Late recurrence of renal cell carcinoma >5 years after surgery: Clinicopathological characteristics and prognosis

Abstract

OBJECTIVE • To evaluate the clinicopathological features and prognosis of late recurrence of renal cell carcinoma (RCC). PATIENTS AND METHODS • A total of 747 patients who had undergone curative surgery for RCC with follow-up of > 5 years or recurrence within 5 years were included in the study. • The patients were stratified into four groups based on cancer-free intervals: no recurrence (no recurrence > 5 years after surgery, n = 425), synchronous metastasis ( n = 138), early recurrence (recurrence within 5 years, n = 143), and late recurrence (recurrence after 5 years, n = 41). • Multivariate analysis was performed to identify the clinicopathological factors affecting late recurrence and its clinical outcome. RESULTS • The subgroups were significantly different in clinicopathological variables, including age, preoperative haemoglobin, platelet count, high-sensitivity C-reactive protein (hs-CRP) levels, pT stage and nuclear grade. • In multiple logistic regression analysis, age (odds ratio [ OR ] 1.085, 95% confidence interval [ CI ] 1.012 - 1.163, P = 0.022), and preoperative hs-CRP levels (OR 6.211, 95% CI 1.590 - 24.270, P = 0.009) were independent predictive factors for late recurrence. • In patients with synchronous metastasis, early recurrence and late recurrence, 5-year cancer-specific survival rates after recurrence were 27.0%, 41.1% and 73.7%, respectively ( P < 0.001). • Multivariate Cox analysis indicated that cancer-free interval, as well as body mass index, initial symptoms, Fuhrman ' s nuclear grade, sarcomatoid differentiation, lymphovascular invasion and metastasectomy, were independent predictive factors for cancer-related death. CONCLUSIONS • Late recurrence of RCC is not a rare event. • Patients with late recurrence had more favourable clinicopathological features and better prognosis with long cancer-specific survival after recurrence. • Age and preoperative hs-CRP levels may be independent predictive factors for late recurrence of RCC. © 2012 The Authors.