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Features, risk factors and clinical outcome of “very late” recurrences after surgery for localized renal carcinoma: A retrospective evaluation of a cohort with a minimum of 10 years of follow up
Author(s) -
Antonelli Alessandro,
Furlan Maria,
Sodano Mario,
Cindolo Luca,
Belotti Sandra,
Tardanico Regina,
Cozzoli Alberto,
Zanotelli Tiziano,
Simeone Claudio
Publication year - 2016
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12962
Subject(s) - medicine , stage (stratigraphy) , renal cell carcinoma , pathological , retrospective cohort study , proportional hazards model , cohort , kidney cancer , surgery , t stage , carcinoma , cancer , urology , paleontology , biology
Objective To evaluate the features and the predictors of “very late” recurrences after surgery for localized renal cell carcinoma. Methods Since 1983, an institutional database with data of more than 2300 consecutive patients treated for renal cancer has been prospectively maintained. Patients N 0 /N x M 0 followed for a minimum of 10 years without recurrences were retrieved. The site, time and treatment of recurrences observed afterwards were recorded, and the predictors were investigated by Cox regression analysis. Results A total of 554 patients (231 women, 323 men; age 59.3 ± 11.6 years) followed for a mean/median time of 15.1/13.6 years (range 10.0–34.1 years) were analyzed. A recurrence was observed in 26 patients (4.6%) after a mean/median interval of 13.3/12.3 years (range 10.5–30.2 years). The pathological stage 2/3 was the only independent predictor of recurrence ( P = 0.003), and it was related also to the latency of recurrence (mean/median latency 15.4/14.0, 11.4/10.8 and 12.5/12.0 years, respectively, for stage 1, 2 and 3; P < 0.005 for stage 1 vs stage 2 or 3). The contralateral kidney was the most frequent site of relapse in patients with stage pT1, whereas multiple sites were more frequent for stage pT2 and pT3. Conclusions The risk of a “very late” recurrence of renal cancer is approximately 5%, and it depends on the pathological stage. For stage pT1, the kidney/s should be surveilled for indefinite time, preferably by ultrasound to reduce the X‐ray exposition; for stage pT2 and pT3, the abdomen and the lungs should be monitored, by computed tomography scan during the first years, and then by abdominal ultrasound and chest X‐ray.