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Local recurrence following resection of intermediate-high risk nonmetastatic renal cell carcinoma: an anatomical classification and analysis of the ASSURE (ECOG-ACRIN E2805) adjuvant trial

  • Ziho Lee 1,
  • Opeyemi A. Jegede 2,
  • Naomi B. Haas 3,
  • Michael R. Pins 11,
  • Edward M. Messing 5,
  • Judith Manola 2,
  • Christopher G. Wood 6,
  • Christopher J. Kane 7,
  • Michael A. S. Jewett 9,
  • Keith T. Flaherty 9,
  • Janice P. Dutcher 10,
  • Robert S. DiPaola 11,
  • Robert G. Uzzo 1
1 Fox Chase Cancer Center-Temple Health System, Philadelphia, Pennsylvania, USA 2 ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA 3 University of Pennsylvania, Philadelphia, Pennsylvania, USA 4 Advocate Lutheran General Hospital, Park Ridge, Illinois, USA 5 University of Rochester, Rochester, New York, USA 6 MD Anderson Cancer Center, Houston, Texas, USA 7 University of California-San Diego, La Jolla, California, USA 8 University of Toronto, Toronto, Ontario, Canada 9 Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA 10 Cancer Research Foundation of New York, Chappaqua, New York, USA 11 University of Kentucky College of Medicine, Lexington, Kentucky, USA

Publication: Journal of Urology, October 2020

https://www.auajournals.org/doi/10.1097/JU.0000000000000588

Purpose

We describe what is to our knowledge a novel classification system for local recurrence after surgery of renal cell carcinoma. We assessed its prognostic implications using prospective, randomized controlled data.

Materials and Methods

We queried the ASSURE (Sunitinib Malate or Sorafenib Tosylate in Treating Patients With Kidney Cancer That Was Removed By Surgery) (ECOG-ACRIN [Eastern Cooperative Oncology Group-American College of Radiology Imaging Network] E2805) trial data for patients with fully resected, intermediate-high risk, nonmetastatic renal cell carcinoma with local recurrence. We used certain definitions, including type I—single recurrence in a remnant kidney or ipsilateral renal fossa, type II—single recurrence in the ipsilateral vasculature, the ipsilateral adrenal gland or a lymph node, type III—single recurrence in other intra-abdominal soft tissues or organs and type IV—any combination of types I-III or multiple recurrences of a single type. Multivariable logistic regression and the log rank test were performed to identify clinicopathological predictors and compare survival, respectively.

Results

Of the 1,943 patients 300 (15.4%) had local recurrence, which was type I, II, III and IV in 66 (22.0%), 97 (32.3%), 87 (29.0%) and 50 (16.7%), respectively. Surgical modality (minimally invasive vs open) and type of surgery (partial vs radical) did not predict any local recurrence. Five-year cancer specific survival and overall survival were worse in patients with type IV recurrence (each p <0.001). There was no difference in survival among patients with types I to III recurrence.

Conclusions

In patients with intermediate-high risk nonmetastatic renal cell carcinoma local recurrence appears to be a function of biology more than of surgical modality or surgery type. The prognosis for solitary intra-abdominal local recurrences appear similar regardless of location (types I-III). Local recurrences involving multiple sites and/or subdivisions are associated with worse survival (type IV).