Predictive factors for ipsilateral recurrence after nephron-sparing surgery in renal cell carcinoma.
BACKGROUND
Ipsilateral recurrence after nephron-sparing surgery (NSS) is rare, and little is known about its specific determinants.


OBJECTIVE
To determine clinical or pathologic features associated with ipsilateral recurrence after NSS performed for renal cell carcinoma (RCC).


METHODS
We analysed 809 NSS procedures performed at eight academic institutions for sporadic RCCs retrospectively.


METHODS
Age, gender, indication, tumour bilaterality, tumour size, tumour location, TNM stage, Fuhrman grade, histologic subtype, and presence of positive surgical margins (PSMs) were assessed as predictors for recurrence in univariate and multivariate analysis by using a Cox proportional hazards regression model.


CONCLUSIONS
Among 809 NSS procedures with a median follow-up of 27 (1-252) mo, 26 ipsilateral recurrences (3.2%) occurred at a median time of 27 (14.5-38.2) mo. In univariate analysis, the following variables were significantly associated with recurrence: pT3a stage (p=0.0489), imperative indication (p<0.01), tumour bilaterality (p<0.01), tumour size >4cm (p<0.01), Fuhrman grade III or IV (p=0.0185), and PSM (p<0.01). In multivariate analysis, tumour bilaterality, tumour size >4cm, and presence of PSM remained independent predictive factors for RCC ipsilateral recurrence. Hazard ratios (HR) were 6.31, 4.57, and 11.5 for tumour bilaterality, tumour size >4cm, and PSM status, respectively. The main limitations of this study included its retrospective nature and a short follow-up.


CONCLUSIONS
RCC ipsilateral recurrence risk after NSS is significantly associated with tumour size >4cm, tumour bilaterality (synchronous or asynchronous), and PSM. Careful follow-up should be advised in patients presenting with such characteristics.
Bernhard
Jean-Christophe
JC
Department of Urology, University Hospital, Bordeaux, France. jcb31000@hotmail.com
Pantuck
Allan J
AJ
Wallerand
Hervé
H
Crepel
Maxime
M
Ferrière
Jean-Marie
JM
Bellec
Laurent
L
Maurice-Tison
Sylvie
S
Robert
Grégoire
G
Albouy
Baptiste
B
Pasticier
Gilles
G
Soulie
Michel
M
Lopes
David
D
Lacroix
Bertrand
B
Bensalah
Karim
K
Pfister
Christian
C
Thuret
Rodolphe
R
Tostain
Jacques
J
De La Taille
Alexandre
A
Salomon
Laurent
L
Abbou
Clément
C
Colombel
Marc
M
Belldegrun
Arie S
AS
Patard
Jean-Jacques
JJ
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D047368:Tumor Burden