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Should patients with low-risk renal cell carcinoma be followed differently after nephron-sparing surgery vs radical nephrectomy?

Abu-Ghanem, Yasmin ; Powles, Thomas ; Capitanio, Umberto ; Beisland, Christian ; Järvinen, Petrus ; Stewart, Grant D. ; Gudmundsson, Eirikur ; Lam, Thomas B.L. ; Marconi, Lorenzo and Fernandéz-Pello, Sergio , et al. (2021) In BJU International 128(3). p.386-394
Abstract

Objective: To investigate whether pT1 renal cell carcinoma (RCC) should be followed differently after partial (PN) or radical nephrectomy (RN) based on a retrospective analysis of a multicentre database (RECUR). Subjects: A retrospective study was conducted in 3380 patients treated for nonmetastatic RCC between January 2006 and December 2011 across 15 centres from 10 countries, as part of the RECUR database project. For patients with pT1 clear-cell RCC, patterns of recurrence were compared between RN and PN according to recurrence site. Univariate and multivariate models were used to evaluate the association between surgical approach and recurrence-free survival (RFS) and cancer-specific mortality (CSM). Results: From the database 1995... (More)

Objective: To investigate whether pT1 renal cell carcinoma (RCC) should be followed differently after partial (PN) or radical nephrectomy (RN) based on a retrospective analysis of a multicentre database (RECUR). Subjects: A retrospective study was conducted in 3380 patients treated for nonmetastatic RCC between January 2006 and December 2011 across 15 centres from 10 countries, as part of the RECUR database project. For patients with pT1 clear-cell RCC, patterns of recurrence were compared between RN and PN according to recurrence site. Univariate and multivariate models were used to evaluate the association between surgical approach and recurrence-free survival (RFS) and cancer-specific mortality (CSM). Results: From the database 1995 patients were identified as low-risk patients (pT1, pN0, pNx), of whom 1055 (52.9%) underwent PN. On multivariate analysis, features associated with worse RFS included tumour size (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14–1.39; P < 0.001), nuclear grade (HR 2.31, 95% CI 1.73–3.08; P < 0.001), tumour necrosis (HR 1.5, 95% CI 1.03–2.3; P = 0.037), vascular invasion (HR 2.4, 95% CI 1.3–4.4; P = 0.005) and positive surgical margins (HR 4.4, 95% CI 2.3–8.5; P < 0.001). Kaplan–Meier analysis of CSM revealed that the survival of patients with recurrence after PN was significantly better than those with recurrence after RN (P = 0.02). While the above-mentioned risk factors were associated with prognosis, type of surgery alone was not an independent prognostic variable for RFS nor CSM. Limitations include the retrospective nature of the study. Conclusion: Our results showed that follow-up protocols should not rely solely on stage and type of primary surgery. An optimized regimen should also include validated risk factors rather than type of surgery alone to select the best imaging method and to avoid unnecessary imaging. A follow-up of more than 3 years should be considered in patients with pT1 tumours after RN. A novel follow-up strategy is proposed.

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Contribution to journal
publication status
published
subject
keywords
#kcsm, #Kidney Cancer, #uroonc, follow up, guidelines, partial nephrectomy, radical nephrectomy, RECUR, renal cell carcinoma, survival
in
BJU International
volume
128
issue
3
pages
386 - 394
publisher
Wiley-Blackwell
external identifiers
  • scopus:85105007881
  • pmid:33794055
ISSN
1464-4096
DOI
10.1111/bju.15415
language
English
LU publication?
yes
id
f8f3a253-373c-4a41-b786-13626cc52554
date added to LUP
2021-05-11 14:08:33
date last changed
2024-05-18 09:26:57
@article{f8f3a253-373c-4a41-b786-13626cc52554,
  abstract     = {{<p>Objective: To investigate whether pT1 renal cell carcinoma (RCC) should be followed differently after partial (PN) or radical nephrectomy (RN) based on a retrospective analysis of a multicentre database (RECUR). Subjects: A retrospective study was conducted in 3380 patients treated for nonmetastatic RCC between January 2006 and December 2011 across 15 centres from 10 countries, as part of the RECUR database project. For patients with pT1 clear-cell RCC, patterns of recurrence were compared between RN and PN according to recurrence site. Univariate and multivariate models were used to evaluate the association between surgical approach and recurrence-free survival (RFS) and cancer-specific mortality (CSM). Results: From the database 1995 patients were identified as low-risk patients (pT1, pN0, pNx), of whom 1055 (52.9%) underwent PN. On multivariate analysis, features associated with worse RFS included tumour size (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14–1.39; P &lt; 0.001), nuclear grade (HR 2.31, 95% CI 1.73–3.08; P &lt; 0.001), tumour necrosis (HR 1.5, 95% CI 1.03–2.3; P = 0.037), vascular invasion (HR 2.4, 95% CI 1.3–4.4; P = 0.005) and positive surgical margins (HR 4.4, 95% CI 2.3–8.5; P &lt; 0.001). Kaplan–Meier analysis of CSM revealed that the survival of patients with recurrence after PN was significantly better than those with recurrence after RN (P = 0.02). While the above-mentioned risk factors were associated with prognosis, type of surgery alone was not an independent prognostic variable for RFS nor CSM. Limitations include the retrospective nature of the study. Conclusion: Our results showed that follow-up protocols should not rely solely on stage and type of primary surgery. An optimized regimen should also include validated risk factors rather than type of surgery alone to select the best imaging method and to avoid unnecessary imaging. A follow-up of more than 3 years should be considered in patients with pT1 tumours after RN. A novel follow-up strategy is proposed.</p>}},
  author       = {{Abu-Ghanem, Yasmin and Powles, Thomas and Capitanio, Umberto and Beisland, Christian and Järvinen, Petrus and Stewart, Grant D. and Gudmundsson, Eirikur and Lam, Thomas B.L. and Marconi, Lorenzo and Fernandéz-Pello, Sergio and Nisen, Harry and Meijer, Richard P. and Volpe, Alessandro and Ljungberg, Börje and Klatte, Tobias and Bensalah, Karim and Dabestani, Saeed and Bex, Axel}},
  issn         = {{1464-4096}},
  keywords     = {{#kcsm; #Kidney Cancer; #uroonc; follow up; guidelines; partial nephrectomy; radical nephrectomy; RECUR; renal cell carcinoma; survival}},
  language     = {{eng}},
  month        = {{04}},
  number       = {{3}},
  pages        = {{386--394}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{BJU International}},
  title        = {{Should patients with low-risk renal cell carcinoma be followed differently after nephron-sparing surgery vs radical nephrectomy?}},
  url          = {{http://dx.doi.org/10.1111/bju.15415}},
  doi          = {{10.1111/bju.15415}},
  volume       = {{128}},
  year         = {{2021}},
}