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Validation of the 2009 UICC/AJCC TMN Staging System for Renal Cell Carcinoma with Venous Extension
Juan I. Martinez-Salamanca, MD1, William C. Huang, MD2, Roberto Bertini, MD3, Fernando Bianco, MD2, Joaquin A. Carballido, MD4, Gaetano Ciancio, MD5, Carlos Hernandez, MD6, Felipe Herranz, MD6, Axel Haferkamp, MD7, Markus Hohenfellner, MD7, Brian Hu, MD8, Theresa Koppie, MD8, Claudio Martinez-Ballesteros, MD4, Francesco Montorsi, MD9, Joan Palou, MD10, Edson Pontes, MD11, Paul Russo, MD2, Marc S. Soloway, MD12, Carlo Terrone, MD13, William C. Faust, MD14, Humberto Villavicencio, MD10, John A. Libertino, MD14, Alexander Volpe, MD13.
1Hospital Universitario Peurta de Hierro-Majadahonda, Madrid, Spain, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA, 3Hosptial San Raffaele, Milan, Italy, 4Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain, 5University of Miami, Miami, FL, USA, 6Hospital General Universitario Gregorio Mara˝ˇn, Madrid, Spain, 7University of Heidelberg Medical School, Heidelberg, Germany, 8University of California, Davis Medical Center, Sacramento, CA, USA, 9Hospital San Raffaele, University Vita-Salute, Milan, Italy, 10Fundaciˇ Puigvert, Barcelona, Spain, 11Wayne State University, Detroid, MI, USA, 12Miller School of Medicine, University of Miami, Miami, FL, USA, 13Maggiore d lla CaritÓ Hospital, University of Eastern Piedmont, Novara, Italy, 14Lahey Clinic, Burlington, MA, USA.

BACKGROUND:
The prognostic significance of venous involvement and tumor 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 renal cell cancer staging system (7th edition) based tumor thrombus level. The goal of this study was to validate the changes to new staging system.
METHODS:
An international consortium of 11 institutions was established to retrospectively review a combined cohort of 1215 patients undergoing radical nephrectomy and tumor thrombectomy for RCC, including 585 patients with inferior vena caval (IVC) involvement or higher. Predictive factors of survival including histology, tumor thrombus level, nodal status, Fürhman grade, and tumor size were analyzed.
RESULTS:
A total of 1122 patients with complete data were reviewed. The median follow-up for all patients was 24.7 months with a median survival of 33.8 months. The 5-year survival for patients with renal vein (RV) involvement was 43.2% vs. 37% for patients with vena caval involvement below the diaphragm and 22% with caval involvement above the diaphragm. On multivariate analysis, tumor size, Fürhman grade, nodal metastasis and tumor thrombus level were independent predictors of survival.
CONCLUSIONS:
Based on analysis of the largest known cohort of patients with RCC and IVC and atrial thrombus involvement, tumor thrombus level is an independent predictor of survival. Our findings validate the changes to the latest AJCC/UICC staging system.


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