Prognosis of patients with renal cell carcinoma with disease recurrence following nephrectomy for localized disease.

Abstract

400 Background: We investigated the prognosis of Japanese patients with recurrent renal cell carcinoma (RCC) following nephrectomy, and analyzed the prognostic impact of metastasectomy and Memorial Sloan-Kettering Cancer Center (MSKCC) risk classification in these patients. Methods: Between 1995 and 2005, 214 patients with recurrent RCC were the subjects of this retrospective analysis. At recurrence, MSKCC risk classification was used to classify patients as being at favorable, intermediate, and poor risk. The endpoint of the present study was overall survival (OS) from time of recurrence. Relationships between overall survival and potential prognostic factors were assessed using the Cox proportional hazard model. Results: Median time to recurrence following nephrectomy was 25 months. At recurrence, 148 (69%) patients had metastasis in one organ and lung was the most common site of recurrence (123 pts, 57%). The median survival from the time of recurrence was 40 months; the estimated 2-year survival rate was 66% (95% CI 60-73). When the MSKCC risk classification was applied to the patients, the median overall survival was not reached, 29 months, and 11 months in the patients classified as favorable (59 pts), intermediate (101 pts), and poor risk (24 pts), respectively. Metastasectomy was performed in 76 (36%) patients. The median survival from the time of recurrence in these patients was 122 months, which was significantly longer than the median survival (27 months) of patients who did not undergo metastasectomy (p<0.001). Multivariate analysis demonstrated that a better risk category of MSKCC risk classification and metastasectomy were associated with more favorable survival (p<0.001). Conclusions: In patients with recurrent RCC following nephrectomy for localized disease, patients classified as favorable risk according to MSKCC risk classification have a good opportunity for long-term survival, especially those who undergo metastasectomy.