Korean J Urol.  2013 Nov;54(11):744-749.

Factors Affecting the Time to Recurrence After Radical Nephrectomy for Localized Renal Cell Carcinoma

• Son HS
• Jeon SH
• Chang SG

Abstract

PURPOSE
The objective of this study was to determine the factors affecting the time to recurrence after radical nephrectomy for localized renal cell carcinoma.
MATERIALS AND METHODS
We retrospectively evaluated 321 patients who received radical nephrectomies for localized renal cell carcinoma (pT1a-pT2b N0M0). Of 29 patients with disease recurrence, 9 had recurrence more than 5 years after radical nephrectomy. We evaluated the clinicopathological factors, with the use of a retrospective study design.
RESULTS
Tumor necrosis was statistically different between the late recurrence group and the recurrence free group (Fisher exact test, p=0.046). Hematuria at diagnosis (chi-square test, p=0.045) was statistically significant in early recurrence. In the univariate logistic regression analysis, tumor necrosis (odds ratio [OR], 4.629; 95% confidence interval [CI], 1.106 to 19.379; p=0.036) and pT stage>1 (OR, 7.232; 95% CI, 1.727 to 30.280; p=0.007) were risk factors of late recurrence. In the multivariable logistic regression analysis, pT stage>1 (OR, 7.143; 5% CI 1.706 to 29.912, p=0.007) was associated with late recurrence. Regarding early recurrence, initial symptoms at diagnosis and pathologic T stage>1 were statistically significant in both univariate and multivariable logistic regression analysis. In terms of recurrence site, patients with late recurrence tended to have unusual metastasis sites other than lung, liver or bone (chi-square test, p=0.012).
CONCLUSIONS
These data suggest that tumor necrosis may affect late disease recurrence. Patients with initial symptoms and hematuria at diagnosis are vulnerable to recurrence in a shorter period after nephrectomy. Patients with late recurrence showed a tendency to have unusual metastasis site other than lung, liver or bone.

Keyword

Disease-free survival; Recurrence; Renal cell carcinoma

MeSH Terms

Carcinoma, Renal Cell*
Disease-Free Survival
Hematuria
Humans
Liver
Logistic Models
Lung
Necrosis
Neoplasm Metastasis
Nephrectomy*
Recurrence*
Retrospective Studies
Risk Factors

Reference

1. Rodriguez-Covarrubias F, Gomez-Alvarado MO, Sotomayor M, Castillejos-Molina R, Mendez-Probst CE, Gabilondo F, et al. Time to recurrence after nephrectomy as a predictor of cancer-specific survival in localized clear-cell renal cell carcinoma. Urol Int. 2011; 86:47–52.

2. Brookman-May S, May M, Shariat SF, Xylinas E, Stief C, Zigeuner R, et al. Features associated with recurrence beyond 5 years after nephrectomy and nephron-sparing surgery for renal cell carcinoma: development and internal validation of a risk model (PRELANE score) to predict late recurrence based on a large multicenter database (CORONA/SATURN Project). Eur Urol. 2013; 64:472–477.

3. Adamy A, Chong KT, Chade D, Costaras J, Russo G, Kaag MG, et al. Clinical characteristics and outcomes of patients with recurrence 5 years after nephrectomy for localized renal cell carcinoma. J Urol. 2011; 185:433–438.

4. Babjuk M, Burger M, Zigeuner R, Shariat S, Van Rhijn B, Comperat E, et al. Guidelines on non-muscle-invasive bladder cancer (TaT1 and CIS). Updated 2013 [Internet]. Arnhem: European Association of Urology;c2013. cited 2013 Jul 22. Available from: http://www.uroweb.org/fileadmin/guidelines/Total_file_2013_large_guidelines_prints.pdf.

5. Park YH, Baik KD, Lee YJ, Ku JH, Kim HH, Kwak C. Late recurrence of renal cell carcinoma >5 years after surgery: clinicopathological characteristics and prognosis. BJU Int. 2012; 110(11 Pt B):E553–E558.

6. Ha YS, Park YH, Kang SH, Hong SH, Hwang TK, Byun SS, et al. Predictive factors for late recurrence in patients with stage T1 clear cell renal cell carcinoma: a multiinstitutional study. Clin Genitourin Cancer. 2013; 11:51–55.

7. Kim JM, Song PH, Kim HT, Park TC. The prognostic factors for patients with pT1a renal cell carcinoma. Korean J Urol. 2010; 51:233–238.

8. Abel EJ, Culp SH, Meissner M, Matin SF, Tamboli P, Wood CG. Identifying the risk of disease progression after surgery for localized renal cell carcinoma. BJU Int. 2010; 106:1277–1283.

9. Miyao N, Naito S, Ozono S, Shinohara N, Masumori N, Igarashi T, et al. Late recurrence of renal cell carcinoma: retrospective and collaborative study of the Japanese Society of Renal Cancer. Urology. 2011; 77:379–384.

10. Kim SP, Weight CJ, Leibovich BC, Thompson RH, Costello BA, Cheville JC, et al. Outcomes and clinicopathologic variables associated with late recurrence after nephrectomy for localized renal cell carcinoma. Urology. 2011; 78:1101–1106.

11. Margulis V, McDonald M, Tamboli P, Swanson DA, Wood CG. Predictors of oncological outcome after resection of locally recurrent renal cell carcinoma. J Urol. 2009; 181:2044–2051.

12. Eggener SE, Yossepowitch O, Pettus JA, Snyder ME, Motzer RJ, Russo P. Renal cell carcinoma recurrence after nephrectomy for localized disease: predicting survival from time of recurrence. J Clin Oncol. 2006; 24:3101–3106.

13. May M, Brookman-Amissah S, Kendel F, Knoll N, Roigas J, Hoschke B, et al. Validation of a postoperative prognostic model consisting of tumor microvascular invasion, size, and grade to predict disease-free and cancer-specific survival of patients with surgically resected renal cell carcinoma. Int J Urol. 2009; 16:616–621.

14. Thompson RH, Leibovich BC, Lohse CM, Cheville JC, Zincke H, Blute ML, et al. Dynamic outcome prediction in patients with clear cell renal cell carcinoma treated with radical nephrectomy: the D-SSIGN score. J Urol. 2007; 177:477–480.

15. Kume H, Teramoto S, Kitamura T. Metachronous bilateral renal cell carcinoma with an interval of more than 10 years. Int Urol Nephrol. 2009; 41:843–846.

16. Lane BR, Kattan MW. Prognostic models and algorithms in renal cell carcinoma. Urol Clin North Am. 2008; 35:613–625.

17. Lee SE, Byun SS, Oh JK, Lee SC, Chang IH, Choe G, et al. Significance of macroscopic tumor necrosis as a prognostic indicator for renal cell carcinoma. J Urol. 2006; 176(4 Pt 1):1332–1337.

18. Minervini A, Di Cristofano C, Gacci M, Serni S, Menicagli M, Lanciotti M, et al. Prognostic role of histological necrosis for nonmetastatic clear cell renal cell carcinoma: correlation with pathological features and molecular markers. J Urol. 2008; 180:1284–1289.

19. Pichler M, Hutterer GC, Chromecki TF, Jesche J, Kampel-Kettner K, Rehak P, et al. Histologic tumor necrosis is an independent prognostic indicator for clear cell and papillary renal cell carcinoma. Am J Clin Pathol. 2012; 137:283–289.

20. Bianchi M, Sun M, Jeldres C, Shariat SF, Trinh QD, Briganti A, et al. Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Ann Oncol. 2012; 23:973–980.

21. Bruin SC, Klijn C, Liefers GJ, Braaf LM, Joosse SA, van Beers EH, et al. Specific genomic aberrations in primary colorectal cancer are associated with liver metastases. BMC Cancer. 2010; 10:662.

22. Yerushalmi R, Tyldesley S, Kennecke H, Speers C, Woods R, Knight B, et al. Tumor markers in metastatic breast cancer subtypes: frequency of elevation and correlation with outcome. Ann Oncol. 2012; 23:338–345.

23. Koo JS, Jung W, Jeong J. Metastatic breast cancer shows different immunohistochemical phenotype according to metastatic site. Tumori. 2010; 96:424–432.