title: Local recurrence after radical nephrectomy for kidney cancer: management and prediction of outcomes. a multi-institutional study.
abstract: BACKGROUND
  Local recurrence (LR) after radical nephrectomy (RN) for kidney cancer is uncommon. Our objectives were to analyse characteristics and therapeutic options of LR after RN and to identify survival prognostic factors.
  
  
  METHODS
  From a multi-institutional retrospective database, we identified 72 patients who experienced LR after RN.
  
  
  RESULTS
  Mean time to LR was 26.5 ± 3.3 months. The location of the recurrence was renal fossa, regional lymph node, homolateral adrenal and both renal fossa and regional lymph node for 43 (59.7%), 27 (37.5%), 9 (12.5%) and 7 (9.7%) patients, respectively. Patients were treated by surgery, systemic therapies, combination of therapies and palliative treatment in 24 (33.3%), 18 (25%), 24 (33.3%) and 6 (8.4%) cases, respectively. Within a mean follow-up of 26.4 ± 3.3 months from the date of local recurrence, 12 (16.6%) patients were alive without disease, 30 (41.7%) patients were alive with disease, 30 patients (41.6%) died including 28 (38.8%) from the disease. In multivariate analysis, time to recurrence <1 year (P < 0.001; HR: 4.81) and surgical treatment (P = 0.027; HR: 0.33) were predictive factors.
  
  
  CONCLUSIONS
  Local recurrence after radical nephrectomy is associated with poor prognosis. The time to recurrence and the completeness of the surgical treatment are major prognostic factors.
authors.affiliation: Cancerology Committee of the French Association of Urology (CCAFU), Paris, France; Department of Urology, Lyon Sud University Hospital, Claude Bernard University Lyon 1, Lyon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Paparel
authors.forename: Pierre
authors.initials: P
authors.lastname: Bigot
authors.forename: Xavier
authors.initials: X
authors.lastname: Matillon
authors.forename: Karim
authors.initials: K
authors.lastname: Bensalah
authors.forename: Laurent
authors.initials: L
authors.lastname: Salomon
authors.forename: Hervé
authors.initials: H
authors.lastname: Baumert
authors.forename: Cyril
authors.initials: C
authors.lastname: Bastide
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Thuret
authors.forename: Gilles
authors.initials: G
authors.lastname: Karsenty
authors.forename: Jean Alexandre
authors.initials: JA
authors.lastname: Long
authors.forename: Myriam
authors.initials: M
authors.lastname: Ammi
authors.forename: Thomas
authors.initials: T
authors.lastname: Bessede
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bin
authors.forename: Adeline
authors.initials: A
authors.lastname: Roux
authors.forename: Bernard
authors.initials: B
authors.lastname: Escudier
authors.forename: Nathalie
authors.initials: N
authors.lastname: Rioux Leclercq
authors.forename: Géraldine
authors.initials: G
authors.lastname: Pignot
authors.forename: Michel
authors.initials: M
authors.lastname: Soulie
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
mesh_terms: D000315:Adrenalectomy; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D009392:Nephrectomy; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
keywords: local recurrence; outcome; renal cell carcinoma; surgery