Late recurrence more than five years after the initial treatment is one of the biological behaviours specific for RCC.
In our study, late recurrence was observed in 8.8% of the patients. Also, patients with late recurrence had more favorable clinicopathological features and better prognosis with long cancer-specific survival after recurrence. Age and preoperative hs-CRP levels may be independent predictive factors for late recurrence of RCC.
OBJECTIVE:To evaluate the clinicopathological features and prognosis of late recurrence of renal cell carcinoma (RCC).
PATIENTS AND METHODS:A total of 747 patients who had undergone curative surgery for RCC with follow-up of >5 years or recurrence within 5 years were included in the study. The patients were stratified into four groups based on cancer-free intervals: no recurrence (no recurrence >5 years after surgery, n= 425), synchronous metastasis (n= 138), early recurrence (recurrence within 5 years, n= 143), and late recurrence (recurrence after 5 years, n= 41). Multivariate analysis was performed to identify the clinicopathological factors affecting late recurrence and its clinical outcome.
RESULTS:The subgroups were significantly different in clinicopathological variables, including age, preoperative haemoglobin, platelet count, high-sensitivity C-reactive protein (hs-CRP) levels, pT stage and nuclear grade. In multiple logistic regression analysis, age (odds ratio [OR] 1.085, 95% confidence interval [CI] 1.012-1.163, P= 0.022), and preoperative hs-CRP levels (OR 6.211, 95% CI 1.590-24.270, P= 0.009) were independent predictive factors for late recurrence. In patients with synchronous metastasis, early recurrence and late recurrence, 5-year cancer-specific survival rates after recurrence were 27.0%, 41.1% and 73.7%, respectively (P < 0.001). Multivariate Cox analysis indicated that cancer-free interval, as well as body mass index, initial symptoms, Fuhrman's nuclear grade, sarcomatoid differentiation, lymphovascular invasion and metastasectomy, were independent predictive factors for cancer-related death.
CONCLUSIONS: Late recurrence of RCC is not a rare event. Patients with late recurrence had more favourable clinicopathological features and better prognosis with long cancer-specific survival after recurrence. Age and preoperative hs-CRP levels may be independent predictive factors for late recurrence of RCC.
Written by:
Park YH, Baik KD, Lee YJ, Ku JH, Kim HH, Kwak C. Are you the author?
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Reference: BJU Int. 2012 May 11. Epub ahead of print.
doi: 10.1111/j.1464-410X.2012.11246.x
PubMed Abstract
PMID: 22578274
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