Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press102710.17650/1726-9776-2008-4-1-9-15DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. RENAL CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак почкиOutcome analysis of treatment of local recurrences of renal cell carcinomaРезультаты лечения местных рецидивов почечно-клеточного ракаSayE. V.СайЕ. В.
Russian Federation

Moscow

Москва

MatveevV. B.МатвеевВ. Б.
Russian Federation

Moscow

Москва

VolkovaM. I.ВолковаМ. И.
Russian Federation

Moscow

Москва

Cancer Research CenterГУ РОНЦ им. Н.Н. Блохина РАМН30032008419151302202013022020https://oncourology.abvpress.ru/oncur/article/view/1027

Purpose: to evaluate results of treatment of local recurrences of renal cell carcinoma (RCC). Material and methods: a retrospective analysis of 119 consecutive patients with local recurrence of RCC after nephrectomy treated from 1975 to 2007 at Cancer Research Center was performed. Mean age of the patients was 52.2 (19—75) years. A male to female ratio was 1.3:1. Local recurrences were localized in the renal fossa in 49 (41.2%), in retroperitoneal lymph nodes - in 46 (38.7%), in both renal fossa and retroperitoneal lymph nodes — in 24 (20.1%) cases. The tumor invaded neighboring organs in 59 (49.6%) of 119 patients. Metastases in the postoperative scar were diagnosed in 27 (22.7%), distant secondaries — in 38 (31.9%) cases. Surgery was performed in 78 (65.5%) cases (complete — 60 (76.9%), incomplete — 13 (16.7%), exploratory — 5 (6.4%)), 41 (34.5%) patients received conservative treatment. Neoadjuvant and/or adjuvant immunotherapy and/or chemotherapy were used in 14 (17.9%) of 78 patients treated with surgery. Of 41 (34.5%) patients receiving conservative treatment immunotherapy was administered in 25 (61.0%), chemotherapy — in 1 (2.4%), immunochemotherapy - in 11 (26.8%), hormonotherapy — in 4 (9.8%) (tamoxifen). Median follow-up was 23.3 (1—126) months. Results: Local recurrences were diagnosed a median of 33.0 (1-151) months after nephrectomy. Progression was registered in 33 (55.0%) of 60 patients following a complete removal of the relapse a median of 23.7 months after surgery (local — 10, distant metastases — 13, both local and distant metastases — 10). Four (12.1%) patients underwent repeat removal of the recurrent tumors, 29 (87.8%) received conservative treatment with no response. One-, 3- and 5 -year disease-specific survival of 119 patients was 72.6%, 41.4% and 30.5% respectively (median — 25.7±5.9 months). In the univariate analysis survival was affected by complete removal of the relapse (p=0.001), number of recurrent nodes (p=0.006), distant metastases (p=0.013) and presence of clinical symptoms (p=0.004). In the multivariate analysis the only factors affected survival significantly were radical surgery (p 0.005) and clinical symptoms of the relapse (p 0.024). Conclusion: Surgery is the only effective method of treatment in isolated recurrence of RCC following nephrectomy.

.

1. Давыдов М.И., Матвеев В.Б. Хирургическое лечение местного рецидива рака почки после нефрэктомии. Клиническая онкоурология. М.; 2003. с. 151—158.Давыдов М.И., Матвеев В.Б. Хирургическое лечение местного рецидива рака почки после нефрэктомии. Клиническая онкоурология. М.; 2003. с. 151—158.2. Kavolius J.P., Mastorakos D.P., Pavlovich C. et al. Resection of metastatic renal cell carcinoma. J Clin Oncol 1998;16(6):2261—6.Kavolius J.P., Mastorakos D.P., Pavlovich C. et al. Resection of metastatic renal cell carcinoma. J Clin Oncol 1998;16(6):2261—6.3. Tanguay S., Pisters L.L., Lawrence D.D., Dinney C.P. Therapy of locally recurrent renal cell carcinoma after nephrectomy. J Urol 1996;155(1):26—9.Tanguay S., Pisters L.L., Lawrence D.D., Dinney C.P. Therapy of locally recurrent renal cell carcinoma after nephrectomy. J Urol 1996;155(1):26—9.4. Fisher R.I. Relapse after successful treatment with immunotherapy: lessons for the future. Cancer J Sci Am 1998;4(2):78—9.Fisher R.I. Relapse after successful treatment with immunotherapy: lessons for the future. Cancer J Sci Am 1998;4(2):78—9.5. Sandhu S.S., Symes A., A'Hern R. et al. Surgical excision of isolated renal-bed recurrence after radical nephrectomy for renal cell carcinoma. BJU Int 2005;95(4):522—5.Sandhu S.S., Symes A., A'Hern R. et al. Surgical excision of isolated renal-bed recurrence after radical nephrectomy for renal cell carcinoma. BJU Int 2005;95(4):522—5.6. Itano N.B., Blute M.L., Spotts B., Zincke H. Outcome of isolated renal cell carcinoma fossa recurrence after nephrectomy. J Urol 2000;164(2):322—5.Itano N.B., Blute M.L., Spotts B., Zincke H. Outcome of isolated renal cell carcinoma fossa recurrence after nephrectomy. J Urol 2000;164(2):322—5.7. Esrig D., Ahlering T.E., Lieskovsky G., Skinner D.G. Experience with fossa recurrence of renal cell carcinoma. J Urol 1992;147(6):1491—4.Esrig D., Ahlering T.E., Lieskovsky G., Skinner D.G. Experience with fossa recurrence of renal cell carcinoma. J Urol 1992;147(6):1491—4.8. Aref I., Bociek R.G., Salhani D. Is post-operative radiation for renal cell carcinoma justified? Radiother Oncol 1997;43(2):155—7.Aref I., Bociek R.G., Salhani D. Is post-operative radiation for renal cell carcinoma justified? Radiother Oncol 1997;43(2):155—7.9. Schrodter S., Hakenberg O.W., Manseck A. et al. Outcome of surgical treatment of isolated local recurrence after radical nephrectomy for renal cell carcinoma. J Urol 2002;167(4):1630—3.Schrodter S., Hakenberg O.W., Manseck A. et al. Outcome of surgical treatment of isolated local recurrence after radical nephrectomy for renal cell carcinoma. J Urol 2002;167(4):1630—3.10. Wiesner C., Jakse G., Rohde D. Therapy of local recurrence of renal cell carcinoma. Oncol Rep 2002;9(1):189—92.Wiesner C., Jakse G., Rohde D. Therapy of local recurrence of renal cell carcinoma. Oncol Rep 2002;9(1):189—92.11. Gogus C., Baltaci S., Beduk Y. et al. Isolated local recurrence of renal cell carcinoma after radical nephrectomy: experience with 10 cases. Urology 2003;61(5):926—9.Gogus C., Baltaci S., Beduk Y. et al. Isolated local recurrence of renal cell carcinoma after radical nephrectomy: experience with 10 cases. Urology 2003;61(5):926—9.12. Skinner D.G., Colvin R.B., Vermillion C.D. et al. Diagnosis and management of renal cell carcinoma. A clinical and pathologic study of 309 cases. Cancer 1971;28(5):1165—77.Skinner D.G., Colvin R.B., Vermillion C.D. et al. Diagnosis and management of renal cell carcinoma. A clinical and pathologic study of 309 cases. Cancer 1971;28(5):1165—77.13. Vukotic-Maletic V., Stojkovic-Djordjevic B., Hadzi-Djokic J., Dragicevic D. Quality of life in patients with renal carcinoma. Acta Chir Iugosl 1999;46(1 Suppl):15—8.Vukotic-Maletic V., Stojkovic-Djordjevic B., Hadzi-Djokic J., Dragicevic D. Quality of life in patients with renal carcinoma. Acta Chir Iugosl 1999;46(1 Suppl):15—8.14. Bruno J.J. 2nd, Snyder M.E., Motzer R.J., Russo P. Renal cell carcinoma local recurrences: impact of surgical treatment and concomitant metastasis on survival. BJU Int 2006;97(5):933—8.Bruno J.J. 2nd, Snyder M.E., Motzer R.J., Russo P. Renal cell carcinoma local recurrences: impact of surgical treatment and concomitant metastasis on survival. BJU Int 2006;97(5):933—8.15. Takashi M., Hibi H., Ohmura M. et al. Renal fossa recurrence of a renal cell carcinoma 13 years after nephrectomy: a case report. Int J Urol 1997;4(5):508—11.Takashi M., Hibi H., Ohmura M. et al. Renal fossa recurrence of a renal cell carcinoma 13 years after nephrectomy: a case report. Int J Urol 1997;4(5):508—11.