[Survival analysis in renal cell carcinoma with invasion of the vena cava]

Ninety-nine consecutive patients with renal cell carcinoma in stages pT1-4/N0-3/V0-2/M0 were analyzed. Overall 5 year survival was 61%. Factors with greater impact on survival were: 1) degree of anaplasia (DI 73%, DII 47%, DIII 27%; p = 0.0005), 2) pathological stage (pT1-2 87%, pT3 39%; p = 0.0000), 3) perirenal fat invasion (pT1-2 87%, pT3a 60%; p = 0.007), 4) node status (N0 72%, N1-3 17%; p = 0.0000) and 5) veins invasion (V0 74%, V1-2 35%; p = 0.005). No difference in survival between V1 and V2 (40% vs 33%; p0.05) tumours was found. A multivariable study showed that the degree of anaplasia and veins invasion have a significant and separate influence on survival (p = 0.0000). Among patients with vascular invasion, those with no perirenal fat invasion or node damage show better survival rates than patients with capsular infiltration (62% vs 40%; p) and perform significantly better than patients with capsular invasion and nodal implication (62% vs 30%; p). No survival differences were observed between pT3b stages with venous invasion only and pT1-2 stages (p0.05). Venous invasion is not in itself of prognostic relevance; the prognostic significance of vascular invasion is directly related to the presence of perirenal fat invasion and/or nodal implication.