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J Urol. 2019 Oct 9:101097JU0000000000000588. doi: 10.1097/JU.0000000000000588. [Epub ahead of print]

Local Recurrence Following Resection of Intermediate-High Risk Nonmetastatic Renal Cell Carcinoma: An Anatomical Classification and Analysis of the ASSURE (ECOG-ACRIN E2805) Adjuvant Trial.

Author information

1
Fox Chase Cancer Center-Temple Health System, Philadelphia, Pennsylvania.
2
ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, Massachusetts.
3
University of Pennsylvania, Philadelphia, Pennsylvania.
4
Advocate Lutheran General Hospital, Park Ridge, Illinois.
5
University of Rochester, Rochester, New York.
6
MD Anderson Cancer Center, Houston, Texas.
7
University of California-San Diego, La Jolla, California.
8
University of Toronto, Toronto, Ontario, Canada.
9
Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
10
Cancer Research Foundation of New York, Chappaqua, New York.
11
University of Kentucky College of Medicine, Lexington, Kentucky.

Abstract

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).

KEYWORDS:

carcinoma; classification; local; neoplasm recurrence; nephrectomy; prognosis; renal cell

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