Preoperative multivariable prognostic models for prediction of survival and major complications following surgical resection of renal cell carcinoma with suprahepatic caval tumor thrombus

Abstract Objective Surgical resection for renal cell carcinoma (RCC) with suprahepatic inferior vena cava tumor thrombus is associated with significant morbidity, yet there are currently no tools for preoperative prognostic evaluation. Our goal was to develop a preoperative multivariable model for p...

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Published in:	Urologic oncology 2015-09, Vol.33 (9), p.388.e1-388.e9
Main Authors:	Haddad, Ahmed Q., M.B.Ch.B., Ph.D, Leibovich, Bradley C., M.D, Abel, Edwin Jason, M.D, Luo, Jun-Hang, M.D, Krabbe, Laura-Maria, M.D, Thompson, Robert Houston, M.D, Heckman, Jennifer E., M.D, Merrill, Megan M., M.D, Gayed, Bishoy A., M.D, Sagalowsky, Arthur I., M.D, Boorjian, Stephen A., M.D, Wood, Christopher G., M.D, Margulis, Vitaly, M.D
Format:	Article
Language:	eng
Subjects:	Adult Aged Aged, 80 and over Area Under Curve Carcinoma, Renal Cell - mortality Carcinoma, Renal Cell - pathology Carcinoma, Renal Cell - surgery Female Humans Inferior vena cava Kidney Neoplasms - mortality Kidney Neoplasms - pathology Kidney Neoplasms - surgery Male Middle Aged Multivariate Analysis Neoplastic Cells, Circulating - pathology Nomogram Nomograms Postoperative Complications - epidemiology Prognosis Proportional Hazards Models Renal cell carcinoma ROC Curve Thrombus Urology Vena Cava, Inferior - pathology Venous Thrombosis - etiology Venous Thrombosis - mortality Venous Thrombosis - surgery
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Summary:	Abstract Objective Surgical resection for renal cell carcinoma (RCC) with suprahepatic inferior vena cava tumor thrombus is associated with significant morbidity, yet there are currently no tools for preoperative prognostic evaluation. Our goal was to develop a preoperative multivariable model for prediction of survival and risk of major complications in patients with suprahepatic thrombi. Methods We identified patients who underwent surgery for RCC with suprahepatic tumor thrombus extension from 2000 to 2013 at 4 tertiary centers. A Cox proportional hazard model was used for analysis of overall survival (OS) and logistic regression was used for major complications within 90 days of surgery (Clavien≥3A). Nomograms were internally calibrated by bootstrap resampling method. Results A total of 49 patients with level III thrombus and 83 patients with level IV thrombus were identified. During median follow-up of 24.5 months, 80 patients (60.6%) died and 46 patients (34.8%) experienced major complication. Independent prognostic factors for OS included distant metastases at presentation (hazard ratio = 2.52, P = 0.002) and Eastern Cooperative Oncology Group (ECOG) performance status (hazard ratio = 1.84, P
ISSN:	1078-1439 1873-2496