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Vol. 43. Issue 2.
Pages 77-83 (March 2019)
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Vol. 43. Issue 2.
Pages 77-83 (March 2019)
Original article
Influence of venous tumour extension on local and remote recurrence of stage pT3a pN0 cM0 kidney tumours
Influencia de la extensión tumoral venosa en la recidiva local y a distancia de los tumores renales en un estadio pT3a pN0 cM0
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G. Barbas Bernardos
Corresponding author
guillermobarbas@gmail.com

Corresponding author.
, F. Herranz Amo, J. Caño Velasco, M.J. Cancho Gil, J. Mayor de Castro, J. Aragón Chamizo, L. Polanco Pujol, C. Hernández Fernández
Unidad de Tumores Renales con Afectación Venosa (TRAV), Servicio de Urología, HGU Gregorio Marañón, Madrid, Spain
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Tables (3)
Table 1. Clinical characteristics of the series and surgical approach.
Table 2. Pathological characteristics of the series.
Table 3. Univariate and multivariate analysis for tumour recurrence.
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Abstract
Introduction and objective

One of the inherent features of kidney tumours is the capacity to spread inside the venous system as tumour thrombi. The aim of this study was to assess in patients with stage pT3apN0cM0 kidney cancer whether venous tumour involvement influenced tumour recurrence.

Materials and methods

A retrospective analysis of patients with stage pT3apN0cM0 kidney cancer treated with radical nephrectomy between 1990 and 2015. Univariate and multivariate Cox regression analysis to identify predictive variables and independent predictive variables relating to recurrence.

Results

The results of 153 patients were studied. The median follow-up was 82 (IQR 36–117) months. Recurrence-free survival at 5 years was 58.9% with a median of 97 (95% CI 49.9–144.1) months. Seventy-seven (50.3%) patients recurred. Seventy cases 70 (90.9%) had distant metastases, 17 (14.2%) of these patients had local recurrence in the bed of nephrectomy. Tumour necrosis (p=0.0001), and microvascular invasion (p=0.001) were identified as independent predictors of tumour recurrence in the multivariable analysis.

Conclusions

In our series, after multivariable analysis, venous tumour extension was not related to recurrence. Tumour necrosis and microvascular infiltration did behave as independent predictive factors of tumour recurrence.

Keywords:
Cancer specific survival
Renal cell carcinoma
Venous tumour thrombus
Resumen
Introducción y objetivo

Una de las características inherentes a los tumores renales es la capacidad de extenderse al interior del sistema venoso como trombos tumorales. El objetivo de este estudio es evaluar en los pacientes con cáncer renal en un estadio pT3apN0cM0 si la existencia de afectación tumoral venosa influye en la recidiva tumoral.

Materiales y métodos

Análisis retrospectivo de pacientes con cáncer renal en estadio pT3apN0cM0 tratados con nefrectomía radical entre 1990-2015. Análisis univariante y multivariante mediante regresión de Cox para identificar variables predictoras y variables predictoras independientes relacionadas con la recidiva.

Resultados

Se analizaron los resultados de 153 pacientes. La mediana de seguimiento fue de 82 (IQR 36-117) meses. La supervivencia libre de recidiva a los 5 años fue del 58,9% con una mediana de 97 (IC95% 49,9-144,1) meses. Recidivaron 77 (50,3%) pacientes. En 70 (90,9%) casos las metástasis fueron a distancia, en 17 (14,2%) de estos pacientes se objetivó recurrencia local en el lecho de nefrectomía sincrónica. En el análisis multivariable se identificaron como variables predictoras independientes de recidiva tumoral la necrosis tumoral (p=0,0001) y la invasión microvascular (p=0,001).

Conclusiones

La existencia de extensión tumoral venosa no se ha relacionado, en nuestra serie y tras la realización del análisis multivariable, con la recidiva. La necrosis tumoral y la infiltración microvascular sí se comportaron como factores predictores independientes de recidiva tumoral.

Palabras clave:
Supervivencia cáncer específica
Cáncer renal
Trombo venoso tumoral

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