Presumed radically treated renal cell carcinoma - Recurrence of the disease and prognostic factors for subsequent survival

Objective: To gain knowledge about when, where and how metastases after presumed radical treatment for renal cell carcinoma (RCC) are detected, and to use this information to establish a follow-up programme for radically treated RCC. Further aims were to establish survival rates, together with identifying prognostic factors influencing survival for different groups of patients after recurrence of the disease. Material and Methods: A retrospective study of 305 pT1-4N0M0/pT1-4NxM0 (clinically N0) tumours treated with nephrectomy was performed. Results: A total of 89 patients (29.2%) developed metastases, with a median time to recurrence of 25.1 months. Within 5 years, 80% of the metastases had been detected. The lungs were the commonest metastatic site. A total of 34.8% of the recurrences were diagnosed as a result of routine follow-up. Median cancer-specific survival (CSS) after recurrence was 9.8 months. For patients with a disease-free interval (DFI) greater than or equal to24 months the median CSS was 35 months. In a univariate analysis, performance status, DFI greater than or equal to24 months, metastases in a single organ, primary tumour size less than or equal to70 mm, primary tumour stage pT1-2 and age <65 years were all associated with better survival. In a multivariate analysis, performance status, DFI and number of organs affected were independent predictors of survival. Conclusion: The information from this material is used to suggest a simple, but adequate, follow-up protocol. Easily accessible information can be used to identify groups with different prognoses regarding survival after recurrence of the disease.