title: Recurrence pattern in patients with locally advanced renal cell carcinoma: The implications of clinicopathological variables.
abstract: OBJECTIVE
  Recurrence rates for patients with locally advanced renal cell carcinoma (LARCC) remain high. To date the predictors of recurrence in those patients remain controversial. The aim of the present study was to assess the relapse pattern in those patients and identify predictors for recurrence.
  
  
  METHODS
  We evaluated retrospectively 112 consecutive patients who underwent surgery for LARCC (T3-T4N0M0) between January 2000 and December 2010. Clinical and pathological data were collected from hospital medical records and compiled into a computerized database. Studied variables were age, mode of presentation, Tumour-Node-Metastasis (TNM) stage, Fuhrman nuclear grade, histological subtype, tumour size, venous thrombus level, collecting-system invasion and sarcomatoid differentiation. Recurrence-free survival (RFS) was estimated using the Kaplan-Meier method. Univariate and multivariate analyses were conducted.
  
  
  RESULTS
  Patients were followed for a mean and median follow-up of 33 and 24 months, respectively, after surgery. During the follow-up, recurrences (distant and/or local) were recorded in 58 patients, representing 52% of the cohort. The mean and median times to recurrence were 25 and 13 months, respectively. Sites of recurrence were multiple in 36 patients (62%), lung only in 14 (24%), and local in eight (14%). RFS rates at 1, 2, and 5 years were 50%, 43% and 34%, respectively, while the median RFS was 23.7 months. Using univariate analysis, RFS after nephrectomy was significantly shorter in patients aged <70 years, symptomatic at presentation, with larger tumours, higher nuclear grade, collecting-system invasion, and/or sarcomatoid differentiation. After multivariate analysis, T-stage, nuclear grade and sarcomatoid differentiation retained their power as independent predictors of RFS (P = 0.032, <0.001 and 0.003, respectively).
  
  
  CONCLUSIONS
  For patients with LARCC, T-stage, grade and sarcomatoid differentiation independently dictate the risk of tumour recurrence. Considering these variables in the postoperative surveillance protocols and in the need for a multimodal therapeutic approach is highly recommended.
authors.affiliation: Department of Urology, Faculty of Medicine, University of Alexandria, Egypt.
authors.forename: Wael M
authors.initials: WM
authors.lastname: Sameh
authors.affiliation: Department of Urology, Faculty of Medicine, University of Alexandria, Egypt.
authors.forename: Mohammed M
authors.initials: MM
authors.lastname: Hashad
authors.affiliation: Department of Urology, Faculty of Medicine, University of Alexandria, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Eid
authors.affiliation: Department of Urology, Faculty of Medicine, University of Alexandria, Egypt.
authors.forename: Tamer A
authors.initials: TA
authors.lastname: Abou Yousif
authors.affiliation: Department of Urology, Faculty of Medicine, University of Alexandria, Egypt.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Atta
keywords: AJCC, American Joint Cancer Committee; CSS, cancer-specific survival; Failure; Kidney; LA, locally advanced; Mass; Prognosis; RCC; RFS, recurrence-free survival; mRCC, metastatic RCC