Renal cell carcinoma clinically involving adjacent organs: Experience with aggressive surgical management

Vitaly Margulis, Ricardo F. Sánchez-Ortiz, Pheroze Tamboli, Daniel D. Cohen, David A. Swanson, Christopher G. Wood

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

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 <pT4 patients and in 10 of 12 (83.3%) of pT4 patients at a median 13.3 and 2.3 months, respectively; 13 (73.3%) <pT4 patients and 5 (41.7%) pT4 patients were alive at the time of analysis. CONCLUSIONS. True pathologic involvement of adjacent organs by RCC cannot be predicted from pre- or intraoperative parameters. A significant proportion of patients clinically suspected of having T4 RCC are downstaged, and benefit from aggressive surgical resection with en bloc removal of involved organs.

Original languageEnglish (US)
Pages (from-to)2025-2030
Number of pages6
JournalCancer
Volume109
Issue number10
DOIs
StatePublished - May 15 2007

Fingerprint

Renal Cell Carcinoma
CD4-Positive T-Lymphocytes
Nephrectomy
Neoplasms
Research Ethics Committees
Databases
Recurrence

Keywords

  • Disease-specific outcome
  • Radical nephrectomy
  • Renal cell carcinoma
  • Tumor staging

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Margulis, V., Sánchez-Ortiz, R. F., Tamboli, P., Cohen, D. D., Swanson, D. A., & Wood, C. G. (2007). Renal cell carcinoma clinically involving adjacent organs: Experience with aggressive surgical management. Cancer, 109(10), 2025-2030. https://doi.org/10.1002/cncr.22629

Renal cell carcinoma clinically involving adjacent organs : Experience with aggressive surgical management. / Margulis, Vitaly; Sánchez-Ortiz, Ricardo F.; Tamboli, Pheroze; Cohen, Daniel D.; Swanson, David A.; Wood, Christopher G.

In: Cancer, Vol. 109, No. 10, 15.05.2007, p. 2025-2030.

Research output: Contribution to journalArticle

Margulis, V, Sánchez-Ortiz, RF, Tamboli, P, Cohen, DD, Swanson, DA & Wood, CG 2007, 'Renal cell carcinoma clinically involving adjacent organs: Experience with aggressive surgical management', Cancer, vol. 109, no. 10, pp. 2025-2030. https://doi.org/10.1002/cncr.22629
Margulis, Vitaly ; Sánchez-Ortiz, Ricardo F. ; Tamboli, Pheroze ; Cohen, Daniel D. ; Swanson, David A. ; Wood, Christopher G. / Renal cell carcinoma clinically involving adjacent organs : Experience with aggressive surgical management. In: Cancer. 2007 ; Vol. 109, No. 10. pp. 2025-2030.
@article{29880963f24142cb8219c221c66c3fe3,
title = "Renal cell carcinoma clinically involving adjacent organs: Experience with aggressive surgical management",
abstract = "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",
keywords = "Disease-specific outcome, Radical nephrectomy, Renal cell carcinoma, Tumor staging",
author = "Vitaly Margulis and S{\'a}nchez-Ortiz, {Ricardo F.} and Pheroze Tamboli and Cohen, {Daniel D.} and Swanson, {David A.} and Wood, {Christopher G.}",
year = "2007",
month = "5",
day = "15",
doi = "10.1002/cncr.22629",
language = "English (US)",
volume = "109",
pages = "2025--2030",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "10",

}

TY - JOUR

T1 - Renal cell carcinoma clinically involving adjacent organs

T2 - Experience with aggressive surgical management

AU - Margulis, Vitaly

AU - Sánchez-Ortiz, Ricardo F.

AU - Tamboli, Pheroze

AU - Cohen, Daniel D.

AU - Swanson, David A.

AU - Wood, Christopher G.

PY - 2007/5/15

Y1 - 2007/5/15

N2 - 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

AB - 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

KW - Disease-specific outcome

KW - Radical nephrectomy

KW - Renal cell carcinoma

KW - Tumor staging

UR - http://www.scopus.com/inward/record.url?scp=34248327187&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34248327187&partnerID=8YFLogxK

U2 - 10.1002/cncr.22629

DO - 10.1002/cncr.22629

M3 - Article

C2 - 17420980

AN - SCOPUS:34248327187

VL - 109

SP - 2025

EP - 2030

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 10

ER -