title: Features associated with recurrence beyond 5 years after nephrectomy and nephron-sparing surgery for renal cell carcinoma: development and internal validation of a risk model (PRELANE score) to predict late recurrence based on a large multicenter database (CORONA/SATURN Project).
abstract: BACKGROUND
  Approximately 10-20% of recurrences in patients treated with nephrectomy for renal cell carcinoma (RCC) develop beyond 5 yr after surgery (late recurrence).
  
  
  OBJECTIVE
  To determine features associated with late recurrence.
  
  
  METHODS
  A total of 5009 patients from a multicenter database comprising 13 107 RCC patients treated surgically had a minimum recurrence-free survival of 60 mo (median follow-up [FU]: 105 mo [range: 78-135]); at last FU, 4699 were disease free (median FU: 103 mo [range: 78-134]), and 310 patients (6.2%) experienced disease recurrence (median FU: 120 mo [range: 93-149]).
  
  
  METHODS
  Patients underwent radical nephrectomy or nephron-sparing surgery.
  
  
  METHODS
  Multivariable regression analyses identified features associated with late recurrence. Cox regression analyses evaluated the association of features with cancer-specific mortality (CSM).
  
  
  CONCLUSIONS
  Lymphovascular invasion (LVI) (odds ratio [OR]: 3.07; p<0.001), Fuhrman grade 3-4 (OR: 1.60; p=0.001), and pT stage >pT1 (OR: 2.28; p<0.001) were significantly associated with late recurrence. Based on accordant regression coefficients, these parameters were weighted with point values (LVI: 2 points; Fuhrman grade 3-4: 1 point, pT stage >1: 2 points), and a risk score was developed for the prediction of late recurrences. The calculated values (0 points: late recurrence risk 3.1%; 1-3 points: 8.4%; 4-5 points: 22.1%) resulted in a good-, intermediate- and poor-prognosis group (area under the curve value for the model: 70%; 95% confidence interval, 67-73). Multivariable Cox regression analysis showed LVI (HR: 2.75; p<0.001), pT stage (HR: 1.24; p<0.001), Fuhrman grade (HR: 2.40; p<0.001), age (HR: 1.01; p<0.001), and gender (HR: 0.71; p=0.027) to influence CSM significantly. Limitations are based on the multicenter and retrospective study design.
  
  
  CONCLUSIONS
  LVI, Fuhrman grade 3/4, and a tumor stage >pT1 are independent predictors of late recurrence after at least 5 yr from surgery in patients with RCC. We developed a risk score that allows for prognostic stratification and individualized aftercare of patients with regard to counseling, follow-up scheduling, and clinical trial design.
authors: Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Department of Urology, Munich, Germany. Electronic address: sabine.brookman-may@email.de
authors: Sabine
authors: S
authors: Brookman-May
authors: Matthias
authors: M
authors: May
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Evanguelos
authors: E
authors: Xylinas
authors: Christian
authors: C
authors: Stief
authors: Richard
authors: R
authors: Zigeuner
authors: Thomas
authors: T
authors: Chromecki
authors: Maximilian
authors: M
authors: Burger
authors: Wolf F
authors: WF
authors: Wieland
authors: Luca
authors: L
authors: Cindolo
authors: Luigi
authors: L
authors: Schips
authors: Ottavio
authors: O
authors: De Cobelli
authors: Bernardo
authors: B
authors: Rocco
authors: Cosimo
authors: C
authors: De Nunzio
authors: Bogdan
authors: B
authors: Feciche
authors: Michael
authors: M
authors: Truss
authors: Christian
authors: C
authors: Gilfrich
authors: Sascha
authors: S
authors: Pahernik
authors: Markus
authors: M
authors: Hohenfellner
authors: Stefan
authors: S
authors: Zastrow
authors: Manfred P
authors: MP
authors: Wirth
authors: Giacomo
authors: G
authors: Novara
authors: Marco
authors: M
authors: Carini
authors: Andrea
authors: A
authors: Minervini
authors: Claudio
authors: C
authors: Simeone
authors: Alessandro
authors: A
authors: Antonelli
authors: Vincenzo
authors: V
authors: Mirone
authors: Nicola
authors: N
authors: Longo
authors: Alchiede
authors: A
authors: Simonato
authors: Giorgio
authors: G
authors: Carmignani
authors: Vincenzo
authors: V
authors: Ficarra
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D003661:Decision Support Techniques; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects / Q000401:mortality; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome