The Impact of Histological Subtype on the Incidence, Timing, and Patterns of Recurrence in Patients with Renal Cell Carcinoma After Surgery—Results from RECUR Consortium

Abstract

Background: Current follow-up strategies for patients with renal cell carcinoma (RCC) after curative surgery rely mainly on risk models and the treatment delivered, regardless of the histological subtype. Objective: To determine the impact of RCC histological subtype on recurrence and to examine the incidence, pattern, and timing of recurrences to improve follow-up recommendations. Design, setting, and participants: This study included consecutive patients treated surgically with curative intention (ie, radical and partial nephrectomy) for nonmetastatic RCC (cT1-4, M0) between January 2006 and December 2011 across 15 centres from 10 countries, as part of the euRopEan association of urology renal cell carcinoma guidelines panel Collaborative multicenter consortium for the studies of follow-Up and recurrence patterns in Radically treated renal cell carcinoma patients (RECUR) database project. Outcome measurements and statistical analysis: The impact of histological subtype (ie, clear cell RCC [ccRCC], papillary RCC [pRCC], and chromophobe RCC [chRCC]) on recurrence-free survival (RFS) was assessed via univariate and multivariate analyses, adjusting for potential interactions with important variables

Biomarkers for Renal Cell Carcinoma Recurrence: State of the Art

“…More specifically, 78% of ccRCC patients were disease free at 5 years versus 86% of pRCC and 91% of chRCC (p = 0.001). The association between histological subtype and recurrence rates remained statistically significant even in multivariable models taking into account the tumor stage, size, nuclear grade, vascular invasion, and surgical margin status [12]. It is of note that not only the recurrence rates were significantly different among different histological subtypes, but also the pattern of recurrence was significantly different.…”

“…Histological subtype represents the most important feature to predict recurrence. In a recent analysis based on RECUR database, Abu-Ghanem et al showed that 5-year recurrence free survival rates significantly differ between ccRCC, papillary RCC (pRCC), and chromophobe RCC (chRCC) [12]. More specifically, 78% of ccRCC patients were disease free at 5 years versus 86% of pRCC and 91% of chRCC (p = 0.001).…”

“…Furthermore, chRCC had low recurrence rate, but liver and bone metastases were more frequent. Moreover, those with curable disease at recurrence harbored more frequently chRCC [12].…”

“…In particular, a more specific knowledge of recurrence pattern could allow to tailor the imaging modalities used for follow-up based on the primary tumor characteristics. For instance, patients diagnosed with pRCC, who showed an apparent tropism for lymphatic recurrences, might be those who benefit the most from abdominal crosssectional imaging after surgery [12]. Moreover, such lymphatic trophism raises questions about the possibility to use routine lymph node dissection in patients with pRCC [12].…”

“…For instance, patients diagnosed with pRCC, who showed an apparent tropism for lymphatic recurrences, might be those who benefit the most from abdominal crosssectional imaging after surgery [12]. Moreover, such lymphatic trophism raises questions about the possibility to use routine lymph node dissection in patients with pRCC [12]. Previous studies showed no clear survival advantage from lymph node dissection in patients with high-risk RCC [36]; however, no specific analysis was performed according to different histological subgroups.…”