Prognostic relevance of intracaval neoplastic extension for patients with renal cell cancer

Objective To assess the diagnosis of vena caval thrombosis (VCT) in patients with renal cell carcinoma (RCC) as an independent indicator of prognostic importance and when combined with additional tumour characteristics in a controlled multivariate analysis. Patients and methods The clinical course of 53 patients (41 men and 12 women, mean age 60 years. range 35-79) with RCC and VCT was compared with that of a control group of 47 patients (37 men and 10 women, mean age 57 years, range 32-76) with RCC but no neoplastic extension into the vena cava. Results With a follow-up of 1-154 months and a mean long-term survival of 32 and 35 months, respectively, for patients with and without VCT, neither the propagation of the tumour into the vena cava (P=0.391) nor the cranial extension of the thrombosis (P=0.158) were identified as having any prognostic value during univariate or multivariate statistical analysis, The presence of regional lymph node (P<0.001) or distant metastases (P=0.009) was an independent prognostic variable for patients with RCC, with a significant decrease in long-term survival (13 and 14 months for patients with lymph node and distant metastases, respectively). Conclusion A radical surgical approach is essential as standard therapy for the treatment of patients with RCC and neoplastic extension into the vena cava. Because they have a significantly decreased life expectancy, asymptomatic patients with lymph node or distant metastases should be treated conservatively.