Local recurrence after radical nephrectomy for kidney cancer: management and prediction of outcomes. a multi-institutional study

Authors

  • Philippe Paparel MD, PHD,

    1. Cancerology Committee of the French Association of Urology (CCAFU), Paris, France
    2. Department of Urology, Lyon Sud University Hospital, Claude Bernard University Lyon 1, Lyon, France
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  • Pierre Bigot MD,

    Corresponding author
    1. Cancerology Committee of the French Association of Urology (CCAFU), Paris, France
    2. Department of Urology, Angers University Hospital, Angers, France
    • Correspondence to: Dr. Pierre Bigot, MD, Department of Urology, Angers University Hospital, 5 rue Larrey, 49000 Angers, France. Fax: +33-2-41-35-53-23. E-mail: pibigot@chu-angers.fr

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  • Xavier Matillon MD,

    1. Department of Urology, Lyon Sud University Hospital, Claude Bernard University Lyon 1, Lyon, France
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  • Karim Bensalah MD, PhD,

    1. Cancerology Committee of the French Association of Urology (CCAFU), Paris, France
    2. Department of Urology, Pontchaillou University Hospital, Rennes, France
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  • Laurent Salomon MD, PhD,

    1. Cancerology Committee of the French Association of Urology (CCAFU), Paris, France
    2. Department of Urology, Henri Mondor University Hospital, Créteil, France
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  • Hervé Baumert MD,

    1. Cancerology Committee of the French Association of Urology (CCAFU), Paris, France
    2. Department of Urology, Saint-Louis University Hospital, Paris, France
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  • Cyril Bastide MD, PhD,

    1. Cancerology Committee of the French Association of Urology (CCAFU), Paris, France
    2. Department of Urology, Nord University Hospital, Marseille, France
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  • Rodolphe Thuret MD, PhD,

    1. Department of Urology, Lapeyronie University Hospital, Montpellier, France
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  • Gilles Karsenty MD, PhD,

    1. Department of Urology, La conception University Hospital, Marseille, France
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  • Jean Alexandre Long MD, PhD,

    1. Cancerology Committee of the French Association of Urology (CCAFU), Paris, France
    2. Department of Urology, Grenoble University Hospital, Grenoble, France
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  • Myriam Ammi MD,

    1. Department of Urology, Angers University Hospital, Angers, France
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  • Thomas Bessede MD, PhD,

    1. Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
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  • Sylvie Bin MD,

    1. Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France
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  • Adeline Roux MD,

    1. Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France
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  • Bernard Escudier MD, PhD,

    1. Cancerology Committee of the French Association of Urology (CCAFU), Paris, France
    2. Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
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  • Nathalie Rioux Leclercq MD, PhD,

    1. Cancerology Committee of the French Association of Urology (CCAFU), Paris, France
    2. Department of Pathology, Pontchaillou University Hospital, Rennes, France
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  • Géraldine Pignot MD, PhD,

    1. Cancerology Committee of the French Association of Urology (CCAFU), Paris, France
    2. Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
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  • Michel Soulie MD, PhD,

    1. Cancerology Committee of the French Association of Urology (CCAFU), Paris, France
    2. Department of Urology, Toulouse University Hospital, Toulouse, France
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  • Jean-Jacques Patard MD, PhD

    1. Cancerology Committee of the French Association of Urology (CCAFU), Paris, France
    2. Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
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  • Philippe Paparel and Pierre Bigot contributed equally to this work.

Abstract

Background

Local recurrence (LR) after radical nephrectomy (RN) for kidney cancer is uncommon. Our objectives were to analyse characteristics and therapeutic options of LR after RN and to identify survival prognostic factors.

Materials and Methods

From a multi-institutional retrospective database, we identified 72 patients who experienced LR after RN.

Results

Mean time to LR was 26.5 ± 3.3 months. The location of the recurrence was renal fossa, regional lymph node, homolateral adrenal and both renal fossa and regional lymph node for 43 (59.7%), 27 (37.5%), 9 (12.5%) and 7 (9.7%) patients, respectively. Patients were treated by surgery, systemic therapies, combination of therapies and palliative treatment in 24 (33.3%), 18 (25%), 24 (33.3%) and 6 (8.4%) cases, respectively. Within a mean follow-up of 26.4 ± 3.3 months from the date of local recurrence, 12 (16.6%) patients were alive without disease, 30 (41.7%) patients were alive with disease, 30 patients (41.6%) died including 28 (38.8%) from the disease. In multivariate analysis, time to recurrence <1 year (P < 0.001; HR: 4.81) and surgical treatment (P = 0.027; HR: 0.33) were predictive factors.

Conclusions

Local recurrence after radical nephrectomy is associated with poor prognosis. The time to recurrence and the completeness of the surgical treatment are major prognostic factors. J. Surg. Oncol. 2014 109:126–131. © 2013 Wiley Periodicals, Inc.

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