BJU International, November 2013, Vol.112(7), pp.909-916
Byline: Sabine D. Brookman-May, Matthias May, Shahrokh F. Shariat, Giacomo Novara, Richard Zigeuner, Luca Cindolo, Ottavio De Cobelli, Cosimo De Nunzio, Sascha Pahernik, Manfred P. Wirth, Nicola Longo, Alchiede Simonato, Sergio Serni, Salvatore Siracusano, Alessandro Volpe, Giuseppe Morgia, Roberto Bertini, Orietta Dalpiaz, Christian Stief, Vincenzo Ficarra, Keywords: renal cell carcinoma (RCC); time to recurrence; early recurrence; late recurrence; prognostic parameters; cancer-specific survival; nephrectomy 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 13107 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 [less than or equal to]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. Article Note: S.D.B.-M. and M.M contributed equally to this manuscript Supporting information: Additional Supporting Information may be found in the online version of this article CAPTION(S): Fig.S1 OS after disease recurrence by risk stratification related to TTR ([less than or equal to]12, 〉12-60, 〉60 months). Fig.S2 OS after disease recurrence by risk stratification related to TTR ([less than or equal to]12, 〉12-48, 〉48 months).
Renal Cell Carcinoma ; Time To Recurrence ; Early Recurrence ; Late Recurrence ; Prognostic Parameters ; Cancer‐Specific Survival ; Nephrectomy