Predictive factors for disease recurrence in patients with locally advanced renal cell carcinoma treated with curative surgery
Tsu-Hao Huang1, Wei-Ming Cheng1, Chih-Chieh Lin1,2,Tzu-Ping Lin1,2, Yi-Hsiu Huang1,2, Hsiao-Jen Chung1,2, Yen-Hwa Chang1,2, Alex T. L. Lin1,2, Kuang-Kuo Chen1,2
1Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan; 2Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan
Purpose: Radical nephrectomy with or without thrombectomy, and partial nephrectomy for highly selected cases, could be a curative treatment for patients with locally advanced renal cell carcinoma (RCC). However, few prognostic factors have been proposed in such patient group. In the present study, we investigated the possible predictive factors for recurrence after curative surgery for locally advanced RCC
Materials and Methods: Patients with RCC staged T3 or higher without distal metastasis receiving partial or radical nephrectomy with or without thrombectomy in our institute from April 1st 2005 to October 31st 2013 were retrospectively reviewed. Preoperative data including risk groups based on MSKCC and Heng models, as well as surgical and pathologic characteristics were correlated to local-recurrence-free, metastasis-free, and disease-free survival respectively. Kaplan-Meier survival curve and forward stepwise analysis test were used for statistical analysis.
Results: A total of 159 patients (110 were males) were included. Mean age at surgery was 62.2 ± 15.3 years. Other demographic data were shown in the Table. Mean duration of follow-up was 37.9 ± 27.9 months. Local recurrence was noticed in 17 (10.7%), and distal metastases developed in 37 (23.3%). 119 (74.8%) remained disease free. Muscular branch but no renal vein involvement by RCC was noticed in 21 patients undergoing partial nephrectomy, and only one developed local recurrence.
Stage higher than pT3a, papillary cell type, higher Fuhrman grade, and poorer Heng's risk group were associated with shorter local-recurrence-free, metastasis-free, and disease-free intervals on univariate analysis. Poorer MSKCC risk group and thrombocytosis were related to shorter metastasis-free (p = 0.0001 and p = 0.006 respectively) and disease-free (p = 0.0001 and p = 0.002 respectively) but not local-recurrence-free intervals intervals. Excess serum alkaline phosphatase was associated with shorter local-recurrence-free interval (p =0.032) only. Other factors including body mass index, blood type, neutrophil-to-lymphocyte ratio, blood transfusion, surgical methods, or positive surgical margin were failed to show any association.
On multivariate analysis, only Heng's risk group and Fuhrman grade had significant association with local-recurrence-free (p = 0.001, 95% IC 3.9 – 146.8; p = 0.021, 95% CI 1.5 – 88.6, respectively), metastasis-free (p = 0.0001, 95% CI 8.8 – 120.5; p = 0.001, 95% CI 1.8 – 11.4, respectively), and disease-free survival (p = 0.0001, 95% CI 12.8 – 210.3; p = 0.001, 95% CI 1.9 – 11.8, respectively).
Conclusion: In patients with locally advanced RCC, Fuhrman grade and Heng's risk group could predict local or distal recurrence after curative surgery. For those undergoing partial nephrectomy, muscular branch involvement could not be a predictive factor.