Arab Journal of Urology (2012) 10, 131–137
Arab Journal of Urology (Official Journal of the Arab Association of Urology) www.sciencedirect.com
ONCOLOGY/RECONSTRUCTION ORIGINAL ARTICLE
Recurrence pattern in patients with locally advanced renal cell carcinoma: The implications of clinicopathological variables Wael M. Sameh *, Mohammed M. Hashad, Ahmed A. Eid, Tamer A. Abou Yousif, Mohammed A. Atta Department of Urology, Faculty of Medicine, University of Alexandria, Egypt Received 1 November 2011, Received in revised form 18 December 2011, Accepted 24 December 2011 Available online 18 February 2012
KEYWORDS Kidney; Mass; Failure; Prognosis; RCC ABBREVIATIONS LA, locally advanced; mRCC, metastatic RCC; RFS, recurrence-free survival; CSS, cancer-specific survival; AJCC, American Joint Cancer Committee
Abstract Objectives: Recurrence rates for patients with locally advanced renal cell carcinoma (LARCC) remain high. To date the predictors of recurrence in those patients remain controversial. The aim of the present study was to assess the relapse pattern in those patients and identify predictors for recurrence. Patients and methods: We evaluated retrospectively 112 consecutive patients who underwent surgery for LARCC (T3–T4N0M0) between January 2000 and December 2010. Clinical and pathological data were collected from hospital medical records and compiled into a computerized database. Studied variables were age, mode of presentation, Tumour-Node-Metastasis (TNM) stage, Fuhrman nuclear grade, histological subtype, tumour size, venous thrombus level, collecting-system invasion and sarcomatoid differentiation. Recurrence-free survival (RFS) was estimated using the Kaplan–Meier method. Univariate and multivariate analyses were conducted. Results: Patients were followed for a mean and median follow-up of 33 and 24 months, respectively, after surgery. During the follow-up, recurrences (distant and/or local) were recorded in 58 patients, representing 52% of the cohort. The mean and median times to recurrence were 25 and 13 months, respectively. Sites of recurrence were multiple in 36 patients (62%), lung only in 14 (24%), and local
* Corresponding author. Address: Genitourinary Surgery Division, Department of Urology, Faculty of Medicine, University of Alexandria, Egypt. Mobile: +20 101557615. E-mail address: [email protected] (W.M. Sameh). 2090-598X ª 2012 Arab Association of Urology. Production and hosting by Elsevier B.V. All rights reserved. Peer review under responsibility of Arab Association of Urology. doi:10.1016/j.aju.2011.12.007
Production and hosting by Elsevier
132
Sameh et al.
in eight (14%). RFS rates at 1, 2, and 5 years were 50%, 43% and 34%, respectively, while the median RFS was 23.7 months. Using univariate analysis, RFS after nephrectomy was significantly shorter in patients aged
Arab Journal of Urology (Official Journal of the Arab Association of Urology) www.sciencedirect.com
ONCOLOGY/RECONSTRUCTION ORIGINAL ARTICLE
Recurrence pattern in patients with locally advanced renal cell carcinoma: The implications of clinicopathological variables Wael M. Sameh *, Mohammed M. Hashad, Ahmed A. Eid, Tamer A. Abou Yousif, Mohammed A. Atta Department of Urology, Faculty of Medicine, University of Alexandria, Egypt Received 1 November 2011, Received in revised form 18 December 2011, Accepted 24 December 2011 Available online 18 February 2012
KEYWORDS Kidney; Mass; Failure; Prognosis; RCC ABBREVIATIONS LA, locally advanced; mRCC, metastatic RCC; RFS, recurrence-free survival; CSS, cancer-specific survival; AJCC, American Joint Cancer Committee
Abstract Objectives: Recurrence rates for patients with locally advanced renal cell carcinoma (LARCC) remain high. To date the predictors of recurrence in those patients remain controversial. The aim of the present study was to assess the relapse pattern in those patients and identify predictors for recurrence. Patients and methods: We evaluated retrospectively 112 consecutive patients who underwent surgery for LARCC (T3–T4N0M0) between January 2000 and December 2010. Clinical and pathological data were collected from hospital medical records and compiled into a computerized database. Studied variables were age, mode of presentation, Tumour-Node-Metastasis (TNM) stage, Fuhrman nuclear grade, histological subtype, tumour size, venous thrombus level, collecting-system invasion and sarcomatoid differentiation. Recurrence-free survival (RFS) was estimated using the Kaplan–Meier method. Univariate and multivariate analyses were conducted. Results: Patients were followed for a mean and median follow-up of 33 and 24 months, respectively, after surgery. During the follow-up, recurrences (distant and/or local) were recorded in 58 patients, representing 52% of the cohort. The mean and median times to recurrence were 25 and 13 months, respectively. Sites of recurrence were multiple in 36 patients (62%), lung only in 14 (24%), and local
* Corresponding author. Address: Genitourinary Surgery Division, Department of Urology, Faculty of Medicine, University of Alexandria, Egypt. Mobile: +20 101557615. E-mail address: [email protected] (W.M. Sameh). 2090-598X ª 2012 Arab Association of Urology. Production and hosting by Elsevier B.V. All rights reserved. Peer review under responsibility of Arab Association of Urology. doi:10.1016/j.aju.2011.12.007
Production and hosting by Elsevier
132
Sameh et al.
in eight (14%). RFS rates at 1, 2, and 5 years were 50%, 43% and 34%, respectively, while the median RFS was 23.7 months. Using univariate analysis, RFS after nephrectomy was significantly shorter in patients aged
