Staník Michal, Poprach Alexander, Littnerová Simona, Čapák Ivo, Hulová Markéta, Šebová Natália, Lakomý Radek, Jarkovský Jiří, Doležel Jan
Department of Urologic Oncology, Clinic of Surgical Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic.
Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic; Department of Comprehensive Cancer Care, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Urol Oncol. 2022 Mar;40(3):111.e27-111.e34. doi: 10.1016/j.urolonc.2021.11.028. Epub 2021 Dec 24.
Isolated retroperitoneal recurrence (IRR) in renal cancer patients after radical nephrectomy (RN) is a rare event and poses a therapeutic dilemma. We evaluated oncologic outcomes in surgically treated patients with IRR and established prognostic factors associated with survival. The benefit of metastasis-directed therapy (MDT) in those with clinical progression after extirpation of IRR was assessed.
This was a retrospective single-institutional study in which 60 renal cancer patients after previous RN underwent surgery for suspicion of IRR within the period of 2004-2019; in 55 of them, RCC recurrence was histologically confirmed. No patient had distant metastatic disease at the time of IRR diagnosis. In cases of clinical progression after IRR surgery, MDT (metastasectomy, stereotactic radiotherapy) was selectively used. Kaplan-Meier curves were used to estimate survival outcomes. Univariable and multivariable Cox proportional hazards regression analyses were used to evaluate associations between clinicopathological parameters and cancer-specific survival.
Median age at IRR diagnosis was 64 years (range 23-81). IRR was diagnosed at a median of 42 months (IQR 19-99) after RN. Surgical complications of grade 3-5 after IRR extirpation were rare (7%). Median follow-up time was 50 months (IQR 19-80). Five-year recurrence-free survival and cancer-specific survival rates were 32% and 66%, respectively. Radiographic progression was observed in 34 (62%) patients at a median of 11 months after IRR surgery, out of which 22 patients (40%) underwent MDT. When compared with 12 patients without MDT, the MDT patients had a prolonged median time to systemic treatment of 58 (vs. 16 months), and median cancer-specific survival of 88 (vs. 46 months). Upon multivariable analysis, the interval from nephrectomy ≤12 months (HR 7.77), tumour grade 3-4 (HR 13.24) and female sex (HR 7.42) were determined to be independent prognostic factors of cancer-related mortality.
Aggressive surgical therapy of IRR is feasible with relatively low morbidity. More than half of the patients experience long-term survival. The interval from nephrectomy to IRR less than 12 months, tumour grade 3-4 and female sex were negative prognostic predictors. In the case of progression, metastasis-directed therapy may prolong the interval to initiation of systemic treatment.
肾癌患者根治性肾切除术后孤立性腹膜后复发（IRR）是一种罕见事件，且带来了治疗难题。我们评估了接受手术治疗的IRR患者的肿瘤学结局，并确定了与生存相关的预后因素。评估了转移导向治疗（MDT）对IRR切除术后临床进展患者的益处。
这是一项回顾性单机构研究，2004年至2019年期间，60例既往接受过根治性肾切除术的肾癌患者因怀疑IRR而接受手术；其中55例经组织学证实为肾细胞癌复发。IRR诊断时无患者有远处转移疾病。在IRR手术后出现临床进展的病例中，选择性使用MDT（转移灶切除术、立体定向放疗）。采用Kaplan-Meier曲线估计生存结局。单变量和多变量Cox比例风险回归分析用于评估临床病理参数与癌症特异性生存之间的关联。
IRR诊断时的中位年龄为64岁（范围23 - 81岁）。IRR在根治性肾切除术后中位42个月（IQR 19 - 99）被诊断。IRR切除术后3 - 5级手术并发症罕见（7%）。中位随访时间为50个月（IQR 19 - 80）。5年无复发生存率和癌症特异性生存率分别为32%和66%。34例（62%）患者在IRR手术后中位11个月出现影像学进展，其中22例（40%）接受了MDT。与12例未接受MDT的患者相比，接受MDT的患者全身治疗的中位时间延长至58个月（vs. 16个月），癌症特异性生存中位时间为88个月（vs. 46个月）。多变量分析显示，肾切除术后间隔≤12个月（HR 7.77）、肿瘤分级3 - 4级（HR 13.24）和女性（HR 7.42）被确定为癌症相关死亡的独立预后因素。
积极的IRR手术治疗是可行的，发病率相对较低。超过一半的患者可长期生存。肾切除至IRR的间隔小于12个月、肿瘤分级3 - 4级和女性是不良预后预测因素。在出现进展的情况下转移导向治疗可能延长开始全身治疗的间隔时间。
