title: Different clinicopathological features between patients who developed early and late recurrence following surgery for renal cell carcinoma.
abstract: BACKGROUND
  To evaluate the clinicopathological features and identify predictive factors in patients with early and late recurrence following initial surgery for localized renal cell carcinoma.
  
  
  METHODS
  From April 1988 to January 2013, 486 patients without metastases at the initial diagnosis underwent either radical nephrectomy or partial nephrectomy and were followed up thereafter. Patients were divided into 3 groups; no recurrence, early recurrence (recurrence within 5 years), and late recurrence (recurrence after 5 years). Cancer-specific survival after recurrence was analyzed by using the Kaplan-Meier method. Multivariate logistic regression analysis was applied to define clinical and pathological factors correlated to early and late recurrence following surgery.
  
  
  RESULTS
  Seventy-seven (15.8 %) and 18 (3.7 %) patients developed early and late recurrence, respectively. In multivariate logistic regression analysis, positive symptoms at diagnosis, ≥pT2, positive lymphovascular invasion, and grade 3 were independent predictive factors for early recurrence. Age at surgery and ≥pT2 were significantly correlated to late recurrence. The 5-year cancer-specific survival rate after recurrence was 72.4 and 52.9 % in the late and the early recurrence groups, respectively (P = 0.044).
  
  
  CONCLUSIONS
  The risk factors for clinical recurrence differed according to the time that had elapsed between initial surgery and the first metastasis in patients with localized renal cell carcinoma. Our study showed age at initial surgery and the pT stage were independent predictive factors for late recurrence. Further investigation of a larger number of patients is required to predict which patients may develop recurrence in the future and to choose appropriate treatment.
authors.affiliation: Department of Urology, Toranomon Hospital, 2-2-2 Toranomon, Minato-Ku, Tokyo, 105-8470, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Fujii
authors.forename: Masaomi
authors.initials: M
authors.lastname: Ikeda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kurosawa
authors.forename: Mariko
authors.initials: M
authors.lastname: Tabata
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kamigaito
authors.forename: Chihiro
authors.initials: C
authors.lastname: Hosoda
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Okaneya
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; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009392:Nephrectomy; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors