SURVIVAL AND PROGRESSION AFTER RADICAL NEPHRECTOMY IN A COHORT OF NON-METASTATIC RENAL CELL CARCINOMA TREATED WITH CURATIVE INTENT
AbstractBackground: Radical nephrectomy (RN) is a standard treatment of cure for non-metastatic renal cell carcinoma (NMRCC). Long-term outcome data are limited for Pakistani population. Our aim was to assess the long-term outcomes of RCC treated with curative intent with radical nephrectomy (RN) and to study the 5 & 10years survival outcomes in patients with NMRCC who underwent radical nephrectomy. Methods: This is a retrospective review and analysis of the data between December 2006 and February 2017. We included all the adult patients (age ≥18 years) with NMRCC from both genders irrespective of their histologic subtypes who underwent radical nephrectomy (RN) with a curative intent. The data was analysed for overall survival and recurrence rates at 5- and 10-years using Kaplan-Meier survival analysis. Multivariate analysis was performed using Cox-regression to identify risk factors associated with poor overall outcome in terms of recurrence and mortality. Results: Three hundred and forty-four patients with 195 (55.5%) males and 149 (44.2%) females with a mean age of 53.5±14.1 years were monitored for a mean follow-up of 31.1±26.77 months (range: 3–132 months). Overall there were 46 (13.4%) deaths. Forty-nine 14.2%) cases had disease recurrence with 33 (9.5%) deaths from disease progression. The 5-year progression-free survival was 37% (95% CI: 49.04–72.76) with the median time to recurrence of 33 months (95% CI: 27.6–38.4) and the median overall survival was 103.7 months (95% CI: 95.7–111.7). The 5-year overall survival was 76.1% (95% CI: 75.2–77) while 10-year survival was 70.8%. There was a significant median survival difference for cases with and without recurrence (log-rank χ2: 117.5, p<0.001), T stage, Fuhrman’s grade, and early postoperative recurrence. Conclusion: Radical nephrectomy offers the best survival for non-metastatic renal cell carcinoma patients with excellent postoperative survival and progression-free profile. Although renal cell cancer presents in younger age group but the long-term survival after radical nephrectomy in Pakistani population is similar to the rest of the world.Keywords: renal cell carcinoma; radical nephrectomy; recurrence; survival
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2014;136(5):359–86.
Znaor A, Lortet-Tieulent J, Laversanne M, Jemal A, Bray F. International Variations and Trends in Renal Cell Carcinoma Incidence and Mortality. Eur Urol 2015;67(3):519–30.
Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer Statistics, 2006. CA Cancer J Clin 2006;56(2):106–30.
Dimarco D, Lohse CM, Zincke H, Cheville JC, Blute ML. Long-term survival of patients with unilateral sporadic multifocal renal cell carcinoma according to histologic subtype compared with patients with solitary tumours after radical nephrectomy. Urology 2004;64(3):462–7.
Richstone L, Scherr DS, Reuter VR, Snyder ME, Rabbani F, Kattan MW, et al. Multifocal renal cortical tumours: frequency, associated clinicopathological features and impact on survival. J Urol 2004;171(2):615–20.
Cohen HT, McGovern FJ. Renal-Cell Carcinoma. N Engl J Med 2005;353(23):2477–90.
Luciani L, Cestari R, Tallarigo C. Incidental renal cell carcinoma-age and stage characterization and clinical implications: study of 1092 patients (1982–1997). Urology 2000;56(1):58–62.
Russo P. Evolving Understanding and Surgical Management of Renal Cortical tumours. Mayo Clin Proc 2000;75(12):1233–5.
Lee J, You C, Min G, Park JS, Lee SB, Ahn H, et al. Comparison of the Surgical Outcome and Renal Function between Radical and Nephron-sparing Surgery for Renal Cell Carcinomas. Korean J Urol 2007;48(7):671–6.
Ljungberg B. Nephron-sparing surgery strategy: the current standard for the treatment of localised renal cell carcinoma. Eur Urol Suppl 2011;10(3):e49–51.
MacLennan S, Imamura M, Lapitan M, Omar M, Lam T, Hilvano-Cabungcal A, et al. Systematic review of oncological outcomes following surgical management of localised renal cancer. Eur Urol 2012;61(5):972–93.
Kim SP, Shah ND, Weight CJ, Thompson RH, Moriatry JP, Shippee ND, et al. Contemporary trends in nephrectomy for renal cell carcinoma in the United States: results from a population based cohort. J Urol 2011;186(5):1779–85.
Lee CT, Katz J, Fearn PA, Russo P. Mode of presentation of renal cell carcinoma provides prognostic information. Urol Oncol 2002;7(4):135–40.
Lipworth L, Tarone RE, McLaughlin JK. The epidemiology of renal cell carcinoma. J Urol 2006;176(6 Pt 1):2353–8.
Marberger MM, Chapple CR. Renal Cell Carcinoma. Official Journal of the European Association of Urology (2003) 4(1): 189–194.
Patard JJ, Rodriguez A, Rioux-Leclercq N, Guille F, Lobel B. Prognostic significance of the mode of detection in renal tumours. BJU Int 2002;90(4):358–63.
Jayson M, Sanders H. Increased incidence of serendipitously discovered renal cell carcinoma. Urology 1998;51(2):203–5.
Patard JJ, Leray E, Rodriguez A , Rioux-Leclercq N, Guille F, Lobel B. Correlation between symptom graduation, tumour characteristics and survival in renal cell carcinoma. Eur Urol 2003;44(2):226–32.
Desai M, Ganpule A, Sharma R, Sabnis R, Muthu V. SCHU-12. Laparoscopic Radical Nephrectomy Versus Open Radical Nephrectomy: A Contemporary Outcome Analysis. Urology 2008;72(5):S6–7.
Swanson DA, Borges PM. Complications of Transabdominal Radical Nephrectomy for Renal Cell Carcinoma. J Urol 1983;129(4):704–7.
Cooper CS, Cohen MB, Donovan JF Jr. Splenectomy complicating left nephrectomy. J Urol 1996;155(1):30–6.
Roberts W, Bhayani S, Allaf M, Chan T, Kavoussi L, Jarrett T. Pathological stage does not alter the prognosis for renal lesions determined to be stage T1 by computerized tomography. J Urol 2005;173(3):713–5.
Palapattu GS, Pantuck AJ, Dorey F, Said JW, Figlin RA, Belldegrun AS. Collecting system invasion in renal cell carcinoma: impact on prognosis and future staging strategies. J Urol 2003;170(3):768–72.
Jeong W, Rha KH, Kim HH, Byun SS, Kwon TG, Seo IY, et al. Comparison of laparoscopic radical nephrectomy and open radical nephrectomy for pathologic stage T1 and T2 renal cell carcinoma with clear cell histologic features: A Multi-institutional Study. Urology 2011;77(4):819–24.
Tsui KH, Shvarts O, Smith RB, Figlin RA, de Kernion JB, Belldegrun A. Prognostic indicators for renal cell carcinoma: a multivariate analysis of 643 patients using the revised 1997 TNM staging criteria. J Urol 2000;163(4):1090–5.