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Renal cell carcinoma clinically involving adjacent organs
Author(s) -
Margulis Vitaly,
SánchezOrtiz Ricardo F.,
Tamboli Pheroze,
Cohen Daniel D.,
Swanson David A.,
Wood Christopher G.
Publication year - 2007
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.22629
Subject(s) - medicine , renal cell carcinoma , nephrectomy , hazard ratio , stage (stratigraphy) , cancer , carcinoma , kidney cancer , disease , institutional review board , oncology , gastroenterology , kidney , surgery , urology , confidence interval , paleontology , biology
BACKGROUND. Historically, patients with nonmetastatic renal cell carcinoma (RCC) involving adjacent organs have been considered inoperable and incurable. The oncologic efficacy of an aggressive surgical approach was evaluated in a selected subpopulation of RCC patients. Further, an attempt was made to define the clinical and pathologic characteristics predictive of surgical failure. METHODS. With Institutional Review Board approval, the institutional nephrectomy database of 3470 patients treated at MD Anderson Cancer Center from 1990 to 2006 was searched for RCC patients treated with radical nephrectomy and resection of at least 1 adjacent organ thought to be directly involved by RCC. Patients with nonmetastatic RCC and a minimum follow‐up of 6 months were included in the analysis. RESULTS. In all, 30 patients with clinical T4NxM0 RCC and median follow‐up of 32.3 months (range, 8.5–140.1) met the study inclusion criteria and comprise the dataset for the analysis. On pathologic evaluation 60% of patients were clinically overstaged, as only 12 (40%) of 30 patients demonstrated direct invasion into adjacent organs resected. None of the clinical tumor characteristics predicted a finding of pathologic T4 RCC. Nodal involvement and pathologic T stage were significant independent predictors of disease recurrence (hazard ratio [HR] 3.726, P = .043, and HR 2.414, P = .045, respectively) and cancer‐specific survival (HR 17.145, P = .002, and HR 3.791, P = .024, respectively). Disease recurred in 11 of 18 (61.1%) of