title: Local Recurrence After Curative Surgical Treatment of Renal Cell Cancer: A Study of 91 Patients.
abstract: Local recurrence (LR) after curative therapy for renal cell cancer is a rare event, and surgery is still the primary treatment option.
  
  
  
  This was a single-institution, single-arm retrospective study from a prospectively conducted database. A total of 91 patients with a median age of 63.0 years (interquartile range, 57.5-68.3), who had undergone LR resection after initial curative treatment of RCC were enrolled. The time to LR (TTLR) was defined as the interval from primary curative surgery to LR. Cancer-specific survival, overall survival, and progression-free survival were evaluated after LR resection. Statistical analyses of the clinical and pathologic variables were performed using Cox regression analysis and the Kaplan-Meier method.
  
  
  
  The median time to LR was 29.8 months (interquartile range, 10.8-64.3). On multivariate analysis, age > 65 years, T3/T4 stage, Fuhrman grade 3/4, major venous infiltration, and positive surgical margins were related to early LR after primary curative surgery. LR size of ≤ 7 cm and TTLR of > 24 months were associated with longer cancer-specific survival. Furthermore, patients with a TTLR of > 24 months had better overall survival and progression-free survival. Of the entire cohort, intraoperative radiation therapy and targeted therapy were used in 17 (18.7%) and 15 (16.5%) patients, respectively.
  
  
  
  Advanced age, T3/T4 stage, Fuhrman grade 3 or 4, major venous infiltration, and positive surgical margins at primary tumor resection were related to a greater risk of early LR. An LR size of ≤ 7 cm and TTLR of > 24 months were associated with favorable oncologic outcomes after LR resection. Thus, patients who present with a longer TTLR and smaller LR size, along with favorable features at primary tumor resection, will benefit from surgical treatment.
authors.affiliation: Department of Urology, University of Heidelberg, Heidelberg, Germany; Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: YueJun
authors.initials: Y
authors.lastname: Du
authors.affiliation: Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Grüllich
authors.affiliation: Department of Urology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Hadaschik
authors.affiliation: Department of Urology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Gencay
authors.initials: G
authors.lastname: Hatiboglu
authors.affiliation: Department of Urology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Hohenfellner
authors.affiliation: Department of Urology, University of Heidelberg, Heidelberg, Germany. Electronic address: Sascha.Pahernik@med.uni-heidelberg.de.
authors.forename: Sascha
authors.initials: S
authors.lastname: Pahernik
mesh_terms: D000367:Age Factors; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Local recurrence; Prognosis; RCC; Risk factor; Surgery