Cancer Res Treat.  2022 Jan;54(1):218-225. 10.4143/crt.2020.1373.

Risk Factors and Patterns of Locoregional Recurrence after Radical Nephrectomy for Locally Advanced Renal Cell Carcinoma

• Yoo GS
• Park W
• Pyo H
• Jeong BC
• Jeon HG
• Kang M
• Seo SI
• Jeon SS
• Lee HM
• Choi HY
• Park BK
• Kim CK
• Park SY
• Kwon GY

• KMID: 2524602
• DOI: http://doi.org/10.4143/crt.2020.1373

Abstract

Purpose
We aimed to investigate the risk factors and patterns of locoregional recurrence (LRR) after radical nephrectomy (RN) in patients with locally advanced renal cell carcinoma (RCC).
Materials and Methods
We retrospectively analyzed 245 patients who underwent RN for non-metastatic pT3-4 RCC from January 2006 to January 2016. We analyzed the risk factors associated with poor locoregional control using Cox regression. Anatomical mapping was performed on reference computed tomography scans showing intact kidneys.
Results
The median follow-up duration was 56 months (range, 1 to 128 months). Tumor extension to renal vessels or the inferior vena cava (IVC) and Fuhrman’s nuclear grade IV were identified as independent risk factors of LRR. The 5-year actuarial LRR rates in groups with no risk factor, one risk factor, and two risk factors were 2.3%, 19.8%, and 30.8%, respectively (p < 0.001). The locations of LRR were distributed as follows: aortocaval area (n=2), paraaortic area (n=4), retrocaval area (n=5), and tumor bed (n=11). No LRR was observed above the celiac axis (CA) or under the inferior mesenteric artery (IMA).
Conclusion
Tumor extension to renal vessels or the IVC and Fuhrman’s nuclear grade IV were the independent risk factors associated with LRR after RN for pT3-4 RCC. The locations of LRR after RN for RCC were distributed in the tumor bed and regional lymphatic area from the bifurcation of the CA to that of the IMA.

Keyword

Locoregional recurrence; Nephrectomy; Patterns of locoregional recurrence; Renal cell carcinoma

Figure

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  Fig. 1 Survival curves for locoregional control (A), distant metastasis-free survival (B), and overall survival (C).

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  Fig. 2 Survival curves for distant metastasis-free survival (A) and overall survival (B) according to the events of locoregional recurrence (LRR) as the first recurrence.

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  Fig. 3 Survival curves for locoregional control according to the risk group. Locoregional recurrence (A), distant metastasis-free survival (B), and overall survival (C).

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  Fig. 4 Anatomical map of locoregional recurrence (LRR). Blue and yellow dots represent the LRR locations for right- and left-renal cell carcinomas, respectively. Red circled dots represent the celiac axis (top), superior mesenteric artery (middle), and inferior mesenteric artery (bottom), respectively.

Reference

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