Long-term Outcomes of Follow-up for Initially Localised Clear Cell Renal Cell Carcinoma: RECUR Database Analysis.
BACKGROUND
Optimal follow-up (FU) strategy to detect potentially curable (PC) recurrences after treatment of localised clear cell renal cell carcinoma (ccRCC) is unclear. This study retrospectively analysed a large international database to determine recurrence patterns and overall survival (OS), as part of a wider project to issue recommendations on FU protocols.


OBJECTIVE
To analyse associations between RCC recurrences in patients with ccRCC, their risk group stratifications, treatments, and subsequent outcomes.


DESIGN, SETTING, AND PARTICIPANTS
Nonmetastatic ccRCC patients treated with curative intent between 1 January 2006 and 31 December 2011, with at least 4 yr of FU, were included. Patient, tumour and recurrence characteristics, Leibovich score, and management and survival data were recorded. Isolated local, solitary, and oligometastatic (three or fewer lesions at a single site) recurrences were considered PC, while all others were probably incurable (PI).


INTERVENTION
Primarily curative surgical treatment of ccRCC while at recurrence detection metastasectomy, systemic therapy, best supportive care, or observation.


OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Incidence, time to recurrence (TTR), and OS were measured. Competing risk analysis, Kaplan-Meier, and Cox regression models were used.


RESULTS AND LIMITATION
Of 1265 patients with ccRCC, 286 had a recurrence, with 131 being PC and 155 PI. Five-year cumulative risks of recurrence for low- (n=53), intermediate- (n=105), and high-risk (n=128) patients were, respectively, 7.2%, 23.2%, and 61.6%, of whom 52.8%, 37.1%, and 30.5% were PC, respectively. Median TTR was 25.0 for PC patients versus 17.3 mo for PI patients (p=0.004). Median OS was longer in PC compared with that in PI patients (p<0.001). Competing risk analysis showed highest risk of ccRCC-related death in younger and high-risk patients. Limitations were no data on comorbidities, retrospective cohort, and insufficient data excluding 12% of cohort.


CONCLUSIONS
Low-risk group recurrences are rare and develop later. Treatment of recurrences with curative intent is disappointing, especially in high-risk patients. An age- and risk score-dependent FU approach is suggested.


PATIENT SUMMARY
We analysed data from eight European countries, and found that the incidence of the kidney cancer recurrence and patient survival correlated with clinical factors known to predict cancer recurrence reliably and age. We conclude that these factors should be used to design follow-up strategies.
['Dabestani|Saeed|S|', 'Beisland|Christian|C|', 'Stewart|Grant D|GD|', 'Bensalah|Karim|K|', 'Gudmundsson|Eirikur|E|', 'Lam|Thomas B|TB|', 'Gietzmann|William|W|', 'Zakikhani|Paimaun|P|', 'Marconi|Lorenzo|L|', 'Fernandéz-Pello|Sergio|S|', 'Monagas|Serenella|S|', 'Williams|Samuel P|SP|', 'Torbrand|Christian|C|', 'Powles|Thomas|T|', 'Van Werkhoven|Erik|E|', 'Meijer|Richard|R|', 'Volpe|Alessandro|A|', 'Staehler|Michael|M|', 'Ljungberg|Börje|B|', 'Bex|Axel|A|']
D000368:Aged D002292:Carcinoma, Renal Cell D016208:Databases, Factual D005260:Female D005500:Follow-Up Studies D006801:Humans D007680:Kidney Neoplasms D008297:Male D008875:Middle Aged D009364:Neoplasm Recurrence, Local D012189:Retrospective Studies D015996:Survival Rate D013997:Time Factors D016896:Treatment Outcome
Follow-up Clear cell renal cell carcinoma Recurrence Survival Kidney cancer Surveillance