Surgical Outcomes in the Management of Isolated Nodal Recurrences: A Multicenter, International Retrospective Cohort

Russell, Christopher; Espiritu, Patrick; Kassouf, Wassim; Schwaab, Thomas; Buethe, David D.; Dhilon, Jasreman; Sexton, Wade J.; Poch, Michael; Pow‐Sang, Julio M.; Tanguay, Simon; Nayan, Madhur; Alsaadi, Hazem; Hanzly, Michael; Spiess, Philippe E.

doi:10.1016/j.juro.2014.02.010

Cited by 17 publications

(11 citation statements)

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“…The paucity of existing data on this cohort probably reflects both the relative infrequency of isolated RPLN recurrence from RCC, as well as clinicians' historical reluctance to consider resection in these cases. To facilitate a more robust assessment (albeit still with a modest sample size), we formed Meanwhile, our present finding of an association between the interval from nephrectomy to the development of RPLN recurrence with outcome after resection is consistent with data from prior series of patients with metastatic RCC [7,12,21,22]. Specifically, we found that RPLN recurrence at ≤12 months of nephrectomy was associated with a significantly increased risk of subsequent progression.…”

Section: Discussionsupporting

confidence: 82%

“…These data represent what is to our knowledge the largest series to date reported on this topic, and suggest that in the setting of RPLN recurrence after nephrectomy, surgical resection should be considered for appropriately selected patients. Two prior small (15 patients and 22 patients, respectively) series have described the use of surgical resection for patients with isolated RPLN recurrence after nephrectomy [21,22]. The paucity of existing data on this cohort probably reflects both the relative infrequency of isolated RPLN recurrence from RCC, as well as clinicians' historical reluctance to consider resection in these cases.…”

Section: Discussionmentioning

confidence: 99%

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Oncological control associated with surgical resection of isolated retroperitoneal lymph node recurrence of renal cell carcinoma

et al. 2015

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ObjectiveTo evaluate the outcome of patients after surgical resection of isolated retroperitoneal lymph node (RPLN) recurrence of renal cell carcinoma (RCC) using a multicentre international cohort. Patients and MethodsIn all, 50 patients were identified who underwent resection of isolated RPLN recurrence of RCC at four institutions after nephrectomy for pT any N any M0 disease. Progression-free (PFS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method. Cox proportional hazards regression models were used to assess the association of clinicopathological characteristics with disease progression. ResultsThe median (interquartile range, IQR) age at resection was 57.0 (50.0-62.5) years. The median (IQR) time to RPLN recurrence after nephrectomy was 12.6 (6.9-39.5) months, with no significant difference in median time to RPLN recurrence between patients with N+ disease at nephrectomy (10.7 [6.5-24.6] months) and those with Nx/pN0 disease at nephrectomy (13.7 [8.7-44.2] months) (P = 0.66). The median (IQR) size of the RPLN recurrence before resection was 2.6 (1.9-5) cm. The most common site for RPLN recurrence was within the interaortocaval region (34%). The median (IQR) follow-up after RPLN resection for patients alive at last follow-up was 28.0 (13.7-51.2) months. During follow-up, 26 patients developed RCC recurrence, at a median (IQR) of 9.9 (4.0-18.5) months after RPLN resection. Of those who developed a secondary recurrence, disease was again isolated to the retroperitoneum in seven patients. In all, 11 patients subsequently died, including 10 who died from disease. The median PFS after RPLN resection was 19.5 months, with a 3-and 5-year PFS of 40.5% and 35.4%, respectively. We also found that RPLN recurrence at ≤12 months after nephrectomy was associated with a significantly inferior median PFS (12.3 months) compared with RPLN recurrence at >12 months after nephrectomy (47.6 months; P = 0.003). Moreover, on multivariate analysis, a shorter time to recurrence remained associated with a significantly increased risk for subsequent disease progression (hazard ratio 3.51; P = 0.005). ConclusionSurgical resection of isolated RPLN recurrence from RCC may result in durable cancer control in appropriately selected patients. Recurrence at ≤12 months after nephrectomy was associated with a significantly increased risk of progression after resection, underscoring the importance of this variable for risk stratification. Thus, we recommend that, in the setting of isolated RPLN recurrence of RCC (in patients without precluding comorbidities), careful consideration with the patients and medical oncology colleagues be undertaken about the relative and individualised benefits of surgical resection, systemic therapy, and surveillance.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Oncological control associated with surgical resection of isolated retroperitoneal lymph node recurrence of renal cell carcinoma

et al. 2015

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“…Of these, 46% progressed to metastatic disease with a median progression free survival of 12.7 months. 27 In our series, we report a larger subgroup of patients(41/102 patients) with localized lymph node recurrence undergoing complete surgical excision. The overall median recurrence free survival was 23 months and we noted no significant differences in CSS where we stratified by location of recurrence (renal fossa/soft tissue, lymph node or adrenal) within the retroperitoneum (Figure 2D).…”

Section: Discussionmentioning

confidence: 86%

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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“…Clear cell renal cell carcinoma (ccRCC) is the most common histologic type in kidney cancers. Overall median progression-free survival (PFS) is 12 months in ccRCC and 17 months in non-clear cell RCCs (2). Although nearly 80% of ccRCC cases are considered to be cured by resection, the median overall survival (OS) for patients with metastatic RCC is less than 3 years (3).…”

Section: Introductionmentioning

confidence: 99%

The Coordinated Actions of TIM-3 on Cancer and Myeloid Cells in the Regulation of Tumorigenicity and Clinical Prognosis in Clear Cell Renal Cell Carcinomas

Komohara

Morita

Annan

et al. 2015

Cancer Immunology Research

102

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Clear cell renal cell carcinoma (ccRCC) is one of most common cancers in urogenital organs. Although recent experimental and clinical studies have shown the immunogenic properties of ccRCC as illustrated by the clinical sensitivities to various immunotherapies, the detailed immunoregulatory machineries governing the tumorigenicity of human ccRCC remain largely obscure. In this study, we demonstrated the clinical significance and functional relevance of T-cell immunoglobulin and mucin domain-containing molecule-3 (TIM-3) expressed on tumor cells and myeloid cells in patients with ccRCC. TIM-3 expression was detected on cancer cells and CD204 þ tumor-associated macrophages (TAM), and higher expression level of TIM-3 was positively correlated with shorter progression-free survival (PFS) in patients with ccRCC. We found that TIM-3 expression was detected on a large number of tumors, and there was significant correlation between an increased number of TAMs and high expression level of TIM-3 in patients with ccRCC. Furthermore, TIM-3 rendered RCC cells with the ability to induce resistance to sunitinib and mTOR inhibitors, the standard regimen for patients with ccRCC, as well as stem cell activities. TIM-3 expression was induced on CD14

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Surgical Outcomes in the Management of Isolated Nodal Recurrences: A Multicenter, International Retrospective Cohort

Cited by 17 publications

References 28 publications

Oncological control associated with surgical resection of isolated retroperitoneal lymph node recurrence of renal cell carcinoma

Oncological control associated with surgical resection of isolated retroperitoneal lymph node recurrence of renal cell carcinoma

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

The Coordinated Actions of TIM-3 on Cancer and Myeloid Cells in the Regulation of Tumorigenicity and Clinical Prognosis in Clear Cell Renal Cell Carcinomas

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