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Local Treatment of Recurrent Renal Cell Carcinoma May Have a Significant Survival Effect Across All Risk-of-recurrence Groups
BACKGROUND: Retrospective comparative studies suggest a survival benefit after complete local treatment of recurrence (LTR) in renal cell carcinoma (RCC), which may be largely due to an indication bias. OBJECTIVE: To determine the role of LTR in a homogeneous population characterised by limited and...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9806698/ https://www.ncbi.nlm.nih.gov/pubmed/36601038 http://dx.doi.org/10.1016/j.euros.2022.11.008 |
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author | Marconi, Lorenzo Kuusk, Teele Capitanio, Umberto Beisland, Christian Lam, Thomas Pello, Sergio Fernandez Stewart, Grant D. Klatte, Tobias Volpe, Alessandro Ljungberg, Borje Dabestani, Saeed Bex, Axel |
author_facet | Marconi, Lorenzo Kuusk, Teele Capitanio, Umberto Beisland, Christian Lam, Thomas Pello, Sergio Fernandez Stewart, Grant D. Klatte, Tobias Volpe, Alessandro Ljungberg, Borje Dabestani, Saeed Bex, Axel |
author_sort | Marconi, Lorenzo |
collection | PubMed |
description | BACKGROUND: Retrospective comparative studies suggest a survival benefit after complete local treatment of recurrence (LTR) in renal cell carcinoma (RCC), which may be largely due to an indication bias. OBJECTIVE: To determine the role of LTR in a homogeneous population characterised by limited and potentially resectable recurrence. DESIGN, SETTING, AND PARTICIPANTS: RECUR is a protocol-based multicentre European registry capturing patient and tumour characteristics, risk of recurrence (RoR), recurrence patterns, and survival of those curatively treated for nonmetastatic RCC from 2006 to 2011. Per-protocol resectable disease (RD) recurrence was defined as (1) solitary metastases, (2) oligometastases, or (3) renal fossa or renal recurrence after radical or partial nephrectomy, respectively. INTERVENTION: Local treatment of recurrence. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Overall survival (OS) and cancer-specific survival was compared in the RD population that underwent LTR versus no LTR. We constructed a multivariate model to predict risk factors for overall mortality and analysed the effect of LTR across RoR groups. RESULTS AND LIMITATIONS: Of 3039 patients with localised RCC treated with curative intent, 505 presented with recurrence, including 176 with RD. Of these patients, 97 underwent LTR and 79 no LTR. Patients in the LTR group were younger (64.3 [40–80] vs 69.2 [45–87] yr; p = 0.001). The median OS was 70.3 mo (95% confidence interval [CI] 58–82.6) versus 27.4 mo (95% CI 23.6–31.15) in the LTR versus no-LTR group (p < 0.001). After a multivariate analysis, having LTR (hazard ratio [HR] 0.37 [95% CI 0.2–0.6]), having low- versus high-risk RoR (HR 0.42 [95% CI [0.20–0.83]), and not having extra-abdominal/thoracic metastasis (HR 1.96 [95% CI 1.02–3.77]) were prognostic factors of longer OS. The LTR effect on survival was consistent across risk groups. OS HR for high, intermediate, and low risks were 0.36 (0.2–0.64), 0.27 (0.11–0.65), and 0.26 (0.08–0.8), respectively. Limitations include retrospective design. CONCLUSIONS: This is the first study assessing the effectiveness of LTR in RCC in a comparable population with RD. This study supports the role of LTR across all RoR groups. PATIENT SUMMARY: We assessed the effectiveness of local treatment of resectable recurrent renal cell carcinoma after surgical treatment of the primary kidney tumour. Local treatment of recurrence was associated with longer survival across groups with a risk of recurrence. |
format | Online Article Text |
id | pubmed-9806698 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-98066982023-01-03 Local Treatment of Recurrent Renal Cell Carcinoma May Have a Significant Survival Effect Across All Risk-of-recurrence Groups Marconi, Lorenzo Kuusk, Teele Capitanio, Umberto Beisland, Christian Lam, Thomas Pello, Sergio Fernandez Stewart, Grant D. Klatte, Tobias Volpe, Alessandro Ljungberg, Borje Dabestani, Saeed Bex, Axel Eur Urol Open Sci Kidney Cancer BACKGROUND: Retrospective comparative studies suggest a survival benefit after complete local treatment of recurrence (LTR) in renal cell carcinoma (RCC), which may be largely due to an indication bias. OBJECTIVE: To determine the role of LTR in a homogeneous population characterised by limited and potentially resectable recurrence. DESIGN, SETTING, AND PARTICIPANTS: RECUR is a protocol-based multicentre European registry capturing patient and tumour characteristics, risk of recurrence (RoR), recurrence patterns, and survival of those curatively treated for nonmetastatic RCC from 2006 to 2011. Per-protocol resectable disease (RD) recurrence was defined as (1) solitary metastases, (2) oligometastases, or (3) renal fossa or renal recurrence after radical or partial nephrectomy, respectively. INTERVENTION: Local treatment of recurrence. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Overall survival (OS) and cancer-specific survival was compared in the RD population that underwent LTR versus no LTR. We constructed a multivariate model to predict risk factors for overall mortality and analysed the effect of LTR across RoR groups. RESULTS AND LIMITATIONS: Of 3039 patients with localised RCC treated with curative intent, 505 presented with recurrence, including 176 with RD. Of these patients, 97 underwent LTR and 79 no LTR. Patients in the LTR group were younger (64.3 [40–80] vs 69.2 [45–87] yr; p = 0.001). The median OS was 70.3 mo (95% confidence interval [CI] 58–82.6) versus 27.4 mo (95% CI 23.6–31.15) in the LTR versus no-LTR group (p < 0.001). After a multivariate analysis, having LTR (hazard ratio [HR] 0.37 [95% CI 0.2–0.6]), having low- versus high-risk RoR (HR 0.42 [95% CI [0.20–0.83]), and not having extra-abdominal/thoracic metastasis (HR 1.96 [95% CI 1.02–3.77]) were prognostic factors of longer OS. The LTR effect on survival was consistent across risk groups. OS HR for high, intermediate, and low risks were 0.36 (0.2–0.64), 0.27 (0.11–0.65), and 0.26 (0.08–0.8), respectively. Limitations include retrospective design. CONCLUSIONS: This is the first study assessing the effectiveness of LTR in RCC in a comparable population with RD. This study supports the role of LTR across all RoR groups. PATIENT SUMMARY: We assessed the effectiveness of local treatment of resectable recurrent renal cell carcinoma after surgical treatment of the primary kidney tumour. Local treatment of recurrence was associated with longer survival across groups with a risk of recurrence. Elsevier 2022-12-15 /pmc/articles/PMC9806698/ /pubmed/36601038 http://dx.doi.org/10.1016/j.euros.2022.11.008 Text en © 2022 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Kidney Cancer Marconi, Lorenzo Kuusk, Teele Capitanio, Umberto Beisland, Christian Lam, Thomas Pello, Sergio Fernandez Stewart, Grant D. Klatte, Tobias Volpe, Alessandro Ljungberg, Borje Dabestani, Saeed Bex, Axel Local Treatment of Recurrent Renal Cell Carcinoma May Have a Significant Survival Effect Across All Risk-of-recurrence Groups |
title | Local Treatment of Recurrent Renal Cell Carcinoma May Have a Significant Survival Effect Across All Risk-of-recurrence Groups |
title_full | Local Treatment of Recurrent Renal Cell Carcinoma May Have a Significant Survival Effect Across All Risk-of-recurrence Groups |
title_fullStr | Local Treatment of Recurrent Renal Cell Carcinoma May Have a Significant Survival Effect Across All Risk-of-recurrence Groups |
title_full_unstemmed | Local Treatment of Recurrent Renal Cell Carcinoma May Have a Significant Survival Effect Across All Risk-of-recurrence Groups |
title_short | Local Treatment of Recurrent Renal Cell Carcinoma May Have a Significant Survival Effect Across All Risk-of-recurrence Groups |
title_sort | local treatment of recurrent renal cell carcinoma may have a significant survival effect across all risk-of-recurrence groups |
topic | Kidney Cancer |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9806698/ https://www.ncbi.nlm.nih.gov/pubmed/36601038 http://dx.doi.org/10.1016/j.euros.2022.11.008 |
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