OBJECTIVES: To assess the prognostic impact of time to recurrence (TTR) on cancer-specific survival (CSS) after recurrence in patients with renal cell carcinoma (RCC) undergoing radical nephrectomy or nephron-sparing surgery.
To analyse differences in clinical and histopathological criteria between patients with early and late recurrence.
PATIENTS AND METHODS: Of 13 107 patients with RCC from an international multicentre database, 1712 patients developed recurrence in the follow-up (FU), at a median (interquartile range) of 50.1 (25-106) months. In all, 1402 patients had recurrence at ≤ 5 years (Group A) and 310 patients beyond this time (Group B). Differences in clinical and histopathological variables between patients with early and late recurrence were analysed. The influence of TTR and further variables on CSS after recurrence was assessed by Cox regression analysis.
RESULTS: Male gender, advanced age, tumour diameter and stage, Fuhrman grade 3-4, lymphovascular invasion (LVI), and pN + stage were significantly more frequent in patients with early recurrence, who had a significantly reduced 3-year CSS of 30% compared with patients in Group B (41%; P = 0.001). Age, gender, tumour histology, pT stage, and continuous TTR (hazard ratio 0.99, P = 0.006; monthly interval) independently predicted CSS. By inclusion of dichotomised TTR in the multivariable model, a significant influence of this variable on CSS was present until 48 months after surgery, but not beyond this time.
CONCLUSIONS: Advanced age, male gender, larger tumour diameters, LVI, Fuhrman grade 3-4, pN + stage, and advanced tumour stages are associated with early recurrence. Up to 4 years from surgery, a shorter TTR independently predicts a reduced CSS after recurrence.
Written by:
Brookman-May SD, May M, Shariat SF, Novara G, Zigeuner R, Cindolo L, De Cobelli O, De Nunzio C, Pahernik S, Wirth MP, Longo N, Simonato A, Serni S, Siracusano S, Volpe A, Morgia G, Bertini R, Dalpiaz O, Stief C, Ficarra V. Are you the author?
Department of Urology, Ludwig-Maximilians-University Munich, Campus Grosshadern, Munich, Germany.
Reference: BJU Int. 2013 May 23. Epub ahead of print.
doi: 10.1111/bju.12246
PubMed Abstract
PMID: 23890378
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