BACKGROUND: Approximately 10-20% of recurrences in patients treated with nephrectomy for renal cell carcinoma (RCC) develop beyond 5 yr after surgery (late recurrence).
OBJECTIVE: To determine features associated with late recurrence.
DESIGN, SETTING, AND PARTICIPANTS: A total of 5009 patients from a multicenter database comprising 13 107 RCC patients treated surgically had a minimum recurrence-free survival of 60 mo (median follow-up [FU]: 105 mo [range: 78-135]); at last FU, 4699 were disease free (median FU: 103 mo [range: 78-134]), and 310 patients (6.2%) experienced disease recurrence (median FU: 120 mo [range: 93-149]).
INTERVENTIONS: Patients underwent radical nephrectomy or nephron-sparing surgery.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable regression analyses identified features associated with late recurrence. Cox regression analyses evaluated the association of features with cancer-specific mortality (CSM).
RESULTS AND LIMITATIONS: Lymphovascular invasion (LVI) (odds ratio [OR]: 3.07; p< 0.001), Fuhrman grade 3-4 (OR: 1.60; p=0.001), and pT stage >pT1 (OR: 2.28; p< 0.001) were significantly associated with late recurrence. Based on accordant regression coefficients, these parameters were weighted with point values (LVI: 2 points; Fuhrman grade 3-4: 1 point, pT stage >1: 2 points), and a risk score was developed for the prediction of late recurrences. The calculated values (0 points: late recurrence risk 3.1%; 1-3 points: 8.4%; 4-5 points: 22.1%) resulted in a good-, intermediate- and poor-prognosis group (area under the curve value for the model: 70%; 95% confidence interval, 67-73). Multivariable Cox regression analysis showed LVI (HR: 2.75; p< 0.001), pT stage (HR: 1.24; p< 0.001), Fuhrman grade (HR: 2.40; p< 0.001), age (HR: 1.01; p< 0.001), and gender (HR: 0.71; p=0.027) to influence CSM significantly. Limitations are based on the multicenter and retrospective study design.
CONCLUSIONS: LVI, Fuhrman grade 3/4, and a tumor stage >pT1 are independent predictors of late recurrence after at least 5 yr from surgery in patients with RCC. We developed a risk score that allows for prognostic stratification and individualized aftercare of patients with regard to counseling, follow-up scheduling, and clinical trial design.
Written by:
Brookman-May S, May M, Shariat SF, Xylinas E, Stief C, Zigeuner R, Chromecki T, Burger M, Wieland WF, Cindolo L, Schips L, De Cobelli O, Rocco B, De Nunzio C, Feciche B, Truss M, Gilfrich C, Pahernik S, Hohenfellner M, Zastrow S, Wirth MP, Novara G, Carini M, Minervini A, Simeone C, Antonelli A, Mirone V, Longo N, Simonato A, Carmignani G, Ficarra V. Are you the author?
Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Department of Urology, Munich, Germany.
Reference: Eur Urol. 2012 Jun 22. Epub ahead of print.
doi: 10.1016/j.eururo.2012.06.030
PubMed Abstract
PMID: 22748912
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