To describe the course of disease of patients surgically treated for locally recurrent renal cell carcinoma (LRRCC) after nephrectomy and to identify potential predictive factors for long-term survival.
We, retrospectively, identified 54 patients who underwent surgical resection of LRRCC after open nephrectomy for localized kidney cancer. The median age at time of surgery for LRRCC was 65 years. Survival rates were determined with the Kaplan-Meier method. Mantel-Haenszel hazard ratios were calculated. Comparisons were made with the log-rank test. Cox proportional hazard models were used to analyze combined effects of variables.
Median time to local recurrence after nephrectomy was 36 months (5-242 months). Median follow-up after surgery for LRRCC was 39 months. At time of analysis 18 patients (33%) were alive without any evidence of disease, 8 patients (15%) were alive with disease, 20 patients (37%) died of renal cell carcinoma, and 8 patients (15%) died of other causes. A 5-year overall survival (OS) was 60% (95% CI: 0.44-0.73) and 10-year OS was 32% (95% CI: 0.15-0.51). The median survival after surgery for LRRCC was 79 months. In univariate analysis OS differed significantly by the time period between primary surgery and occurrence of LRRCC (<2 years vs. ≥2 years: 10-year OS rate 31% (95% CI: 10.2-55.0) vs. 45% (95% CI: 21.5-65.8; hazard ratio = 0.26; P = 0.0034). In multivariate analysis sarcomatoid features in the primary nephrectomy specimen, positive surgical margins of the LRRCC specimen and a Charlson score of ≥2 were associated with a significantly worse prognosis in this cohort.
In patients with a disease-free interval of more than 2 years after surgery for the primary tumor, surgical removal of LRRCC may achieve long-term survival in most patients. In those with a shorter disease-free interval, long-term survival is unlikely.
Urologic oncology. 2017 Sep 15 [Epub ahead of print]
Roman Herout, Johannes Graff, Angelika Borkowetz, Stefan Zastrow, Steffen Leike, Rainer Koch, Desiree-Louise Draeger, Chris Protzel, Oliver W Hakenberg, Manfred P Wirth, Michael Froehner
Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. Electronic address: ., Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany., Institute of Medical Biometrics and Informatics, Technische Universität Dresden, Dresden, Germany., Department of Urology, University of Rostock, Rostock, Germany.