Clinicopathological features and outcomes in patients with late recurrence of renal cell carcinoma after radical surgery.
To characterize patients experiencing late recurrence after primary radical surgery for renal cell carcinoma and to approach the mechanism of late recurrence.



We retrospectively analyzed 657 consecutive patients who underwent radical surgery for pathologically confirmed ≤stage III renal cell carcinoma in a single institution between January 1981 and December 2008. Early or late recurrence was defined as a recurrence occurring before or after 60 months after primary surgery.



Of 657 patients, 96 (14.6%) experienced early recurrence, and 41 (6.2%) developed late recurrence. Patients with late recurrence had smaller diameter of primary tumor (median 5 cm vs 8 cm, P < 0.001), lower pathological stage (P < 0.001) and lower nuclear grade (P = 0.004) at primary surgery than those with early recurrence. On multivariate analysis, vascular invasion (including microscopic and gross invasion) was the predictor of late recurrence (P < 0.01, HR 3.79). Overall survival and disease-specific survival after recurrence were longer in patients with late recurrence (median 64 and 76 months, respectively) than in those with early recurrence (34.5 and 35 months, respectively; P = 0.008 and 0.002).



These results suggest that micrometastasis at the time of surgery associated with vascular invasion at primary tumor site and their relatively lower malignant potential could lead to late recurrence. Further studies are warranted for better understanding and managing late recurrence of renal cell carcinoma.
Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.
Kazuhiro
K
Kobayashi
Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.
Toshihiro
T
Saito
Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.
Yasuo
Y
Kitamura
Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.|Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Vladimir
V
Bilim
Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.|Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Tomotaka
T
Toba
Department of Pathology, Niigata Cancer Center Hospital, Niigata, Japan.
Takashi
T
Kawasaki
Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.|Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.|Division of Molecular Oncology, Department of Signal Transduction Research, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Noboru
N
Hara
Department of Urology, Niigata Cancer Center Hospital, Niigata, Japan.
Toshiki
T
Tanikawa
Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Yoshihiko
Y
Tomita
D002292:Carcinoma, Renal Cell / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009392:Nephrectomy; D011379:Prognosis; D012189:Retrospective Studies
clinicopathological features; late recurrence; nephrectomy; prognosis; renal cell carcinoma