Peritoneal recurrence (PREC) following nephrectomy for localized renal cancer (RCC) is rare. Our objective was to report a multicenter analysis of PREC to analyze incidence, treatment, survival and risk factors.
Between 1987 and 2023, patients with PREC following radical or partial nephrectomy (PN) for localized RCC across ten European institutions (UroCCR, NKI, IRCCS, Foch and Gustave Roussy centers) were included. PREC patterns were defined as isolated PREC (iPREC) and PREC associated with other metastatic sites (mPREC). The main objective was to evaluate PREC incidence (n PREC / n RCC surgeries). Secondary objectives were to assess PREC treatments, patients survival and risk factors associated with iPREC as compared to mPREC.
We included 117 patients with PREC, including 35 iPREC (30%) and 82 mPREC (70%). PREC incidence was 0.88%. Compared to mPREC, iPREC was significantly associated with PN (OR 4.1, 95% CI [1.7-9.5], P= 0.001), minimally invasive surgery (MIS) (OR 3.3, 95% CI [1.3-8.2], P= 0.007), and lower Leibovich risk scores (OR 4.6, 95% CI [1.9-11.0], P= 0.001). In multivariable analysis, Leibovich score remained significant (OR 3.3, 95% CI [1.2-8.8], P= 0.016). Treatment was mainly systemic (66.7%). Surgical treatment was performed in 11 iPREC cases, with 10 patients remaining progression-free at a median follow-up of 54 months. Overall survival was significantly better in iPREC group (P= 0.007).
PREC incidence was below 1%. Our results suggest 2 distinct mechanisms. One involves local spread, potentially favored by MIS and PN, while the other corresponds to a metastatic dissemination driven by tumor aggressiveness. iPREC appears to have better prognosis as compared to mPREC and be effectively treated with surgery.
Urologic oncology. 2025 Sep 04 [Epub ahead of print]
Caroline Pettenati, Jean-Christophe Bernhard, Zine-Eddine Khene, Umberto Capitanio, Giacomo Musso, Laurence Albiges, Larissa Rainho, Gaëlle Margue, Thibault Waeckel, Gregory Verhoest, Lucas Bento, Nicolas Doumerc, Louis Surlemont, Yann Neuzillet, Thierry Lebret, Niels Graafland, Saeed Dabestani, Axel Bex, Morgan Rouprêt, Karim Bensalah, Pierre Bigot
Department of Urology, Hôpital Franco-Britannique, Cognacq-Jay Foundation, Levallois-Perret, France; Cancer Committee of the French Association of Urology (CCAFU), France. Electronic address: ., Cancer Committee of the French Association of Urology (CCAFU), France; Department of Urology, Pellegrin University Hospital, Bordeaux, France., Cancer Committee of the French Association of Urology (CCAFU), France; Department of Urology, University Hospital of Rennes, Rennes, France., IRCCS San Raffaele Scientific Institute, Urological Research Institute (URI), Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy., Cancer Committee of the French Association of Urology (CCAFU), France; Department of Medical Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France., Department of Medical Oncology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France., Cancer Committee of the French Association of Urology (CCAFU), France; Department of Urology, University Hospital of Caen, Caen, France., Department of Urology, University Hospital of Rennes, Rennes, France., Department of Urology, University Hospital of Toulouse, Toulouse, France., Cancer Committee of the French Association of Urology (CCAFU), France; Department of Urology, University Hospital of Toulouse, Toulouse, France., Department of Urology, University Hospital of Rouen, Rouen, France., Department of Urology, Hôpital Foch, Versailles - Saint-Quentin-en-Yvelines University, Suresnes, France., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, Kristianstad Central Hospital, Region Skane, Kristianstad, Sweden; Department of Translational Medicine, Division of Urological Cancers, Lund University, Lund, Sweden., Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Urology, Royal Free London NHS Foundation Trust, University College London, Division of Surgery and Interventional Science, London, United Kingdom., Cancer Committee of the French Association of Urology (CCAFU), France; Department of Urology, AP-HP, Hôpital La Pitié-Salpétrière, Sorbonne University, Paris, France., Department of Urology, Pellegrin University Hospital, Bordeaux, France., Cancer Committee of the French Association of Urology (CCAFU), France; Department of Urology, University Hospital of Angers, Angers, France.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/40912981