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The Impact of Histological Subtype on the Incidence, Timing, and Patterns of Recurrence in Patients with Renal Cell Carcinoma After Surgery-Results from RECUR Consortium

Abu-Ghanem, Yasmin ; Powles, Thomas ; Capitanio, Umberto ; Beisland, Christian ; Järvinen, Petrus ; Stewart, Grant D. ; Gudmundsson, Eiríkur Orri ; Lam, Thomas B. ; Marconi, Lorenzo and Fernandéz-Pello, Sergio , et al. (2021) In European Urology Oncology 4(3). p.473-482
Abstract

BACKGROUND: Current follow-up strategies for patients with renal cell carcinoma (RCC) after curative surgery rely mainly on risk models and the treatment delivered, regardless of the histological subtype. OBJECTIVE: To determine the impact of RCC histological subtype on recurrence and to examine the incidence, pattern, and timing of recurrences to improve follow-up recommendations. DESIGN, SETTING, AND PARTICIPANTS: This study included consecutive patients treated surgically with curative intention (ie, radical and partial nephrectomy) for nonmetastatic RCC (cT1-4, M0) between January 2006 and December 2011 across 15 centres from 10 countries, as part of the euRopEan association of urology renal cell carcinoma guidelines panel... (More)

BACKGROUND: Current follow-up strategies for patients with renal cell carcinoma (RCC) after curative surgery rely mainly on risk models and the treatment delivered, regardless of the histological subtype. OBJECTIVE: To determine the impact of RCC histological subtype on recurrence and to examine the incidence, pattern, and timing of recurrences to improve follow-up recommendations. DESIGN, SETTING, AND PARTICIPANTS: This study included consecutive patients treated surgically with curative intention (ie, radical and partial nephrectomy) for nonmetastatic RCC (cT1-4, M0) between January 2006 and December 2011 across 15 centres from 10 countries, as part of the euRopEan association of urology renal cell carcinoma guidelines panel Collaborative multicenter consortium for the studies of follow-Up and recurrence patterns in Radically treated renal cell carcinoma patients (RECUR) database project. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The impact of histological subtype (ie, clear cell RCC [ccRCC], papillary RCC [pRCC], and chromophobe RCC [chRCC]) on recurrence-free survival (RFS) was assessed via univariate and multivariate analyses, adjusting for potential interactions with important variables (stage, grade, risk score, etc.) Patterns of recurrence for all histological subtypes were compared according to recurrence site and risk criteria. RESULTS AND LIMITATIONS: Of the 3331 patients, 62.2% underwent radical nephrectomy and 37.8% partial nephrectomy. A total of 2565 patients (77.0%) had ccRCC, 535 (16.1%) had pRCC, and 231 (6.9%) had chRCC. The median postoperative follow-up period was 61.7 (interquartile range: 47-83) mo. Patients with ccRCC had significantly poorer 5-yr RFS than patients with pRCC and chRCC (78% vs 86% vs 91%, p = 0.001). The most common sites of recurrence for ccRCC were the lung and bone. Intermediate-/high-risk pRCC patients had an increased rate of lymphatic recurrence, both mediastinal and retroperitoneal, while recurrence in chRCC was rare (8.2%), associated with higher stage and positive margins, and predominantly in the liver and bone. Limitations include the retrospective nature of the study. CONCLUSIONS: The main histological subtypes of RCC exhibit a distinct pattern and dynamics of recurrence. Results suggest that intermediate- to high-risk pRCC may benefit from cross-sectional abdominal imaging every 6 mo until 2 yr after surgery, while routine imaging might be abandoned for chRCC except for abdominal computed tomography in patients with advanced tumour stage or positive margins. PATIENT SUMMARY: In this analysis of a large database from 15 countries around Europe, we found that the main histological subtypes of renal cell carcinoma have a distinct pattern and dynamics of recurrence. Patients should be followed differently according to subtype and risk score.

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organization
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type
Contribution to journal
publication status
published
subject
keywords
Chromophobe, Clear cell, Follow-up, Papillary, RECUR database, Recurrence-free survival, Renal cell carcinoma
in
European Urology Oncology
volume
4
issue
3
pages
10 pages
publisher
Elsevier
external identifiers
  • pmid:33109495
  • scopus:85101667483
ISSN
2588-9311
DOI
10.1016/j.euo.2020.09.005
language
English
LU publication?
yes
additional info
Publisher Copyright: Copyright © 2020. Published by Elsevier B.V.
id
dc4a5948-2b08-448c-bff7-78a253ac1557
date added to LUP
2021-12-20 13:21:10
date last changed
2024-02-20 18:45:35
@article{dc4a5948-2b08-448c-bff7-78a253ac1557,
  abstract     = {{<p>BACKGROUND: Current follow-up strategies for patients with renal cell carcinoma (RCC) after curative surgery rely mainly on risk models and the treatment delivered, regardless of the histological subtype. OBJECTIVE: To determine the impact of RCC histological subtype on recurrence and to examine the incidence, pattern, and timing of recurrences to improve follow-up recommendations. DESIGN, SETTING, AND PARTICIPANTS: This study included consecutive patients treated surgically with curative intention (ie, radical and partial nephrectomy) for nonmetastatic RCC (cT1-4, M0) between January 2006 and December 2011 across 15 centres from 10 countries, as part of the euRopEan association of urology renal cell carcinoma guidelines panel Collaborative multicenter consortium for the studies of follow-Up and recurrence patterns in Radically treated renal cell carcinoma patients (RECUR) database project. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The impact of histological subtype (ie, clear cell RCC [ccRCC], papillary RCC [pRCC], and chromophobe RCC [chRCC]) on recurrence-free survival (RFS) was assessed via univariate and multivariate analyses, adjusting for potential interactions with important variables (stage, grade, risk score, etc.) Patterns of recurrence for all histological subtypes were compared according to recurrence site and risk criteria. RESULTS AND LIMITATIONS: Of the 3331 patients, 62.2% underwent radical nephrectomy and 37.8% partial nephrectomy. A total of 2565 patients (77.0%) had ccRCC, 535 (16.1%) had pRCC, and 231 (6.9%) had chRCC. The median postoperative follow-up period was 61.7 (interquartile range: 47-83) mo. Patients with ccRCC had significantly poorer 5-yr RFS than patients with pRCC and chRCC (78% vs 86% vs 91%, p = 0.001). The most common sites of recurrence for ccRCC were the lung and bone. Intermediate-/high-risk pRCC patients had an increased rate of lymphatic recurrence, both mediastinal and retroperitoneal, while recurrence in chRCC was rare (8.2%), associated with higher stage and positive margins, and predominantly in the liver and bone. Limitations include the retrospective nature of the study. CONCLUSIONS: The main histological subtypes of RCC exhibit a distinct pattern and dynamics of recurrence. Results suggest that intermediate- to high-risk pRCC may benefit from cross-sectional abdominal imaging every 6 mo until 2 yr after surgery, while routine imaging might be abandoned for chRCC except for abdominal computed tomography in patients with advanced tumour stage or positive margins. PATIENT SUMMARY: In this analysis of a large database from 15 countries around Europe, we found that the main histological subtypes of renal cell carcinoma have a distinct pattern and dynamics of recurrence. Patients should be followed differently according to subtype and risk score.</p>}},
  author       = {{Abu-Ghanem, Yasmin and Powles, Thomas and Capitanio, Umberto and Beisland, Christian and Järvinen, Petrus and Stewart, Grant D. and Gudmundsson, Eiríkur Orri and Lam, Thomas B. and Marconi, Lorenzo and Fernandéz-Pello, Sergio and Nisen, Harry and Meijer, Richard P. and Volpe, Alessandro and Ljungberg, Börje and Klatte, Tobias and Dabestani, Saeed and Bex, Axel}},
  issn         = {{2588-9311}},
  keywords     = {{Chromophobe; Clear cell; Follow-up; Papillary; RECUR database; Recurrence-free survival; Renal cell carcinoma}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{3}},
  pages        = {{473--482}},
  publisher    = {{Elsevier}},
  series       = {{European Urology Oncology}},
  title        = {{The Impact of Histological Subtype on the Incidence, Timing, and Patterns of Recurrence in Patients with Renal Cell Carcinoma After Surgery-Results from RECUR Consortium}},
  url          = {{http://dx.doi.org/10.1016/j.euo.2020.09.005}},
  doi          = {{10.1016/j.euo.2020.09.005}},
  volume       = {{4}},
  year         = {{2021}},
}