Isolated loco-regional recurrence after radical nephrectomy for renal cell carcinoma: A study of 22patients

Fayek, Ihab Samy; Habashy, Hany; Habashy, Nevine Fayez

doi:10.1016/j.jnci.2014.05.003

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…Consistent with previous reports, the median time to development of RFR after RN in the present cohort was 1.4 years. This relatively short median time to development of RFR after RN is consistent with previous studies, in which median time to recurrence ranged from 1.1 to 3.3 years . The majority of these lesions were discovered on standard surveillance imaging.…”

Section: Discussionsupporting

confidence: 90%

Renal fossa recurrence after nephrectomy for renal cell carcinoma: prognostic features and oncological outcomes

et al. 2016

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ObjectivesTo describe the clinicopathological features associated with increased risk of renal fossa recurrence (RFR) after radical nephrectomy (RN) and to describe the prognostic features associated with cancer-specific survival (CSS) among patients with RFR treated with primary locally directed therapy, systemically directed therapy or expectant management. Patients and MethodsThe records of 2 502 patients treated with RN for unilateral, sporadic, localized renal cell carcinoma (RCC) between 1970 and 2006 were reviewed. CSS after RFR was estimated using the Kaplan-Meier method. Associations with the development of RFR and CSS after RFR were evaluated using Cox proportional hazards regression models. ResultsA total of 33 (1.3%) patients developed isolated RFR (iRFR) and 30 (1.2%) patients developed RFR in the setting of synchronous metastases after RN (study cohort, N = 63). The median follow-up for the series was 9.0 years after RN and 6.0 years after RFR diagnosis. On multivariable analysis, advanced pathological stage (pT2: hazard ratio [HR] 4.36, P = 0.004; pT3/4: HR 4.39, P = 0.003) and coagulative necrosis (HR 2.71, P = 0.006) were independently associated with increased risk of iRFR. The median time to recurrence was 1.5 years after RN among the 33 patients with iRFR, and 1.4 years among all patients. Overall, the median CSS was 2.5 years after diagnosis of iRFR, 1.3 years after RFR in the setting of synchronous metastases, and 2.2 years overall. After primary locally directed therapy (surgery, ablation or radiation), systemic therapy or expectant management, the 3-year CSS rates among patients with iRFR were 63%, 50% and 13% (P = 0.001) and were 64%, 50% and 28% (P = 0.006) among all patients, respectively. On multivariable analysis, when compared with observation, locally directed therapies were associated with a significantly decreased risk of death from RCC (HR 0.26, P < 0.001). ConclusionsRenal fossa recurrence is a rare event after RN for RCC and portends a poor prognosis, even in the absence of synchronous metastases. Development of iRFR is associated with advanced stage and aggressive tumour biology. Patients who underwent primary locally directed therapy had superior CSS compared with those treated with expectant management, supporting the use of aggressive local treatment in carefully selected patients with RFR. Future research is needed to determine the optimum role and sequencing of combined therapy in patients with this rare entity.

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Section: Discussionsupporting

confidence: 90%

Renal fossa recurrence after nephrectomy for renal cell carcinoma: prognostic features and oncological outcomes

et al. 2016

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“…Therefore, efforts to reduce the incidence of LRR after RN for locally advanced RCC should be made in patients with risk factors, despite distant metastasis being the main pattern of recurrence after RN for locally advanced RCC [15,17].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, our study showed that LRR as the first recurrence event is significantly associated with subsequent distant metastasis or death. Therefore, efforts to reduce the incidence of LRR after RN for locally advanced RCC should be made in patients with risk factors, despite distant metastasis being the main pattern of recurrence after RN for locally advanced RCC [ 15 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Patterns of Locoregional Recurrence after Radical Nephrectomy for Locally Advanced Renal Cell Carcinoma

et al. 2022

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We aimed to investigate the risk factors and patterns of locoregional recurrence (LRR) after radical nephrectomy (RN) in patients with locally advanced renal cell carcinoma (RCC). Materials and MethodsWe retrospectively analyzed 245 patients who underwent RN for non-metastatic pathologic T3-4 RCC from January 2006 to January 2016. We analyzed the risk factors associated with poor locoregional control using Cox regression. Anatomical mapping was performed on reference computed tomography scans showing intact kidneys. ResultsThe median follow-up duration was 56 months (1-128 months). Tumor extension to renal vessels or the inferior vena cava (IVC) and Fuhrman's nuclear grade IV were identified as independent risk factors of LRR. The 5-year actuarial LRR rates in groups with no risk factor, one risk factor, and two risk factors were 2.3%, 19.8%, and 30.8%, respectively (p<0.0001).The locations of LRR were distributed as follows: aortocaval area (n=2), retrocaval area (n=5), and tumor bed (n=11). No LRR was observed above the celiac axis (CA) or under the inferior mesenteric artery (IMA). ConclusionsTumor extension to renal vessels or the IVC and Fuhrman's nuclear grade IV are the independent risk factors associated with LRR after RN for pT3-4 RCC. The locations of LRR after RN for RCC were distributed in the tumor bed and regional lymphatic area from the bifurcation of the CA to that of the IMA.

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“…According to different sources, the prevalence of this dangerous occurrence ranges between 2 and 10% [ 7 , 8 ]. The interim between nephrectomy and development of LR is variable – from 3 months to 45 years – which calls attention to the momentousness of long-term follow-up [ 9 ]. What is more important – patients with isolated LR are at higher risk of distant metastatic disease [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Local recurrence of renal cell carcinoma after partial nephrectomy: applicability of the apparent diffusion coefficient of MRI as an imaging marker – a multicentre study

et al. 2022

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Purpose The goal of the study was an assessment of the diagnostic performance of diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) of magnetic resonance imaging (MRI) in distinguishing local recurrence (LR) of renal cell carcinoma (RCC) from benign conditions after partial nephrectomy. Material and methods Thirty-nine patients after partial nephrectomy for solid RCC were enrolled in the study. Patients were followed up using MRI, which included DWI sequence ( b = 800 s/mm 2 ). All patients with MRI features of LR were included in the main group ( n = 14) and patients without such features – into the group of comparison ( n = 25). Apparent diffusion coefficient (ADC) values of suspicious lesions were recorded. In all patients with signs of locally recurrent RCC, surgical treatment was performed followed by pathologic analysis. Results The mean ADC values of recurrent RCC demonstrated significantly higher numbers compared to benign fibrous tissues and were 1.64 ± 0.15 × 10 -3 mm 2 /s vs. 1.02 ± 0.26 × 10 -3 mm 2 /s ( p < 0.001). The mean ADC values of RCCs’ LR and benign post-op changes in renal scar substantially differed from mean ADC values of healthy kidneys’ parenchyma; the latter was 2.58 ± 0.05 × 10 -3 mm 2 /s ( p < 0.001). In ROC analysis, the use of ADC with a threshold value of 1.28 × 10 -3 mm 2 /s allowed us to differentiate local recurrence of RCC from benign postoperative changes with 100% sensitivity, 80% specificity, and accuracy: AUC = 0.980 ( p < 0.001). Conclusions The apparent diffusion coefficient of DWI of MRI can be used as a potential imaging marker for the diagnosis of local recurrence of RCC.

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Isolated loco-regional recurrence after radical nephrectomy for renal cell carcinoma: A study of 22patients

Abstract: ILR after radical nephrectomy for RCC is more common with more advanced stages, where interval to recurrence tends to be shorter. The management should be surgical, which was possible in nearly 60% of cases. Complete excision was associated with better overall and disease free survival.

Cited by 4 publications

References 27 publications

Renal fossa recurrence after nephrectomy for renal cell carcinoma: prognostic features and oncological outcomes

Renal fossa recurrence after nephrectomy for renal cell carcinoma: prognostic features and oncological outcomes

Risk Factors and Patterns of Locoregional Recurrence after Radical Nephrectomy for Locally Advanced Renal Cell Carcinoma

Local recurrence of renal cell carcinoma after partial nephrectomy: applicability of the apparent diffusion coefficient of MRI as an imaging marker – a multicentre study

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