Local Treatment of Recurrent Renal Cell Carcinoma May Have a Significant Survival Effect Across All Risk-of-recurrence Groups

Lorenzo Marconi; Teele Kuusk; Umberto Capitanio; Christian Beisland; Thomas Lam; Sergio Fernandez Pello; Grant D Stewart; Tobias Klatte; Alessandro Volpe; Borje Ljungberg; Saeed Dabestani; Axel Bex

doi:10.1016/j.euros.2022.11.008

Local Treatment of Recurrent Renal Cell Carcinoma May Have a Significant Survival Effect Across All Risk-of-recurrence Groups

Eur Urol Open Sci. 2022 Dec 15:47:65-72. doi: 10.1016/j.euros.2022.11.008. eCollection 2023 Jan.

Authors

Lorenzo Marconi¹, Teele Kuusk², Umberto Capitanio^{3

4}, Christian Beisland^{5

6}, Thomas Lam^{7

8}, Sergio Fernandez Pello⁹, Grant D Stewart^{10

11}, Tobias Klatte¹², Alessandro Volpe¹³, Borje Ljungberg¹⁴, Saeed Dabestani¹⁵, Axel Bex^{16

17

18}

Affiliations

¹ Department of Urology and Renal Transplantation, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
² Royal London Hospital, Barts Health NHS Trust, London, UK.
³ Department of Urology, San Raffaele Scientific Institute, Milan, Italy.
⁴ Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy.
⁵ Department of Clinical Medicine, University of Bergen, Bergen, Norway.
⁶ Department of Urology, Haukeland University Hospital, Bergen, Norway.
⁷ Academic Urology Unit, University of Aberdeen, Aberdeen, UK.
⁸ Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
⁹ Department of Urology, Cabueñes University Hospital, Gijón, Spain.
¹⁰ Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.
¹¹ Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
¹² Department of Urology, Charité Universitaetsmedizin Berlin, Berlin, Germany.
¹³ Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
¹⁴ Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
¹⁵ Department of Translational Medicine, Division of Urological Cancers, Lund University, Malmö, Sweden.
¹⁶ Department of Urology, The Royal Free London NHS Foundation Trust, London, UK.
¹⁷ Division of Surgery and Interventional Science, University College London, London, UK.
¹⁸ Surgical Oncology Division, Urology Department, The Netherlands Cancer Institute, Amsterdam, The Netherlands.

Abstract

Background: Retrospective comparative studies suggest a survival benefit after complete local treatment of recurrence (LTR) in renal cell carcinoma (RCC), which may be largely due to an indication bias.

Objective: To determine the role of LTR in a homogeneous population characterised by limited and potentially resectable recurrence.

Design setting and participants: RECUR is a protocol-based multicentre European registry capturing patient and tumour characteristics, risk of recurrence (RoR), recurrence patterns, and survival of those curatively treated for nonmetastatic RCC from 2006 to 2011. Per-protocol resectable disease (RD) recurrence was defined as (1) solitary metastases, (2) oligometastases, or (3) renal fossa or renal recurrence after radical or partial nephrectomy, respectively.

Intervention: Local treatment of recurrence.

Outcome measurements and statistical analysis: Overall survival (OS) and cancer-specific survival was compared in the RD population that underwent LTR versus no LTR. We constructed a multivariate model to predict risk factors for overall mortality and analysed the effect of LTR across RoR groups.

Results and limitations: Of 3039 patients with localised RCC treated with curative intent, 505 presented with recurrence, including 176 with RD. Of these patients, 97 underwent LTR and 79 no LTR. Patients in the LTR group were younger (64.3 [40-80] vs 69.2 [45-87] yr; p = 0.001). The median OS was 70.3 mo (95% confidence interval [CI] 58-82.6) versus 27.4 mo (95% CI 23.6-31.15) in the LTR versus no-LTR group (p < 0.001). After a multivariate analysis, having LTR (hazard ratio [HR] 0.37 [95% CI 0.2-0.6]), having low- versus high-risk RoR (HR 0.42 [95% CI [0.20-0.83]), and not having extra-abdominal/thoracic metastasis (HR 1.96 [95% CI 1.02-3.77]) were prognostic factors of longer OS. The LTR effect on survival was consistent across risk groups. OS HR for high, intermediate, and low risks were 0.36 (0.2-0.64), 0.27 (0.11-0.65), and 0.26 (0.08-0.8), respectively. Limitations include retrospective design.

Conclusions: This is the first study assessing the effectiveness of LTR in RCC in a comparable population with RD. This study supports the role of LTR across all RoR groups.

Patient summary: We assessed the effectiveness of local treatment of resectable recurrent renal cell carcinoma after surgical treatment of the primary kidney tumour. Local treatment of recurrence was associated with longer survival across groups with a risk of recurrence.

Keywords: Metastasectomy; Metastatic; Radiotherapy; Renal cell cancer; Stereotactic body radiotherapy; Surgery; Systemic therapy.