Identifying the risk of disease progression after surgery for localized renal cell carcinoma

OBJECTIVE: To identify factors in a large cohort of patients with pathologically localized renal cell carcinoma (RCC) that predicted disease progression after surgery, as RCC most commonly presents as a localized tumour which is treated with surgical excision. PATIENTS AND METHODS: Using an institutional database, we identified all patients who underwent radical or partial nephrectomy and had pathologically confirmed pT1 or pT2 RCC. Multivariable stepwise logistic regression analysis was used to calculate an odds ratio corresponding to the odds of progression to metastatic disease during surveillance, based on several clinical and pathological variables. We defined those variables that remained significant on multivariable analysis as risk factors and, based on the number of risk factors, we assessed risk of disease progression. RESULTS: In all, 925 patients were eligible for analysis with a median follow-up of 48.2 months. There was progression to metastatic disease in 53 (5.7%) patients; pT1 in 20/774 (2.6%), pT2 in 33/151 (21.9%). Risk factors included pT2 disease, male gender, symptoms at presentation (local or constitutional), presence of sarcomatoid de-differentiation, and macroscopic necrosis on final pathology. In 177 patients with no risk factors, none progressed; 20 of 618 (3.2%) with one or two risk factors had progression at a median of 37.1 months; 33 of 130 (25.4%) with three or more risk factors progressed at a median of 25.2 months. CONCLUSIONS: We identified five risk factors that can help to predict those patients with pT1 or pT2 RCC at highest risk for disease progression after surgery. The potential for disease progression is exceedingly low in patients with no risk factors and surveillance can be minimized in this group.