Risk Factors and Patterns of Locoregional Recurrence after Radical Nephrectomy for Locally Advanced Renal Cell...

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Locoregional recurrence (LRR) is a concern after radical nephrectomy (RN) for locally advanced renal cell carcinoma (RCC).
• Identifying risk factors for LRR is crucial for improving patient outcomes and guiding treatment strategies.

Purpose of the Study:

• To investigate the risk factors and patterns of locoregional recurrence (LRR) following radical nephrectomy (RN) in patients with locally advanced renal cell carcinoma (RCC).

Main Methods:

• Retrospective analysis of 245 patients with non-metastatic pT3-4 RCC undergoing RN (January 2006 - January 2016).
• Cox regression analysis to identify independent risk factors for LRR.
• Anatomical mapping of LRR locations using computed tomography (CT) scans.

Main Results:

• Tumor extension to renal vessels or the inferior vena cava (IVC) and Fuhrman's nuclear grade IV were independent risk factors for LRR.
• 5-year actuarial LRR rates were 2.3% (no risk factor), 19.8% (one risk factor), and 30.8% (two risk factors) (p < 0.001).
• LRR commonly occurred in the tumor bed, aortocaval, paraaortic, and retrocaval areas, predominantly below the celiac axis and above the inferior mesenteric artery.

Conclusions:

• Tumor extension into renal vessels/IVC and Fuhrman's grade IV are key predictors of LRR after RN for pT3-4 RCC.
• LRR after RN for RCC is concentrated in the tumor bed and regional lymphatics between the celiac axis and inferior mesenteric artery.