title: Presumed radically treated renal cell carcinoma--recurrence of the disease and prognostic factors for subsequent survival.
abstract: OBJECTIVE
  To gain knowledge about when, where and how metastases after presumed radical treatment for renal cell carcinoma (RCC) are detected, and to use this information to establish a follow-up programme for radically treated RCC. Further aims were to establish survival rates, together with identifying prognostic factors influencing survival for different groups of patients after recurrence of the disease.
  
  
  METHODS
  A retrospective study of 305 pT1-4N0M0/pT1-4NxM0 (clinically N0) tumours treated with nephrectomy was performed.
  
  
  RESULTS
  A total of 89 patients (29.2%) developed metastases, with a median time to recurrence of 25.1 months. Within 5 years, 80% of the metastases had been detected. The lungs were the commonest metastatic site. A total of 34.8% of the recurrences were diagnosed as a result of routine follow-up. Median cancer-specific survival (CSS) after recurrence was 9.8 months. For patients with a disease-free interval (DFI) > or =24 months the median CSS was 35 months. In a univariate analysis, performance status, DFI > or =24 months, metastases in a single organ, primary tumour size < or =70 mm, primary tumour stage pT1-2 and age <65 years were all associated with better survival. In a multivariate analysis, performance status, DFI and number of organs affected were independent predictors of survival.
  
  
  CONCLUSIONS
  The information from this material is used to suggest a simple, but adequate, follow-up protocol. Easily accessible information can be used to identify groups with different prognoses regarding survival after recurrence of the disease.
authors.affiliation: Department of Surgery, Innlandet Hospital-Lillehammer, Lillehammer, Norway. Christian.Beisland@haukeland.no
authors.forename: Christian
authors.initials: C
authors.lastname: Beisland
authors.forename: Per Christian
authors.initials: PC
authors.lastname: Medby
authors.forename: Hans Olav
authors.initials: HO
authors.lastname: Beisland
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome