TY - JOUR
T1 - Local Recurrence Following Resection of Intermediate-High Risk Nonmetastatic Renal Cell Carcinoma
T2 - An Anatomical Classification and Analysis of the ASSURE (ECOG-ACRIN E2805) Adjuvant Trial
AU - Lee, Ziho
AU - Jegede, Opeyemi A.
AU - Haas, Naomi B.
AU - Pins, Michael R.
AU - Messing, Edward M.
AU - Manola, Judith
AU - Wood, Christopher G.
AU - Kane, Christopher J.
AU - Jewett, Michael A.S.
AU - Flaherty, Keith T.
AU - Dutcher, Janice P.
AU - Dipaola, Robert S.
AU - Uzzo, Robert G.
N1 - Publisher Copyright:
© 2020 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH, INC.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Purpose:We describe what is to our knowledge a novel classification system for local recurrence after surgery of renal cell carcinoma. We assessed its prognostic implications using prospective, randomized controlled data.Materials and Methods:We queried the ASSURE (Sunitinib Malate or Sorafenib Tosylate in Treating Patients With Kidney Cancer That Was Removed By Surgery) (ECOG-ACRIN [Eastern Cooperative Oncology Group-American College of Radiology Imaging Network] E2805) trial data for patients with fully resected, intermediate-high risk, nonmetastatic renal cell carcinoma with local recurrence. We used certain definitions, including type I - single recurrence in a remnant kidney or ipsilateral renal fossa, type II - single recurrence in the ipsilateral vasculature, the ipsilateral adrenal gland or a lymph node, type III - single recurrence in other intra-abdominal soft tissues or organs and type IV - any combination of types I-III or multiple recurrences of a single type. Multivariable logistic regression and the log rank test were performed to identify clinicopathological predictors and compare survival, respectively.Results:Of the 1,943 patients 300 (15.4%) had local recurrence, which was type I, II, III and IV in 66 (22.0%), 97 (32.3%), 87 (29.0%) and 50 (16.7%), respectively. Surgical modality (minimally invasive vs open) and type of surgery (partial vs radical) did not predict any local recurrence. Five-year cancer specific survival and overall survival were worse in patients with type IV recurrence (each p <0.001). There was no difference in survival among patients with types I to III recurrence.Conclusions:In patients with intermediate-high risk nonmetastatic renal cell carcinoma local recurrence appears to be a function of biology more than of surgical modality or surgery type. The prognosis for solitary intra-abdominal local recurrences appear similar regardless of location (types I-III). Local recurrences involving multiple sites and/or subdivisions are associated with worse survival (type IV).
AB - Purpose:We describe what is to our knowledge a novel classification system for local recurrence after surgery of renal cell carcinoma. We assessed its prognostic implications using prospective, randomized controlled data.Materials and Methods:We queried the ASSURE (Sunitinib Malate or Sorafenib Tosylate in Treating Patients With Kidney Cancer That Was Removed By Surgery) (ECOG-ACRIN [Eastern Cooperative Oncology Group-American College of Radiology Imaging Network] E2805) trial data for patients with fully resected, intermediate-high risk, nonmetastatic renal cell carcinoma with local recurrence. We used certain definitions, including type I - single recurrence in a remnant kidney or ipsilateral renal fossa, type II - single recurrence in the ipsilateral vasculature, the ipsilateral adrenal gland or a lymph node, type III - single recurrence in other intra-abdominal soft tissues or organs and type IV - any combination of types I-III or multiple recurrences of a single type. Multivariable logistic regression and the log rank test were performed to identify clinicopathological predictors and compare survival, respectively.Results:Of the 1,943 patients 300 (15.4%) had local recurrence, which was type I, II, III and IV in 66 (22.0%), 97 (32.3%), 87 (29.0%) and 50 (16.7%), respectively. Surgical modality (minimally invasive vs open) and type of surgery (partial vs radical) did not predict any local recurrence. Five-year cancer specific survival and overall survival were worse in patients with type IV recurrence (each p <0.001). There was no difference in survival among patients with types I to III recurrence.Conclusions:In patients with intermediate-high risk nonmetastatic renal cell carcinoma local recurrence appears to be a function of biology more than of surgical modality or surgery type. The prognosis for solitary intra-abdominal local recurrences appear similar regardless of location (types I-III). Local recurrences involving multiple sites and/or subdivisions are associated with worse survival (type IV).
KW - carcinoma
KW - classification
KW - local
KW - neoplasm recurrence
KW - nephrectomy
KW - prognosis
KW - renal cell
UR - http://www.scopus.com/inward/record.url?scp=85086035170&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85086035170&partnerID=8YFLogxK
U2 - 10.1097/JU.0000000000000588
DO - 10.1097/JU.0000000000000588
M3 - Article
C2 - 31596672
AN - SCOPUS:85086035170
SN - 0022-5347
VL - 203
SP - 684
EP - 689
JO - Journal of Urology
JF - Journal of Urology
IS - 4
ER -