PURPOSE: We report a multicenter international cohort representing the largest surgical experience in the management of isolated retroperitoneal nodal recurrences of renal cell carcinoma (RCC), a unique subset of locoregional disease, yet to be described in detail.
MATERIALS AND METHODS: Patients with isolated nodal recurrence of pTanyN+M0 disease following nephrectomy were identified through retrospective chart review at three independent institutions. Progression free survival (PFS), estimated using the Kaplan-Meier method, was utilized to compare survival outcomes between primary T(1-2)NanyM0 and T3NanyM0 tumors, as well as clear cell and non-clear cell histology RCC's.
RESULTS: A total of 22 patients met inclusion criteria. Median time to local post-nephrectomy recurrence was 31.5 months (IQR 12.9-43.3). Following resection of isolated nodal recurrence, 10 patients (46%) developed a secondary recurrence at a median of 11.2 months (IQR 8.1-18.4), and of those 2 (9%) succumbed to their disease. Overall median PFS was 12.7 months, and was 24.8 months in T(1-2)NanyM0 tumors, 9.9 months in T3NanyM0 tumors, 13.4 months in clear cell RCC's, and 17.6 months in non-clear cell RCC's.
CONCLUSION: Surgical resection represents the best curative option for patients presenting with isolated retroperitoneal lymph node recurrence of RCC, and a durable PFS following surgery is attainable in many patients regardless of histology or clinical TNM staging. In addition, our cohort demonstrated a lower RCC related mortality rate than previously reported series of local metastasis. As such, all patients free of precluding comorbidities should be considered for complete surgical resection by an experienced genitourinary surgeon.
Written by:
Russell CM, Espiritu PN, Kassouf W, Schwaab T, Buethe DD, Dhilon J, Sexton WJ, Poch M, Powsang JM, Tanguay S, Nayan M, Alsaadi H, Hanzly MI, Spiess PE. Are you the author?
USF Morsani College of Medicine, Tampa, FL; H. Lee Moffitt Cancer Center, Tampa, FL; McGill University, Montreal, Quebec; Roswell Park Cancer Institute, Buffalo, NY.
Reference: J Urol. 2014 Feb 13. pii: S0022-5347(14)00261-4.
doi: 10.1016/j.juro.2014.02.010
PubMed Abstract
PMID: 24530987
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