Saeed Dabestani1, Christian Beisland2, Grant D Stewart3, Karim Bensalah4, Eirikur Gudmundsson5, Thomas B Lam6, William Gietzmann6, Paimaun Zakikhani6, Lorenzo Marconi7, Sergio Fernandéz-Pello8, Serenella Monagas9, Samuel P Williams10, Christian Torbrand1, Thomas Powles11, Erik Van Werkhoven12, Richard Meijer13, Alessandro Volpe14, Michael Staehler15, Börje Ljungberg16, Axel Bex17. 1. Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden. 2. Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway. 3. Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK. 4. Department of Urology, University of Rennes, Rennes, France. 5. Department of Urology, Landspitali University Hospital, Reykjavik, Iceland. 6. Academic Urology Unit, University of Aberdeen, Aberdeen, UK. 7. Department of Urology, Coimbra University Hospital, Coimbra, Portugal. 8. Department of Urology, Cabueñes University Hospital, Gijón, Spain. 9. Department of Urology, San Agustin University Hospital, Avilés, Spain. 10. Department of Urology, University of Edinburgh, Edinburgh, UK. 11. Barts Cancer Institute, Queen Mary University of London, London, UK. 12. Department of Bioinformatics and Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 13. Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands. 14. Department of Urology, University of Eastern Piedmont, Novara, Italy. 15. Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany. 16. Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden. 17. Division of Surgical Oncology, Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: a.bex@nki.nl.
Abstract
BACKGROUND: Optimal follow-up (FU) strategy to detect potentially curable (PC) recurrences after treatment of localised clear cell renal cell carcinoma (ccRCC) is unclear. This study retrospectively analysed a large international database to determine recurrence patterns and overall survival (OS), as part of a wider project to issue recommendations on FU protocols. OBJECTIVE: To analyse associations between RCC recurrences in patients with ccRCC, their risk group stratifications, treatments, and subsequent outcomes. DESIGN, SETTING, AND PARTICIPANTS: Nonmetastatic ccRCC patients treated with curative intent between 1 January 2006 and 31 December 2011, with at least 4 yr of FU, were included. Patient, tumour and recurrence characteristics, Leibovich score, and management and survival data were recorded. Isolated local, solitary, and oligometastatic (three or fewer lesions at a single site) recurrences were considered PC, while all others were probably incurable (PI). INTERVENTION: Primarily curative surgical treatment of ccRCC while at recurrence detection metastasectomy, systemic therapy, best supportive care, or observation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Incidence, time to recurrence (TTR), and OS were measured. Competing risk analysis, Kaplan-Meier, and Cox regression models were used. RESULTS AND LIMITATION: Of 1265 patients with ccRCC, 286 had a recurrence, with 131 being PC and 155 PI. Five-year cumulative risks of recurrence for low- (n=53), intermediate- (n=105), and high-risk (n=128) patients were, respectively, 7.2%, 23.2%, and 61.6%, of whom 52.8%, 37.1%, and 30.5% were PC, respectively. Median TTR was 25.0 for PC patients versus 17.3 mo for PI patients (p=0.004). Median OS was longer in PC compared with that in PI patients (p<0.001). Competing risk analysis showed highest risk of ccRCC-related death in younger and high-risk patients. Limitations were no data on comorbidities, retrospective cohort, and insufficient data excluding 12% of cohort. CONCLUSIONS: Low-risk group recurrences are rare and develop later. Treatment of recurrences with curative intent is disappointing, especially in high-risk patients. An age- and risk score-dependent FU approach is suggested. PATIENT SUMMARY: We analysed data from eight European countries, and found that the incidence of the kidney cancer recurrence and patient survival correlated with clinical factors known to predict cancer recurrence reliably and age. We conclude that these factors should be used to design follow-up strategies.
BACKGROUND: Optimal follow-up (FU) strategy to detect potentially curable (PC) recurrences after treatment of localised clear cell renal cell carcinoma (ccRCC) is unclear. This study retrospectively analysed a large international database to determine recurrence patterns and overall survival (OS), as part of a wider project to issue recommendations on FU protocols. OBJECTIVE: To analyse associations between RCC recurrences in patients with ccRCC, their risk group stratifications, treatments, and subsequent outcomes. DESIGN, SETTING, AND PARTICIPANTS: Nonmetastatic ccRCC patients treated with curative intent between 1 January 2006 and 31 December 2011, with at least 4 yr of FU, were included. Patient, tumour and recurrence characteristics, Leibovich score, and management and survival data were recorded. Isolated local, solitary, and oligometastatic (three or fewer lesions at a single site) recurrences were considered PC, while all others were probably incurable (PI). INTERVENTION: Primarily curative surgical treatment of ccRCC while at recurrence detection metastasectomy, systemic therapy, best supportive care, or observation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Incidence, time to recurrence (TTR), and OS were measured. Competing risk analysis, Kaplan-Meier, and Cox regression models were used. RESULTS AND LIMITATION: Of 1265 patients with ccRCC, 286 had a recurrence, with 131 being PC and 155 PI. Five-year cumulative risks of recurrence for low- (n=53), intermediate- (n=105), and high-risk (n=128) patients were, respectively, 7.2%, 23.2%, and 61.6%, of whom 52.8%, 37.1%, and 30.5% were PC, respectively. Median TTR was 25.0 for PC patients versus 17.3 mo for PI patients (p=0.004). Median OS was longer in PC compared with that in PI patients (p<0.001). Competing risk analysis showed highest risk of ccRCC-related death in younger and high-risk patients. Limitations were no data on comorbidities, retrospective cohort, and insufficient data excluding 12% of cohort. CONCLUSIONS: Low-risk group recurrences are rare and develop later. Treatment of recurrences with curative intent is disappointing, especially in high-risk patients. An age- and risk score-dependent FU approach is suggested. PATIENT SUMMARY: We analysed data from eight European countries, and found that the incidence of the kidney cancer recurrence and patient survival correlated with clinical factors known to predict cancer recurrence reliably and age. We conclude that these factors should be used to design follow-up strategies.
Authors: Joana B Neves; Leyre Vanaclocha Saiz; Saeed Dabestani; Maxine G B Tran; Axel Bex; Yasmin Abu-Ghanem; Marta Marchetti; My-Anh Tran-Dang; Soha El-Sheikh; Ravi Barod; Christian Beisland; Umberto Capitanio; David Cullen; Tobias Klatte; Börje Ljungberg; Faiz Mumtaz; Prasad Patki; Grant D Stewart Journal: World J Urol Date: 2021-04-13 Impact factor: 4.226
Authors: Tobias Klatte; Kevin M Gallagher; Luca Afferi; Alessandro Volpe; Nils Kroeger; Silvia Ribback; Alan McNeill; Antony C P Riddick; James N Armitage; Tevita F 'Aho; Tim Eisen; Kate Fife; Axel Bex; Allan J Pantuck; Grant D Stewart Journal: BMC Med Date: 2019-10-03 Impact factor: 8.775