EMUC 2020: Management and Survival of Patients with Retroperitoneal Recurrences Following Radical Nephrectomy

(UroToday.com) In a talk presented in the Oral Presentations session of the 12th European Multidisciplinary Congress on Urological Cancers (EMUC), Dr. Michele Marchioni presented recent work examining the management of patients with retroperitoneal recurrences following radical nephrectomy for renal cell carcinoma. This is a relatively uncommon clinical situation and thus, there is minimal data available to date.


The authors relied on a large international collaborative dataset to identify patients with local recurrence following radical nephrectomy. The authors sought to examine the effect of treatment approach (categorized as observation, surgery only, surgery and systemic therapy, or systemic therapy alone) as well as other predictors on cancer-specific survival. Secondarily, the authors examined synchronous metastatic disease and progression-free survival as outcomes. They used the Kaplan Meier method and Cox proportional hazards models to identify predictors of cancer specific mortality and progression free survival and logistic regression models to identify predictors of metastasis at the time of recurrence.

Drawing on this large, international dataset, the authors were able to identify 96 patients with retroperitoneal recurrence which occurred at a median of 14.5 months following radical nephrectomy, of whom 44 (46%) had metastatic disease.

On the basis of multivariable logistic regression analyses, metastatic disease at the time of retroperitoneal recurrence was less common among those who underwent laparoscopic radical nephrectomy (odds ratio 0.21, 95% confidence interval 0.04 to 0.77; alternatively suggesting that isolated retroperitoneal recurrence in the absence of metastatic disease may be more common after this treatment approach) but more common along patients aged 55 to 70 years (odds ratio 3.0, 95% confidence interval 1.1-9.3).

Among the 96 included patients, 21% had a combination of surgery and systemic therapy, 27% received surgery alone, 30% received systemic therapy alone, and 23% received neither. Cancer-specific survival rates at 3 years were higher for patients who received surgery and systemic therapy (93%) and surgery alone (63%) than those who received systemic therapy alone (23%) or neither treatment (21%), though this likely reflected selection biases. In Cox proportional hazards models, receipt of systemic therapy alone (hazard ratio 5.4, 95% confidence interval 2.1 to 14.2) and receipt of neither treatment (hazard ratio 5.6, 95% confidence interval 2.2 to 14.9) were associated with higher cancer specific mortality.

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Surgical resection of retroperitoneal recurrences was associated with relatively infrequent and minor complications with only 2 patients of 50 having Clavien-Dindo grade 3 or greater events.

The authors conclude that combined surgical resection and systemic therapy in the treatment of retroperitoneal recurrences may offer a survival benefit, though I would caution that the influence of selection bias cannot be overstated in interpreting these data.

Presented by: Michele Marchioni, MD, Urologist, Cantalicem Italy

Written by: Christopher J.D. Wallis, Urologic Oncology Fellow, Vanderbilt University Medical Center, Contact: @WallisCJD on Twitter at the 12th European Multidisciplinary Congress on Urological Cancers (EMUC) (#EMUC20 ), November 13th - 14th, 2020

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