Prognostic implications of vena caval extension of XXXX .

@entity1 @entity66 @entity5 @entity1358 @entity3 @entity715 @entity703
Vena caval extension of @entity1358 occurs in 4 to 10 per cent of the @entity1 and usually is considered a poor prognostic sign. To ascertain the true effect of vena caval extension on survival a retrospective analysis was done of 27 @entity1 who had undergone radical nephrectomy and removal of vena caval thrombus between 1970 and 1980. An additional 46 cases were collected from series in the literature and composite statistics were compiled. Extension to the vena cava alone had a limited impact on prognosis (survival for 2 years--81 per cent, 5 years--53 per cent, median--81 months). Capsular invasion negatively influenced survival (2-year survival 66 per cent). Disease in the regional lymph nodes had a much greater impact on survival, with a 2-year survival rate of 35 per cent and no @entity1 survived 5 years (median survival 24 months). Only 5 per cent of the @entity1 with distant @entity3 survived 2 years and none survived 5 years (median survival 8.5 months). In conclusion, the prognosis of @entity1 with vena caval @entity5 thrombus is influenced primarily by known adverse prognostic factors: capsular invasion, @entity66 and distant @entity3 . Aggressive surgery in @entity1 with gross nodal involvement or distant @entity3 is unwarranted since it contributes nothing to survival and only 7 per cent of the @entity1 had significant signs or symptoms secondary to the vena caval thrombus itself. @entity1 with vena caval extension alone have a cure rate approaching that of @entity1 with stage I @entity703 following radical @entity715 .
