OBJECTIVE - The primary treatment approach to locoregional renal cell carcinoma (RCC) is surgical resection. Most relapses occur within the first 2 years but some patients experience late recurrences. Surgical resection of oligometastatic disease may be considered a curative option for relapsed RCC.
However, limited data are available of long-term follow-up of late relapse regarding treatment choice.
PATIENTS AND METHODS - We identified 104 patients with RCC from our database, who relapsed after≥2 years from resection of their primary tumor. Median age at primary diagnosis was 61 years and sex distribution was F:M = 40:64. Histology was clear cell, n = 103 and papillary, n = 1. Sites of relapse were local, n = 14 (13. 4%); lung only, n = 25 (24. 0%); or extrapulmonary, n = 65 (62. 5%). Treatment at first relapse was local therapy (LT) in n = 60 (57. 7%) patients, of these, n = 55 patients had surgery done and n = 5 patients had underwent radiotherapy. Systemic therapy was used in n = 9 (8. 7%) patients. Overall, 35 patients received best supportive care (33. 7%).
RESULTS - We found a median overall survival (OS) of 49. 8 months (95% CI: 29. 3-70. 2) and a progression-free survival (PFS) of 21. 6 months (95% CI: 12. 6-30. 5) for all patients. Patients receiving LT had a median OS of 99. 9 months (95% CI: 77. 2-122. 6) and a PFS of 31. 1 months (95% CI: 21. 5-40. 7). Patients treated with systemic therapy, in turn, had an OS of 21. 1 months (95% CI: 8. 4-33. 8) and a PFS of 4 months (95% CI: 1. 0-6. 2). Patients who received best supportive care had an OS of 10 months (95% CI: 1. 3-18. 7). This difference was highly significant (log rank for PFS: P<0. 001; log rank for OS: P<0. 003). Subgroup analysis of the LT group showed a superior outcome for local relapses (OS: not reached, PFS: 61. 4mo [95% CI: 28. 5-9. 2]) compared to visceral relapses (OS: 35. 5mo [95% CI: 17. 9-53. 1], PFS: 21. 1mo [95% CI: 19. 2-22. 9]).
CONCLUSIONS - Local salvage therapy should be considered the first therapeutic option in late relapse of RCC irrespective of the site of relapse.
Urologic oncology. 2015 Dec 28 [Epub ahead of print]
Carsten Grüllich, Sonia Vallet, Christopher Hecht, Stephan Duensing, Boris Hadaschik, Dirk Jäger, Markus Hohenfellner, Sascha Pahernik
Department of Medical Oncology, National Center for Tumor Diseases Heidelberg, Heidelberg University Hospital, Heidelberg, Germany. Department of Medical Oncology, National Center for Tumor Diseases Heidelberg, Heidelberg University Hospital, Heidelberg, Germany. , Department of Urology, Heidelberg University Hospital, Heidelberg, Germany. , Section of Molecular Urooncology, Department of Urology, Heidelberg University Hospital, Heidelberg, Germany. , Department of Urology, Heidelberg University Hospital, Heidelberg, Germany. , Department of Medical Oncology, National Center for Tumor Diseases Heidelberg, Heidelberg University Hospital, Heidelberg, Germany. , Department of Urology, Heidelberg University Hospital, Heidelberg, Germany. , Department of Urology, Heidelberg University Hospital, Heidelberg, Germany.