title: Features, risk factors and clinical outcome of "very late" recurrences after surgery for localized renal carcinoma: A retrospective evaluation of a cohort with a minimum of 10 years of follow up.
abstract: OBJECTIVE
  To evaluate the features and the predictors of "very late" recurrences after surgery for localized renal cell carcinoma.
  
  
  METHODS
  Since 1983, an institutional database with data of more than 2300 consecutive patients treated for renal cancer has been prospectively maintained. Patients N0 /Nx M0 followed for a minimum of 10 years without recurrences were retrieved. The site, time and treatment of recurrences observed afterwards were recorded, and the predictors were investigated by Cox regression analysis.
  
  
  RESULTS
  A total of 554 patients (231 women, 323 men; age 59.3 ± 11.6 years) followed for a mean/median time of 15.1/13.6 years (range 10.0-34.1 years) were analyzed. A recurrence was observed in 26 patients (4.6%) after a mean/median interval of 13.3/12.3 years (range 10.5-30.2 years). The pathological stage 2/3 was the only independent predictor of recurrence (P = 0.003), and it was related also to the latency of recurrence (mean/median latency 15.4/14.0, 11.4/10.8 and 12.5/12.0 years, respectively, for stage 1, 2 and 3; P < 0.005 for stage 1 vs stage 2 or 3). The contralateral kidney was the most frequent site of relapse in patients with stage pT1, whereas multiple sites were more frequent for stage pT2 and pT3.
  
  
  CONCLUSIONS
  The risk of a "very late" recurrence of renal cancer is approximately 5%, and it depends on the pathological stage. For stage pT1, the kidney/s should be surveilled for indefinite time, preferably by ultrasound to reduce the X-ray exposition; for stage pT2 and pT3, the abdomen and the lungs should be monitored, by computed tomography scan during the first years, and then by abdominal ultrasound and chest X-ray.
authors.affiliation: Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonelli
authors.affiliation: Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Furlan
authors.affiliation: Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Sodano
authors.affiliation: Department of Pathology, Spedali Civili Hospital, University of Brescia, Brescia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.affiliation: Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy.
authors.forename: Sandra
authors.initials: S
authors.lastname: Belotti
authors.affiliation: Department of Urology, San Pio da Petralcina Hospital, Vasto, Italy.
authors.forename: Regina
authors.initials: R
authors.lastname: Tardanico
authors.affiliation: Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cozzoli
authors.affiliation: Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Zanotelli
authors.affiliation: Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Simeone
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
keywords: follow up; oncological outcome; recurrence; renal cell carcinoma; stage