Abstract
Background
Local recurrence (LR) after curative therapy for renal cell cancer is a rare event,
and surgery is still the primary treatment option.
Patients and Methods
This was a single-institution, single-arm retrospective study from a prospectively
conducted database. A total of 91 patients with a median age of 63.0 years (interquartile
range, 57.5-68.3), who had undergone LR resection after initial curative treatment
of RCC were enrolled. The time to LR (TTLR) was defined as the interval from primary
curative surgery to LR. Cancer-specific survival, overall survival, and progression-free
survival were evaluated after LR resection. Statistical analyses of the clinical and
pathologic variables were performed using Cox regression analysis and the Kaplan-Meier
method.
Results
The median time to LR was 29.8 months (interquartile range, 10.8-64.3). On multivariate
analysis, age > 65 years, T3/T4 stage, Fuhrman grade 3/4, major venous infiltration,
and positive surgical margins were related to early LR after primary curative surgery.
LR size of ≤ 7 cm and TTLR of > 24 months were associated with longer cancer-specific
survival. Furthermore, patients with a TTLR of > 24 months had better overall survival
and progression-free survival. Of the entire cohort, intraoperative radiation therapy
and targeted therapy were used in 17 (18.7%) and 15 (16.5%) patients, respectively.
Conclusion
Advanced age, T3/T4 stage, Fuhrman grade 3 or 4, major venous infiltration, and positive
surgical margins at primary tumor resection were related to a greater risk of early
LR. An LR size of ≤ 7 cm and TTLR of > 24 months were associated with favorable oncologic
outcomes after LR resection. Thus, patients who present with a longer TTLR and smaller
LR size, along with favorable features at primary tumor resection, will benefit from
surgical treatment.
Keywords
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References
- Renal cell carcinoma.BMJ. 2014; 349: g4797
- Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012.Eur J Cancer. 2013; 49: 1374-1403
- Features associated with recurrence beyond 5 years after nephrectomy and nephron-sparing surgery for renal cell carcinoma: development and internal validation of a risk model (PRELANE score) to predict late recurrence based on a large multicenter database (CORONA/SATURN project).Eur Urol. 2013; 64: 472-477
- Predictors of oncological outcome after resection of locally recurrent renal cell carcinoma.J Urol. 2009; 181: 2044-2051
- Renal cell recurrence for T1 tumors after laparoscopic partial nephrectomy.J Endourol. 2013; 27: 1468-1470
- Two decades' experience with a prospective biobank for urologic oncology: research, clinical care, and the patients' view.Urol Oncol. 2013; 31: 990-996
- EAU guidelines on renal cell carcinoma: 2014 update.Eur Urol. 2015; 67: 913-924
- The Heidelberg classification of renal cell tumours.J Pathol. 1997; 183: 131-133
- The Clavien-Dindo classification of surgical complications: five-year experience.Ann Surg. 2009; 250: 187-196
- 10-Year oncologic outcomes after laparoscopic and open partial nephrectomy.J Urol. 2013; 190: 44-49
- Age at diagnosis as a powerful predictor for disease recurrence after radical nephrectomy in Japanese patients with pT1 renal cell carcinoma.Int J Urol. 2011; 18: 121-125
- Prognostic ability of simplified nuclear grading of renal cell carcinoma.Cancer. 2007; 109: 868-874
- Fas expression in renal cell carcinoma accurately predicts patient survival after radical nephrectomy.Urol Int. 2012; 88: 263-270
- Role of preoperative platelet level in clinical and pathological outcomes after surgery for renal cortical malignancies.BJU Int. 2011; 108: 73-79
- Outcomes and clinicopathologic variables associated with late recurrence after nephrectomy for localized renal cell carcinoma.Urology. 2011; 78: 1101-1106
- Time to recurrence is a significant predictor of cancer-specific survival after recurrence in patients with recurrent renal cell carcinoma—results from a comprehensive multi-centre database (CORONA/SATURN-project).BJU Int. 2013; 112: 909-916
- Prognostic indicators for renal cell carcinoma: a multivariate analysis of 643 patients using the revised 1997 TNM staging criteria.J Urol. 2000; 163: 1090-1095
- Management of isolated renal fossa recurrence following radical nephrectomy.J Urol. 2005; 174: 473-477
- Experience with fossa recurrence of renal cell carcinoma.J Urol. 1992; 147: 1491-1494
- Laparoscopic resection of local recurrence after previous radical nephrectomy for clinically localized renal-cell carcinoma: perioperative outcomes and initial observations.J Endourol. 2010; 24: 1609-1612
- Long-term outcomes after maximal surgical resection and intraoperative electron radiotherapy for locoregionally recurrent or locoregionally advanced primary renal cell carcinoma.Int J Radiat Oncol Biol Phys. 2012; 82: 1938-1943
- Intraoperative electron radiation therapy (IOERT) in patients with locally recurrent renal cell carcinoma.Radiat Oncol. 2013; 8: 282
- A systematic review of sequencing and combinations of systemic therapy in metastatic renal cancer.Eur Urol. 2015; 67: 100-110
Article info
Publication history
Published online: February 05, 2016
Accepted:
January 31,
2016
Received in revised form:
January 21,
2016
Received:
October 26,
2015
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
