Local Treatment of Recurrent Renal Cell Carcinoma May Have a Significant Survival Effect Across All Risk-of-recurrence Groups

Abstract

Background Retrospective comparative studies suggest a survival benefit after complete local treatment of recurrence (LTR) in renal cell carcinoma (RCC), which may be largely due to an indication bias.

Objective To determine the role of LTR in a homogeneous population characterised by limited and potentially resectable recurrence.

Design, setting, and participants RECUR is a protocol-based multicentre European registry capturing patient and tumour characteristics, risk of recurrence (RoR), recurrence patterns, and survival of those curatively treated for nonmetastatic RCC from 2006 to 2011. Per-protocol resectable disease (RD) recurrence was defined as (1) solitary metastases, (2) oligometastases, or (3) renal fossa or renal recurrence after radical or partial nephrectomy, respectively.

Intervention Local treatment of recurrence.

Outcome measurements and statistical analysis Overall survival (OS) and cancer-specific survival was compared in the RD population that underwent LTR versus no LTR. We constructed a multivariate model to predict risk factors for overall mortality and analysed the effect of LTR across RoR groups.

Results and limitations Of 3039 patients with localised RCC treated with curative intent, 505 presented with recurrence, including 176 with RD. Of these patients, 97 underwent LTR and 79 no LTR. Patients in the LTR group were younger (64.3 [40–80] vs 69.2 [45–87] yr; p = 0.001). The median OS was 70.3 mo (95% confidence interval [CI] 58–82.6) versus 27.4 mo (95% CI 23.6–31.15) in the LTR versus no-LTR group (p < 0.001). After a multivariate analysis, having LTR (hazard ratio [HR] 0.37 [95% CI 0.2–0.6]), having low- versus high-risk RoR (HR 0.42 [95% CI [0.20–0.83]), and not having extra-abdominal/thoracic metastasis (HR 1.96 [95% CI 1.02–3.77]) were prognostic factors of longer OS. The LTR effect on survival was consistent across risk groups. OS HR for high, intermediate, and low risks were 0.36 (0.2–0.64), 0.27 (0.11–0.65), and 0.26 (0.08–0.8), respectively. Limitations include retrospective design.

Conclusions This is the first study assessing the effectiveness of LTR in RCC in a comparable population with RD. This study supports the role of LTR across all RoR groups.