腎切除術後晚期局部復發之腎細胞癌：九年與三十一年復發病例報告

Late Local Recurrence of Renal Cell Carcinoma After Nephrectomy: A Report of Two Cases With 9-Year and 31-Year Recurrence Intervals

張有元、陳穎政、曹智惟

Yu-Yuan, Chang、Ying-Zheng, Chen、Chih-Wei, Tsao

三軍總醫院外科部泌尿外科

Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical University

Purpose

Late recurrence of renal cell carcinoma (RCC), defined as recurrence >5 years after nephrectomy, occurs in 6–12% of disease-free patients [1]. The 10-year incidence of ipsilateral local recurrence after partial nephrectomy (PN) is 6.2% [2], while renal fossa recurrence (RFR) after radical nephrectomy (RN) occurs in 1.3–3.7% of patients [3,4]. We present two cases of remarkably late RCC recurrence — at 9 and 31 years — highlighting distinct recurrence patterns after PN and RN.

Materials and Methods

We retrospectively reviewed two patients who developed late local recurrence of RCC after initial curative nephrectomy at our institution.

Results

Case 1: A 58-year-old male underwent right PN in 2016 for papillary RCC (grade II, pT1a, 2.5 × 2.2 cm, margin free 0.1 cm), with concurrent left hemicolectomy for colon adenocarcinoma (pT3N0M0). After 9 years, MRI revealed a 3.6-cm recurrent right renal mass and a 1.7-cm left renal nodule. Right radical nephrectomy and left renal biopsy were performed. Pathology confirmed recurrent papillary RCC (pT1aNx, 2.9 × 2.5 × 2.1 cm); the left kidney was benign. Follow-up MRI at 3 months showed no recurrence.

Case 2: A patient with left RCC status post RN in 1994 was incidentally found to have a 4.3-cm left renal fossa mass 31 years later. MRI showed a 4.7-cm mass abutting the pancreatic tail and spleen. Biopsy confirmed clear cell RCC. Exploratory laparotomy with tumor excision revealed a 4.5 × 3.5 × 3.5 cm clear cell RCC (margin 0.1 cm).

Discussion

Case 1 illustrates the paradox in pT1a papillary RCC: despite favorable overall prognosis, late recurrence (≥5 years) is significantly more common than in clear cell RCC at the same stage (4.8% vs 0.3%) [5]. Our patient harbored no high-risk PRELANE features (LVI, grade 3–4, >pT1) [1], yet recurred at 9 years, reinforcing that conventional risk models may underestimate late relapse risk in papillary histology. Case 2 represents one of the longest reported RFR intervals. In the largest RFR series, advanced stage and coagulative necrosis independently predicted isolated RFR, and locally directed therapy conferred markedly superior survival versus observation (HR 0.26, p<0.001) [3]. The recurrence pattern of clear cell RCC shifts over time, with retroperitoneal recurrences increasing proportionally beyond 10 years [6] — consistent with our patient's renal fossa recurrence. Both cases were managed with aggressive surgical excision, which remains the preferred approach for isolated local recurrence regardless of surgical history.

Conclusion

RCC can recur decades after curative surgery, even in low-stage, low-grade disease. Papillary and clear cell subtypes exhibit distinct late recurrence patterns that warrant histology-tailored, extended surveillance beyond the conventional 5-year follow-up. Surgical excision remains the treatment of choice for isolated local recurrence.

References

1.      Brookman-May S, et al. Features associated with recurrence beyond 5 years after nephrectomy and nephron-sparing surgery for renal cell carcinoma: development and internal validation of a risk model (PRELANE Score). Eur Urol. 2013;64(3):472-477.

2.      Britton CJ, et al. Incidence and predictors of ipsilateral local recurrence following partial nephrectomy. Urol Oncol. 2024;42(10):334.e1-334.e9.

3.      Psutka SP, et al. Renal fossa recurrence after nephrectomy for renal cell carcinoma: prognostic features and oncological outcomes. BJU Int. 2017;119(1):116-127.

4.      Romeo A, et al. Renal fossa recurrence after radical nephrectomy: current management, and oncological outcomes. Urol Oncol. 2020;38(1):42.e7-42.e12.

5.      Yoo S, et al. Histologic subtype needs to be considered after partial nephrectomy in patients with pathologic T1a renal cell carcinoma: papillary vs. clear cell renal cell carcinoma. J Cancer Res Clin Oncol. 2017;143(9):1845-1851.

6.      Noguchi G, et al. Time-dependent change in relapse sites of renal cell carcinoma after curative surgery. Clin Exp Metastasis. 2018;35(3):69-75.