Abstract
Purpose:We describe what is to our knowledge a novel classification system for local recurrence after surgery of renal cell carcinoma. We assessed its prognostic implications using prospective, randomized controlled data.Materials and Methods:We queried the ASSURE (Sunitinib Malate or Sorafenib Tosylate in Treating Patients With Kidney Cancer That Was Removed By Surgery) (ECOG-ACRIN [Eastern Cooperative Oncology Group-American College of Radiology Imaging Network] E2805) trial data for patients with fully resected, intermediate-high risk, nonmetastatic renal cell carcinoma with local recurrence. We used certain definitions, including type I - single recurrence in a remnant kidney or ipsilateral renal fossa, type II - single recurrence in the ipsilateral vasculature, the ipsilateral adrenal gland or a lymph node, type III - single recurrence in other intra-abdominal soft tissues or organs and type IV - any combination of types I-III or multiple recurrences of a single type. Multivariable logistic regression and the log rank test were performed to identify clinicopathological predictors and compare survival, respectively.Results:Of the 1,943 patients 300 (15.4%) had local recurrence, which was type I, II, III and IV in 66 (22.0%), 97 (32.3%), 87 (29.0%) and 50 (16.7%), respectively. Surgical modality (minimally invasive vs open) and type of surgery (partial vs radical) did not predict any local recurrence. Five-year cancer specific survival and overall survival were worse in patients with type IV recurrence (each p <0.001). There was no difference in survival among patients with types I to III recurrence.Conclusions:In patients with intermediate-high risk nonmetastatic renal cell carcinoma local recurrence appears to be a function of biology more than of surgical modality or surgery type. The prognosis for solitary intra-abdominal local recurrences appear similar regardless of location (types I-III). Local recurrences involving multiple sites and/or subdivisions are associated with worse survival (type IV).
Original language | English (US) |
---|---|
Pages (from-to) | 684-689 |
Number of pages | 6 |
Journal | Journal of Urology |
Volume | 203 |
Issue number | 4 |
DOIs | |
State | Published - Apr 1 2020 |
Keywords
- carcinoma
- classification
- local
- neoplasm recurrence
- nephrectomy
- prognosis
- renal cell
ASJC Scopus subject areas
- Urology