title: Time to recurrence is a significant predictor of cancer-specific survival after recurrence in patients with recurrent renal cell carcinoma--results from a comprehensive multi-centre database (CORONA/SATURN-Project).
abstract: OBJECTIVE
  To assess the prognostic impact of time to recurrence (TTR) on cancer-specific survival (CSS) after recurrence in patients with renal cell carcinoma (RCC) undergoing radical nephrectomy or nephron-sparing surgery. To analyse differences in clinical and histopathological criteria between patients with early and late recurrence.
  
  
  METHODS
  Of 13,107 patients with RCC from an international multicentre database, 1712 patients developed recurrence in the follow-up (FU), at a median (interquartile range) of 50.1 (25-106) months. In all, 1402 patients had recurrence at ≤5 years (Group A) and 310 patients beyond this time (Group B). Differences in clinical and histopathological variables between patients with early and late recurrence were analysed. The influence of TTR and further variables on CSS after recurrence was assessed by Cox regression analysis.
  
  
  RESULTS
  Male gender, advanced age, tumour diameter and stage, Fuhrman grade 3-4, lymphovascular invasion (LVI), and pN + stage were significantly more frequent in patients with early recurrence, who had a significantly reduced 3-year CSS of 30% compared with patients in Group B (41%; P = 0.001). Age, gender, tumour histology, pT stage, and continuous TTR (hazard ratio 0.99, P = 0.006; monthly interval) independently predicted CSS. By inclusion of dichotomised TTR in the multivariable model, a significant influence of this variable on CSS was present until 48 months after surgery, but not beyond this time.
  
  
  CONCLUSIONS
  Advanced age, male gender, larger tumour diameters, LVI, Fuhrman grade 3-4, pN + stage, and advanced tumour stages are associated with early recurrence. Up to 4 years from surgery, a shorter TTR independently predicts a reduced CSS after recurrence.
authors.affiliation: Department of Urology, Ludwig-Maximilians-University Munich, Campus Grosshadern, Munich, Germany.
authors.forename: Sabine D
authors.initials: SD
authors.lastname: Brookman-May
authors.forename: Matthias
authors.initials: M
authors.lastname: May
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.forename: Ottavio
authors.initials: O
authors.lastname: De Cobelli
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.forename: Sascha
authors.initials: S
authors.lastname: Pahernik
authors.forename: Manfred P
authors.initials: MP
authors.lastname: Wirth
authors.forename: Nicola
authors.initials: N
authors.lastname: Longo
authors.forename: Alchiede
authors.initials: A
authors.lastname: Simonato
authors.forename: Sergio
authors.initials: S
authors.lastname: Serni
authors.forename: Salvatore
authors.initials: S
authors.lastname: Siracusano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Volpe
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Morgia
authors.forename: Roberto
authors.initials: R
authors.lastname: Bertini
authors.forename: Orietta
authors.initials: O
authors.lastname: Dalpiaz
authors.forename: Christian
authors.initials: C
authors.lastname: Stief
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ficarra
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
keywords: cancer-specific survival; early recurrence; late recurrence; nephrectomy; prognostic parameters; renal cell carcinoma (RCC); time to recurrence