ABSTRACT
Objective:
To investigate the
efficacy of different
treatment modes for locoregional
recurrence after
nephrectomy in
patients with
renal cell carcinoma.
Methods:
A total of 106
patients with locoregional
recurrence after
nephrectomy without distant
metastasis (77
males and 29
females) admitted to
Sun Yat-sen
University Cancer Center from October 2001 to July 2020 were retrospectively analyzed. The median age was 51 (40, 60) years old. Radical
nephrectomy was performed in 90
patients with primary
tumor and partial
nephrectomy was performed in 16
patients. Pathological
diagnosis showed that 54 cases were clear
cell carcinoma and 52 cases were non-clear
cell carcinoma. 53 cases were in stage T 1-2 and 53 cases in stage T 3-4. The median diameter of recurrent lesions was 3.2 (2.0, 6.3) cm, and the median number was 2 (1, 4). The
recurrence sites were divided into renal fossa
recurrence (33 cases), renal fossa±retroperitoneal
lymph node recurrence (38 cases), and intra-abdominal spread (35 cases). The median duration from primary
surgery to local
recurrence was 14.8 (7.3, 35.8) months. Two
treatment groups were identified as systemic
therapy alone (Group A) and local
therapy with or without systemic
therapy (Group B). The Kaplan-Meier
method was used to compare the
progression free survival (PFS) and overall
survival (OS) between Group A and Group B. The
Cox model was used to perform univariate and
multivariate analysis.
Results:
Of all the 106
patients, 33
patients were in Group A and 73
patients were in Group B. In Group A, 29
patients (87.9%) received targeted
therapy, and 4
patients (12.1%) received targeted
therapy combined with
immunotherapy. In Group B, 34
patients (46.6%) received
surgery or ablation and 39
patients (53.4%) received SBRT, of which 62
patients (84.9%) received concurrent systemic
therapy. Among them, 58
patients (93.5%) received targeted
therapy, and 4
patients (6.5%) received targeted
therapy combined with
immunotherapy. The median follow-up period was 29.0 (15.4, 45.9) months, 64
patients progressed on
tumor including 28
patients died. The median PFS and OS were 15.6 (7.1, 35.2) months and 66.9 (37.8, not reached) months. The median PFS of Group A and Group B were 7.6(5.0, 17.2)months and 22.2(9.6, 63.9)months respectively ( P=0.001), median OS of Group A and Group B were 45.7 (23.4, 62.8)months and 71.0(50.6, not reached)months respectively, and the 2-year OS were 70.6% and 85.5% in Group A and Group B respectively ( P=0.023). The univariate
analysis showed local
therapy with or without systemic
therapy was significantly reduced 56%
risk of
tumor progression ( HR=0.44, P=0.003) and reduced 60%
risk of
death ( HR=0.40, P=0.028). The
multivariate analysis showed that the OS was associated with ECOG score( HR=10.20, 95% CI 4.13-25.30, P<0.001)and local
therapy( HR=0.23, 95% CI 0.09-0.58, P=0.002).
Conclusion:
Compared with systemic
therapy alone, local
therapy with or without systemic
therapy can effectively improve the PFS and OS of
patients with locoregional
recurrence after
nephrectomy.