi.org/10.1016/j.eururo.2010.10.001
Martínez-Salamanca, Juan I. ; Huang, William C. ; Millán, Isabel ; Bertini, Roberto ; Bianco, Fernando J. ; Carballido, Joaquin A. ; Ciancio, Gaetano ; Hernández, Carlos ; Herranz, Felipe ; Haferkamp, Axel ; Hohenfellner, Markus ; Hu, Brian ; Koppie, Theresa ; Martínez-Ballesteros, Claudio ; Montorsi, Francesco ; Palou, Joan ; Pontes, J. Edson ; Russo, Paul ; Terrone, Carlo ; Villavicencio, Humberto ; Volpe, Alessandro ; Libertino, John A. / Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension. In: European Urology. 2011 ; Vol. 59, No. 1. pp. 120-127.
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abstract = "Background: The prognostic significance of venous involvement and tumour thrombus level in renal cell carcinoma (RCC) remains highly controversial. In 2010, the American Joint Committee on Cancer (AJCC) and the Union International Centre le Cancer (UICC) revised the RCC staging system (7th edition) based on tumour thrombus level, differentiating the T stage of tumours limited to renal-vein-only involvement. Objective: We aimed to evaluate the impact of tumour thrombus extension in a multi-institutional cohort of patients. Design, setting, and participants: An international consortium of 11 institutions was established to retrospectively review a combined cohort of 1215 patients undergoing radical nephrectomy and tumour thrombectomy for RCC, including 585 patients with inferior vena cava (IVC) involvement or higher. Measurements: Predictive factors of survival, including histology, tumour thrombus level, nodal status, Fuhrman grade, and tumour size, were analysed. Results and limitations: A total of 1122 patients with complete data were reviewed. The median follow-up for all patients was 24.7 mo, with a median survival of 33.8 mo. The 5-yr survival was 43.2{\%} (renal vein involvement), 37{\%} (IVC below the diaphragm), and 22{\%} with caval involvement above the diaphragm. On multivariate analysis, tumour size (hazard ratio [HR]: 1.64 [range: 1.03-2.59]; p = 0.036), Fuhrman grade (HR: 2.26 [range: 1.65-3.1]; p = 0.000), nodal metastasis (HR: 1.32 [range: 1.09-1.67]; p = 0.005), and tumour thrombus level (HR: 2.10 [range: 1.53-3.0]; p = 0.00) correlated independently with survival. Conclusions: Based on analysis of the largest known cohort of patients with RCC along with IVC and atrial thrombus involvement, tumour thrombus level is an independent predictor of survival. Our findings support the changes to the latest AJCC/UICC staging system.",
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T1 - Prognostic impact of the 2009 UICC/AJCC TNM staging system for renal cell carcinoma with venous extension

AU - Martínez-Salamanca, Juan I.

AU - Huang, William C.

AU - Millán, Isabel

AU - Bertini, Roberto

AU - Bianco, Fernando J.

AU - Carballido, Joaquin A.

AU - Ciancio, Gaetano

AU - Hernández, Carlos

AU - Herranz, Felipe

AU - Haferkamp, Axel

AU - Hohenfellner, Markus

AU - Hu, Brian

AU - Koppie, Theresa

AU - Martínez-Ballesteros, Claudio

AU - Montorsi, Francesco

AU - Palou, Joan

AU - Pontes, J. Edson

AU - Russo, Paul

AU - Terrone, Carlo

AU - Villavicencio, Humberto

AU - Volpe, Alessandro

AU - Libertino, John A.

PY - 2011/1/1

Y1 - 2011/1/1

N2 - Background: The prognostic significance of venous involvement and tumour thrombus level in renal cell carcinoma (RCC) remains highly controversial. In 2010, the American Joint Committee on Cancer (AJCC) and the Union International Centre le Cancer (UICC) revised the RCC staging system (7th edition) based on tumour thrombus level, differentiating the T stage of tumours limited to renal-vein-only involvement. Objective: We aimed to evaluate the impact of tumour thrombus extension in a multi-institutional cohort of patients. Design, setting, and participants: An international consortium of 11 institutions was established to retrospectively review a combined cohort of 1215 patients undergoing radical nephrectomy and tumour thrombectomy for RCC, including 585 patients with inferior vena cava (IVC) involvement or higher. Measurements: Predictive factors of survival, including histology, tumour thrombus level, nodal status, Fuhrman grade, and tumour size, were analysed. Results and limitations: A total of 1122 patients with complete data were reviewed. The median follow-up for all patients was 24.7 mo, with a median survival of 33.8 mo. The 5-yr survival was 43.2% (renal vein involvement), 37% (IVC below the diaphragm), and 22% with caval involvement above the diaphragm. On multivariate analysis, tumour size (hazard ratio [HR]: 1.64 [range: 1.03-2.59]; p = 0.036), Fuhrman grade (HR: 2.26 [range: 1.65-3.1]; p = 0.000), nodal metastasis (HR: 1.32 [range: 1.09-1.67]; p = 0.005), and tumour thrombus level (HR: 2.10 [range: 1.53-3.0]; p = 0.00) correlated independently with survival. Conclusions: Based on analysis of the largest known cohort of patients with RCC along with IVC and atrial thrombus involvement, tumour thrombus level is an independent predictor of survival. Our findings support the changes to the latest AJCC/UICC staging system.

AB - Background: The prognostic significance of venous involvement and tumour thrombus level in renal cell carcinoma (RCC) remains highly controversial. In 2010, the American Joint Committee on Cancer (AJCC) and the Union International Centre le Cancer (UICC) revised the RCC staging system (7th edition) based on tumour thrombus level, differentiating the T stage of tumours limited to renal-vein-only involvement. Objective: We aimed to evaluate the impact of tumour thrombus extension in a multi-institutional cohort of patients. Design, setting, and participants: An international consortium of 11 institutions was established to retrospectively review a combined cohort of 1215 patients undergoing radical nephrectomy and tumour thrombectomy for RCC, including 585 patients with inferior vena cava (IVC) involvement or higher. Measurements: Predictive factors of survival, including histology, tumour thrombus level, nodal status, Fuhrman grade, and tumour size, were analysed. Results and limitations: A total of 1122 patients with complete data were reviewed. The median follow-up for all patients was 24.7 mo, with a median survival of 33.8 mo. The 5-yr survival was 43.2% (renal vein involvement), 37% (IVC below the diaphragm), and 22% with caval involvement above the diaphragm. On multivariate analysis, tumour size (hazard ratio [HR]: 1.64 [range: 1.03-2.59]; p = 0.036), Fuhrman grade (HR: 2.26 [range: 1.65-3.1]; p = 0.000), nodal metastasis (HR: 1.32 [range: 1.09-1.67]; p = 0.005), and tumour thrombus level (HR: 2.10 [range: 1.53-3.0]; p = 0.00) correlated independently with survival. Conclusions: Based on analysis of the largest known cohort of patients with RCC along with IVC and atrial thrombus involvement, tumour thrombus level is an independent predictor of survival. Our findings support the changes to the latest AJCC/UICC staging system.

KW - 2009 TNM

KW - Prognostic factors

KW - Renal cell carcinoma

KW - Survival

KW - Venous extension

KW - Venous thrombus

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