Local recurrence after radical nephrectomy for kidney cancer: management and prediction of outcomes. a multi‐institutional study

Paparel, P.; Bigot, Pierre; Matillon, X.; Bensalah, Karim; Salomon, Laurent; Bastide, Cyril; Thuret, Rodolphe; Karsenty, G.; Long, Jean-Alexandre; Ammi, Myriam; Bessède, Thomas; Bin, Sylvie; Roux, Adeline; Escudier, Bernard; Leclercq, Nathalie; Pignot, G.; Soulié, M.; Patard, Jean‐Jacques

doi:10.1002/jso.23473

Cited by 27 publications

(37 citation statements)

References 24 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%

“…Among this cohort, 33 patients presented with iRFR, while 30 patients presented with RFR in the setting of synchronous metastatic disease. The finding that nearly half of patients presented with RFR and synchronous metastases is similar to that reported by Bruno et al The present series of RFRs differed from several of the previously reported case series and retrospective cohorts in that ipsilateral adrenal recurrences were excluded from the study cohort, such that RFR describes only radiographical recurrences to the renal fossa and regional lymph nodes .…”

Section: Discussionsupporting

confidence: 82%

“…Approximately 20–38% of patients undergoing nephrectomy for localized RCC will have subsequent disease progression , with 0.8–3.6% of local recurrences within the ipsilateral retroperitoneum including soft tissue recurrences within the renal fossa, ipsilateral psoas muscle, ipsilateral adrenal gland and regional lymph nodes . The reported incidence of recurrences isolated to the renal fossa alone is 1–2% of which 50–80% are asymptomatic and discovered on routine surveillance imaging . There is disagreement as to whether a renal fossa recurrence (RFR) represents a de novo metastasis or growth of residual RCC cells; however, most authors agree that development of RFR portends a poor prognosis for the patient, and heralds the development of widespread metastatic disease .…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…They noted, on univariate analysis only, that time to recurrence and surgical intervention remained independent predictive factors for cancer specific mortality. 26 However, this study included a significant number of patients (30%) with concomitant distant metastases at time of RPR. In contrast, all cases in our study were performed at a single institution, and no patients had detectable distant metastases at the time of RPR surgery.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Local Retroperitoneal Recurrence of Renal Cell Carcinoma after Radical Nephrectomy

et al. 2015

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Purpose Isolated local retroperitoneal recurrence (RPR) after radical nephrectomy (RN) for renal cell carcinoma (RCC) poses a therapeutic challenge. We investigated the outcomes of patients with localized RPR treated with surgical resection. Methods This was a retrospective single-institutional study of 102 patients with RPR treated with surgery from 1990-2014. Demographics, clinical and pathological features, location of RPR, perioperative complications were reported using descriptive statistics. Recurrence free survival (RFS) and cancer-specific survival (CSS) were studied using univariate and multivariate analyses. Results Median age at RPR diagnosis was 55 years (IQR 49-64). Sixty-two (60.8%) patients were pT3-4 and 20 (19.6%) were pN1. No patients had distant metastatic disease at time of RPR surgery. Median time from nephrectomy to RPR diagnosis was 19 months (IQR 5-38.8). The median size of resected RPR was 4.5cm (IQR 2.7-7). Median follow up after RPR surgery was 32 months (IQR 16-57). Metastatic progression was observed in 60 (58.8%) patients after RPR surgery. Neoadjuvant and salvage systemic therapy were administered in 46 (45.1%) and 48 (47.1%) patients, respectively. On multivariate analysis, pathological nodal stage at original nephrectomy and maximum diameter of RPR were identified as independent risk factors for cancer specific death. Conclusion Clinico-pathological factors at the time of nephrectomy as well as RPR surgery are important prognosticators. Aggressive surgical resection offers potential cure in a substantial number of patients with RPR with acceptable complications, and still plays a dominant role in the management of isolated locally recurrent RCC.

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“…Patients undergoing surgery for symptomatic recurrences have a higher rate of incomplete resection of recurrence, positive surgical margins and worse survival compared to surgery without symptoms. [41][42][43] Extensive tumour recurrence reduces the possibility of complete surgical resection, which is standard therapy for patients with local recurrence or resectable solitary metastasis. Furthermore, an early diagnosis of metastatic disease relapse may enhance efficacy of systemic therapy or allow for metastasectomy if the tumour burden is low.…”

Section: Kassouf Et Al Non-metastatic Rcc Followupmentioning

confidence: 99%

Canadian Urological Association guideline for followup of patients after treatment of non-metastatic renal cell carcinoma

Kassouf

Monteiro

Drachenberg

et al. 2018

CUAJ

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Local recurrence after radical nephrectomy for kidney cancer: management and prediction of outcomes. a multi‐institutional study

Abstract: Local recurrence after radical nephrectomy is associated with poor prognosis. The time to recurrence and the completeness of the surgical treatment are major prognostic factors.

Cited by 27 publications

References 24 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

Surgical Management of Local Retroperitoneal Recurrence of Renal Cell Carcinoma after Radical Nephrectomy

Canadian Urological Association guideline for followup of patients after treatment of non-metastatic renal cell carcinoma

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