Management of local recurrence after radical nephrectomy: surgical removal with or without systemic treatment is still the gold standard. Results from a multicenter international cohort.

Abstract

OBJECTIVE:

To evaluate the survival outcomes of patients with local recurrence after radical nephrectomy (RN) and to test the effect of surgery, as monotherapy or in combination with systemic treatment, on cancer-specific mortality (CSM).

METHODS:

Patients with local recurrence after RN were abstracted from an international dataset. The primary outcome was CSM. Cox's proportional hazard models tested the main predictors of CSM. Kaplan-Meier method estimates the 3-year survival rates.

RESULTS:

Overall, 96 patients were included. Of these, 44 (45.8%) were metastatic at the time of recurrence. The median time to recurrence after RN was 14.5 months. The 3-year cancer-specific survival rates after local recurrence were 92.3% (± 7.4%) for those who were treated with surgery and systemic therapy, 63.2% (± 13.2%) for those who only underwent surgery, 22.7% (± 0.9%) for those who only received systemic therapy and 20.5% (± 10.4%) for those who received no treatment (p < 0.001). Receiving only medical treatment (HR: 5.40, 95% CI 2.06-14.15, p = 0.001) or no treatment (HR: 5.63, 95% CI 2.21-14.92, p = 0.001) were both independently associated with higher CSM rates, even after multivariable adjustment. Following surgical treatment of local recurrence 8 (16.0%) patients reported complications, and 2/8 were graded as Clavien-Dindo ≥ 3.

CONCLUSIONS:

Surgical treatment of local recurrence after RN, when feasible, should be offered to patients. Moreover, its association with a systemic treatment seems to warrantee adjunctive advantages in terms of survival, even in the presence of metastases.

• Authors: Michele Marchioni, Petros Sountoulides, Maria Furlan, Maria Carmen Mir, Lucia Aretano, Jose Rubio-Briones, Mario Alvarez-Maestro, Marta Di Nicola, Alfredo Aguilera Bazán, Alessandro Antonelli, Claudio Simeone, Luigi Schips
• Journal: International urology and nephrology (Int Urol Nephrol) Vol. 53 Issue 11 Pg. 2273-2280 (Nov 2021) ISSN: 1573-2584 [Electronic] Netherlands
• PMID: 34417970 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2021. The Author(s).

Topics

• Aged
• Carcinoma, Renal Cell (surgery, therapy)
• Cohort Studies
• Female
• Humans
• Internationality
• Kidney Neoplasms (surgery, therapy)
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Nephrectomy (methods)
• Retrospective Studies