title: Predictive factors for ipsilateral recurrence after nephron-sparing surgery in renal cell carcinoma.
abstract: 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.
authors.affiliation: Department of Urology, University Hospital, Bordeaux, France. jcb31000@hotmail.com
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Bernhard
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Pantuck
authors.forename: Hervé
authors.initials: H
authors.lastname: Wallerand
authors.forename: Maxime
authors.initials: M
authors.lastname: Crepel
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Ferrière
authors.forename: Laurent
authors.initials: L
authors.lastname: Bellec
authors.forename: Sylvie
authors.initials: S
authors.lastname: Maurice-Tison
authors.forename: Grégoire
authors.initials: G
authors.lastname: Robert
authors.forename: Baptiste
authors.initials: B
authors.lastname: Albouy
authors.forename: Gilles
authors.initials: G
authors.lastname: Pasticier
authors.forename: Michel
authors.initials: M
authors.lastname: Soulie
authors.forename: David
authors.initials: D
authors.lastname: Lopes
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lacroix
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Christian
authors.initials: C
authors.lastname: Pfister
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Thuret
authors.forename: Jacques
authors.initials: J
authors.lastname: Tostain
authors.forename: Alexandre
authors.initials: A
authors.lastname: De La Taille
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Clément
authors.initials: C
authors.lastname: Abbou
authors.forename: Marc
authors.initials: M
authors.lastname: Colombel
authors.forename: Arie S
authors.initials: AS
authors.lastname: Belldegrun
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
mesh_terms: 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