Fox Chase Cancer Center-Temple Health System, Philadelphia, Pennsylvania.
ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, Massachusetts.
J Urol. 2020 Apr;203(4):684-689. doi: 10.1097/JU.0000000000000588. Epub 2019 Oct 9.
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.
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.
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.
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).
我们描述了一种新颖的肾细胞癌手术后局部复发分类系统，这在我们的认知范围内尚属首次。我们使用前瞻性、随机对照数据评估了该分类系统的预后意义。
我们查询了 ASSURE（苹果酸舒尼替尼或索拉非尼甲苯磺酸盐治疗手术切除的肾癌患者）（ECOG-ACRIN [东部肿瘤协作组-美国放射肿瘤学会影像学网络] E2805）试验数据，以确定完全切除、中高危、无远处转移且局部复发的肾细胞癌患者。我们使用了特定的定义，包括 I 型——残肾或同侧肾窝单发复发、II 型——同侧血管、同侧肾上腺或淋巴结单发复发、III 型——其他腹腔内软组织或器官单发复发和 IV 型——任何类型 I-III 的组合或同一类型的多次复发。我们分别使用多变量逻辑回归和对数秩检验来确定临床病理预测因素和比较生存情况。
在 1943 例患者中，有 300 例（15.4%）发生局部复发，其中 I 型、II 型、III 型和 IV 型分别为 66 例（22.0%）、97 例（32.3%）、87 例（29.0%）和 50 例（16.7%）。手术方式（微创与开放）和手术类型（部分与根治）均不能预测任何局部复发。IV 型复发患者的 5 年癌症特异性生存率和总生存率均较差（均<0.001）。I 至 III 型复发患者的生存率无差异。
在中高危、无远处转移的肾细胞癌患者中，局部复发似乎是生物学因素的结果，而不是手术方式或手术类型的结果。孤立性腹腔内局部复发的预后似乎与位置无关（I 至 III 型）。涉及多个部位和/或亚区的局部复发与较差的生存率相关（IV 型）。
