Abstract
We evaluated prognostic risk factors of recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS) outcomes in patients with non-metastatic renal cell carcinoma (nmRCC) after curative nephrectomy during long-term follow-up. The medical records of 4,260 patients with nmRCC who underwent curative nephrectomy between 2000 and 2012 from five Korean institutions and follow-up after postoperative 1 month until December 2017 were retrospectively analyzed for RFS, MFS, OS, and CSS. During the median 43.86 months of follow-up, 342 recurrences, 127 metastases, and 361 deaths, including 222 cancer-specific deaths, were reported. In addition to the unreached median survival of RFS and MFS, the median OS and CSS times were 176.75 and 227.47 months, respectively. Multivariable analyses showed that nephrectomy type (laparoscopy vs. open), pathological T stages, and nuclear grade were common significant risk factors for survival, and the baseline ASA, hemoglobin, and pathological N stage were common factors only for RFS, OS, and CSS (p < 0.05). Further, tumor necrosis for MFS; platelet count, extent (partial vs. radical) of surgery, and lymphovascular invasion for RFS; baseline diabetes, hypertension, age, body mass index, extent of surgery, and pathological sarcomatoid differentiation for OS; and baseline diabetes, hypertension, body mass index, and pathological sarcomatoid differentiation for CSS were additionally significant risk factors (p < 0.05). RFS, MFS, OS, and CSS were significantly different depending on the pathological T stages (p < 0.05). In conclusion, this large-numbered, long-term follow-up study revealed significant factors affecting the survival of patients with nephrectomized nmRCC.
Highlights
Worldwide, renal cell carcinoma (RCC) represents 2–3% of all cancers, with approximately 84,400 new patients and 34,700 kidney cancer-related deaths reported in the 2012 European Union Reports [1, 2]
Multivariable analysis of predictive prognostic factors for metastasis-free survival (MFS) showed significant factors such as laparoscopic nephrectomy (HR 0.56, 95% confidence interval (CI) 0.36–0.86), nuclear grade 3–4 (HR 2.78, 95% CI 1.75–4.40), presence of necrosis within the tumor (HR 1.72, 95% CI 1.08–2.75), and pathological T stage, in which increased pT stage had worse hazard ratio (HR)
For significant factors of recurrence-free survival (RFS), multivariable analysis showed American Society of Anethesiologists (ASA) 3–4 (HR 2.1, 95% CI 1.35–3.26), no anemia (HR 0.61, 95% CI 0.48–0.78), thrombocytopenia (HR 0.38, 95% CI 0.18–0.80), laparoscopic nephrectomy (HR 0.72, 95% CI 0.55–0.94), radical nephrectomy (HR 1.79, 95% CI 1.23–2.61), pT stage (HR 2.03, 95% CI 1.48–2.80 for pT2; HR 3.24, 95% CI 2.45–4.29 for pT3; and HR 4.98, 95% CI 2.63–9.43 for pT4), pN1 stage (HR 2.89, 95% CI 1.90–4.40), nuclear grade 3–4 (HR 1.85, 95% CI 1.41– 2.44), and presence of lymphovascular invasion (HR 1.61, 95% CI 1.12–2.32) (p < 0.05, Table 3B)
Summary
Renal cell carcinoma (RCC) represents 2–3% of all cancers, with approximately 84,400 new patients and 34,700 kidney cancer-related deaths reported in the 2012 European Union Reports [1, 2]. Factors affecting the long-term outcomes of RCC after primary surgical resection depend on the characteristics of recurrent carcinoma or metastatic type, nephrectomy, and primary tumor, the treatment-free interval, or disease recurrence-free survival (RFS) [5,6,7,8,9,10,11,12]. Recurrence or metastasis occurs even after 5 years of close follow-up with a 20–40% recurrence rate and a 5–15% metastasis rate depending on the pathological/clinical stages and tumor nuclear grade after curative nephrectomy [4, 5, 7,8,9,10]
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