Metachronous bilateral renal cell carcinoma: risk assessment, prognosis and relevance of the primary-free interval.
OBJECTIVE
We evaluated the prognosis, risk factors and relevance of the primary-free interval in a large cohort with metachronous bilateral renal cell carcinoma.


METHODS
We studied 120 patients with metachronous, bilateral renal cell carcinoma who were treated at 12 international academic centers. Logistic regression was performed to evaluate risk factors for contralateral metachronous renal cell carcinoma during followup. Disease specific survival was evaluated with univariate and multivariate analysis.


RESULTS
Median age at diagnosis of the first and second renal cell carcinomas was 54 and 62 years, respectively. The most common histological subtype was bilateral clear cell renal cell carcinoma (89% of cases). Familial renal cell carcinoma was found in 14% of patients, von Hippel-Lindau disease was found in 4% and nonfamilial renal cell carcinoma was found in 81%. The 15-year disease specific survival rates for the first and second renal cell carcinomas were 66% and 44%, respectively. Logistic regression revealed von Hippel-Lindau disease, a family history of renal cell carcinoma, multifocal first renal cell carcinoma and young patient age as independent risk factors for contralateral renal cell carcinoma after surgery for unilateral renal cell carcinoma. A longer primary-free interval was associated with a better prognosis. When calculating disease specific survival from the diagnosis of the first renal cell carcinoma, the primary-free interval was an independent prognostic factor.


CONCLUSIONS
Long-term survival rates of metachronous, bilateral renal cell carcinoma are moderate. von Hippel-Lindau disease, a family history of renal cell carcinoma, multifocal first renal cell carcinoma and young patient age are independent risk factors for contralateral renal cell carcinoma. These risk factors support close and extended abdominal surveillance following nephrectomy for unilateral renal cell carcinoma. Patients with a longer primary-free interval have a more favorable prognosis.
Klatte
Tobias
T
Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90025, USA.
Patard
Jean-Jacques
JJ
Wunderlich
Heiko
H
Goel
Rakhee H
RH
Lam
John S
JS
Junker
Kerstin
K
Schubert
Jörg
J
Böhm
Malte
M
Allhoff
Ernst P
EP
Kabbinavar
Fairooz F
FF
Crepel
Maxime
M
Cindolo
Luca
L
De La Taille
Alexandre
A
Tostain
Jacques
J
Mejean
Arnaud
A
Soulie
Michel
M
Bellec
Laurent
L
Bernhard
Jean Christophe
JC
Ferriere
Jean-Marie
JM
Pfister
Christian
C
Albouy
Baptiste
B
Colombel
Marc
M
Zisman
Amnon
A
Belldegrun
Arie S
AS
Pantuck
Allan J
AJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000209:etiology* / Q000401:mortality* / Q000628:therapy; D002648:Child; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000209:etiology* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000209:etiology* / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome