Elsevier

Urology

Volume 77, Issue 2, February 2011, Pages 379-384
Urology

Oncology
Late Recurrence of Renal Cell Carcinoma: Retrospective and Collaborative Study of the Japanese Society of Renal Cancer

https://doi.org/10.1016/j.urology.2010.07.462Get rights and content

Objectives

To evaluate in collaboration the clinical features of late recurrence of renal cell carcinoma (RCC). Late recurrence is one of the specific biologic behaviors of RCC; however, the clinical and pathologic features of the late recurrence of RCC are not fully understood.

Methods

A total of 470 patients who had undergone curative treatment of RCC and had not developed recurrence within 10 years of follow-up were documented from 13 institutions of the board members of the Japanese Society of Renal Cancer. Multivariate analysis with Cox proportional hazards model was used to determine the pathologic and clinical factors affecting the late recurrence and survival of patients with RCC ≥10 years after surgery. Survival analysis was performed using the Kaplan-Meier method.

Results

During the 10-28-year (median 13.2) observation period, 30 patients (6.4%) developed a late recurrence. The disease-free survival rate at 15 and 20 years was 89.5% and 78.4%, respectively. Multivariate analysis showed that lymph node metastasis was the only factor to predict for late recurrence (P = .0334). Age at nephrectomy was the only prognostic factor for overall survival on multivariate analysis (P < .0001). Of the 470 patients, 30 had developed late recurrence in 44 sites, including the lung (36.4%), kidney (25%), and bone (13.6%), followed by the brain, pancreas, adrenal gland, lymph nodes, and liver. Late recurrences in the lung or kidney were observed at any time ≥10 years after nephrectomy.

Conclusions

Late recurrence of RCC after initial treatment is not a rare event, and lifelong follow-up is necessary.

Section snippets

Inclusion and Exclusion Criteria

Patients who had undergone curative treatment of RCC before 1992 and had not developed recurrence within 10 years of follow-up observation were included in the present study. Late recurrence was defined as recurrence that developed in those patients who had a ≥10-year disease-free interval after their initial surgery. The patients who had died of any cause or were lost to follow-up within 10 years after surgery were excluded from study. Also, the patients with metastasis at the initial surgery,

Clinical and Pathologic Characteristics

The clinical and pathologic data are listed in Table 1; 67.9% of the patients had Stage pT1 tumors and only 4.5% had grade 3 tumors. Clear cell carcinoma was observed in 429 patients and papillary carcinoma in 7. For the remaining 34, the histologic subtype was not available. Of the 470 patients, 331 (>70%) had undergone lymph node dissection at the initial surgery and 9 of these patients (2.7%) proved to have lymph node metastasis.

Postnephrectomy Adjuvant Therapy

Of the 9 patients with lymph node metastasis, 8 underwent

Comment

Urologists know that late recurrence is one of the specific biologic behaviors of RCC; however, little is known about the phenomenon. A limited number of reports showed late recurrence of RCC4, 5, 6; however, the clinical characteristics, including the predictive factors, of late recurrence have not been fully clarified. The aims of the present study included revealing the natural history of long-term disease-free patients who had undergone surgical treatment of RCC. The patients in the present

Conclusions

We evaluated the predictive factors and clinical course of the late recurrence of RCC. Late recurrence of RCC was observed in 30 (6.8%) of 470 patients who had been disease free for ≥10 years after nephrectomy. The recurrence rate at 15 and 20 years of follow-up was 10.5% and 21.6%, respectively. The pathologic lymph node status was the only independent factor to predict late recurrence; however, overall survival was influenced by patient age at the initial surgery, not by the recurrence

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