Investigators who studied patients with local or regional cancer recurrence after curative surgery for localized renal cell carcinoma (RCC) found that almost half of those who underwent local salvage therapy had a 2-year secondary recurrence-free survival rate of nearly 50% without the need for systemic therapy.
Salvage therapy usually was surgical excision, although a few patients were treated with ablative technologies such as cryoablation.
The retrospective study included 1895 patients who underwent partial or radical nephrectomy for clinically localized RCC from 2004 to 2018, 30 (1.6%) of whom had isolated local recurrence (LR) or regional recurrence (RR) without distant metastatic recurrence. Of these, 26 patients received local therapy (either surgical resection [24 patients] or thermal ablation [2 patients]). Over a median follow-up duration of 29.5 months, recurrence developed in 14 patients (53.8%).
The 1-year and 2-year secondary recurrence-free survival rates for the 30 patients in the recurrence cohort were 60.7% and 49.7%, respectively, a team led by Phillip M. Pierorazio, MD, of The James Buchanan Brady Urological Institute at Johns Hopkins University School of Medicine in Baltimore, Maryland, reported in Urology.
“A minority of patients will experience an isolated local or regional recurrence of RCC after definitive surgery, supporting the notion that most recurrences of RCC manifest as systematic disease,” the investigators wrote. “However, almost 50% of patients with LR or RR in this select surgical/ablative series demonstrated a disease-free interval without the need for systemic therapy.”
The investigators also found that 2 or more sites of LR or RR significantly predicted a 2.2-fold increased risk of secondary recurrence or metastasis after local therapy for local recurrence.
“Patients with a solitary site of recurrence may be most appropriate for local therapy, although durable disease-free survival was also observed in patients with multiple sites of recurrence,” Dr Pierorazio and colleagues concluded. “This work provides a framework onto which further studies regarding surgery/ablation and locoregional recurrence of clinically localized RCC can be performed.”
Ray S, Cheaib JG, Biles MJ, et al. Local and regional recurrences of clinically localized renal cell carcinoma after nephrectomy: A 15 year institutional experience with prognostic features and oncologic outcomes. Published online April 14, 2021. Urology. doi:10.1016/j.urology.2021.03.038