title: Renal cell carcinoma recurrences and metastases in primary non-metastatic patients: a population-based study.
abstract: OBJECTIVE
  To present the occurrence of metastases and local recurrences in primary non-metastatic patients with renal cell carcinoma (RCC) in a contemporary Swedish population-based cohort.
  
  
  METHODS
  Between 2005 and 2009, a total of 4527 patients were included in the prospective National Swedish Kidney Cancer Register accounting for nearly all RCC patients in Sweden. Among M0 patients, 472 (13 %) had no follow-up data registered within 5-year follow-up time and were excluded from the analysis.
  
  
  RESULTS
  In total, 939 (21 %) had distant metastases at presentation with a decrease from 23 to 18 % during the inclusion period. Of 3107 patients with follow-up data and with M0 disease, 623 (20 %) were diagnosed with a tumor recurrence during 5-year follow-up. Mean time to recurrence was 24 months (SD ± 20 months). Among these, 570 patients (92 %) were at primary diagnosis treated with radical nephrectomy, 23 patients (3.7 %) with partial nephrectomy and 12 patients (1.9 %) with minimally invasive treatments. The most frequent sites of metastases were lung (54 %), lymph nodes (22 %) and bone (20 %). The treatment of recurrence was in 50 % systemic treatments, while metastasectomy was performed in 17 % of the patients, out of which 68 % were with a curative intention.
  
  
  CONCLUSIONS
  In this population-based study, 21 % of the patients had metastatic disease at presentation, with a decreasing trend over the study period. During 5-year follow-up, 20 % of the primary non-metastatic patients had recurrent disease. Of the patients with recurrence, half were given systemic oncological treatment and 17 % underwent metastasectomy.
authors: Department of Urology, Skåne University Hospital, 205 02, Malmö, Sweden.
authors: Saeed
authors: S
authors: Dabestani
authors: Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institute, 171 64, Solna, Stockholm, Sweden.
authors: Andreas
authors: A
authors: Thorstenson
authors: Department of Urology, Faculty of Medicine and Health, Örebro University, 701 85, Örebro, Sweden.
authors: Per
authors: P
authors: Lindblad
authors: Department of Oncology, Karolinska University Hospital, 171 64, Solna, Stockholm, Sweden.
authors: Ulrika
authors: U
authors: Harmenberg
authors: Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, 901 85, Umeå, Sweden. borje.ljungberg@umu.se.
authors: Börje
authors: B
authors: Ljungberg
authors: Department of Urology, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.
authors: Sven
authors: S
authors: Lundstam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000556:secondary* / Q000628:therapy*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D013548:Sweden; D055815:Young Adult
keywords: Local recurrence; Metastases; Minimal invasive therapy; Nephrectomy; Partial nephrectomy; Recurrent disease; Renal cell carcinoma; Surgery