Russo Paul, Blum Kyle A, Weng Stanley, Graafland Niels, Bex Axel
Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Eur Urol Open Sci. 2022 May 6;40:125-132. doi: 10.1016/j.euros.2022.04.005. eCollection 2022 Jun.
We managed a cohort of patients treated with minimally invasive surgery (MIS) for a kidney tumor presenting with atypical tumor recurrence (ATR) involving port sites, intraperitoneal carcinomatosis, and nephrectomy bed/perinephric tumor implants.
To determine the clinical characteristics, management, and oncologic outcomes for patients with localized renal cell carcinoma (RCC) who develop ATR following curative-intent MIS for partial or radical nephrectomy.
The study cohort comprised patients from 1999 to 2021 with localized RCC managed at Memorial Sloan Kettering Cancer Center (New York, NY, USA) after MIS for partial or radical nephrectomy who developed ATR. Outcome measurements and statistical analysis: We collected data on clinicopathologic characteristics, treatments, time to ATR, and overall survival.
The median age of the 58 RCC patients was 61 yr. Forty-one patients (71%) were male, 26 (45%) had robot-assisted operations, and 39 (67%) had clear cell RCC. Twenty-nine patients had stage pT1 disease (50%) and ten (17%) had positive surgical margins. The most common ATR site was perinephric/nephrectomy bed implants ( = 28, 48%). Management included: surgical resection alone ( = 11, 19%), systemic therapy alone ( = 12, 21%), surgical resection and systemic therapy ( = 17, 29%), and palliative care ( = 8, 14%). At median follow-up of 59 mo (interquartile range [IQR] 28-92), the median time to ATR was 12 mo (IQR 5-28). Overall survival at 5 yr was 69.0% (95% confidence interval 57.4-83.1%) with only nine patients alive with no evidence of disease. Limitations include the potential for referral, detection, and selection biases, as well as uncertainty regarding the true incidence of ATR.
ATR following MIS for partial or radical nephrectomy is an understudied, poor prognostic event which leads to a heavy treatment burden. Further investigation into its etiology and means of prevention is warranted.
Patients experiencing recurrence of kidney cancer in an atypical site require a heavy treatment burden and have a guarded overall prognosis. Continued research is needed to determine the precise incidence of these recurrences and identify methods for mitigating them.
我们管理了一组接受微创手术（MIS）治疗的肾肿瘤患者，这些患者出现了非典型肿瘤复发（ATR），包括术口部位复发、腹膜内播散性转移以及肾切除床/肾周肿瘤种植。
确定接受根治性意图的部分或根治性肾切除术后发生ATR的局限性肾细胞癌（RCC）患者的临床特征、治疗方法和肿瘤学结局。
设计、设置和参与者：研究队列包括1999年至2021年期间在美国纽约纪念斯隆凯特琳癌症中心接受MIS进行部分或根治性肾切除术后发生ATR的局限性RCC患者。结局测量和统计分析：我们收集了有关临床病理特征、治疗、ATR发生时间和总生存期的数据。
58例RCC患者的中位年龄为61岁。41例（71%）为男性，26例（45%）接受了机器人辅助手术，39例（67%）为透明细胞RCC。29例患者为pT1期疾病（50%），10例（17%）手术切缘阳性。最常见的ATR部位是肾周/肾切除床种植（n = 28，48%）。治疗方法包括：单纯手术切除（n = 11，19%）、单纯全身治疗（n = 12，21%）、手术切除加全身治疗（n = 17，29%）和姑息治疗（n = 8，14%）。中位随访59个月（四分位间距[IQR] 28 - 92），ATR的中位发生时间为12个月（IQR 5 - 28）。5年总生存率为69.0%（95%置信区间57.4 - 83.1%），仅有9例患者存活且无疾病证据。局限性包括存在转诊、检测和选择偏倚的可能性，以及ATR真实发病率的不确定性。
部分或根治性肾切除术后的ATR是一个研究不足、预后不良的事件，会导致沉重的治疗负担。有必要对其病因和预防方法进行进一步研究。
在非典型部位发生肾癌复发的患者需要承担沉重的治疗负担，总体预后不佳。需要持续研究以确定这些复发的精确发病率并确定减轻复发的方法。
