Recurrences and Subsequent Treatments After Curative-Intent Surgery for Localised and Locally Advanced Renal Cell Carcinoma

BACKGROUND: There is a lack of evidence concerning recurrent patterns and treatment of repeat recurrences for surgically treated renal cell carcinoma (RCC). Thus, the objective was to describe patterns of recurrences and subsequent treatments in patients with recurrent RCC.

PATIENTS AND METHODS: We identified 525 patients who received surgical treatment for RCC at our institution in 2010-2015. The treatment of recurrences was classified as no active treatment, treatment with the aim to achieve no evidence of disease (NED) or systemic oncological treatment (OT). Relationships were analysed using multivariable Cox regression and log-rank analysis.

RESULTS: The median follow-up was 7.8 [interquartile range (IQR 6.5-9.4)] years. Ninety-one patients experienced a first recurrence, of which 49 received NED-aimed treatment-47 of these patients had their recurrence more than 2 years after surgery. Thirty patients experienced a second recurrence with 17 patients undergoing NED-aimed treatment. Eight patients had a third recurrence with four undergoing NED-aimed treatment. The most common locations of recurrence were pulmonary, local or multiple sites-30% and 38% of patients experienced a second or third recurrence in the same location, respectively. The 3-year overall survival estimates for patients receiving NED-aimed treatment for their first recurrence were 83.1% [95% confidence interval (CI) 72.3-93.8%] and 79.3% (95% CI 58.4-100%) for patients receiving NED following a second recurrence.

CONCLUSIONS: Treatments aimed at achieving NED seem to provide good oncological control and in repeat recurrences, 50% or more were managed with repeat NED-aimed treatments.