Re: Late recurrence of renal cell sarcinoma 5 years after surgery: Clinicopathological characteristics and prognosis

摘要

Objective: To evaluate the clinicopathological features and prognosis of late recurrence of renal cell carcinoma (RCC). Patients and Methods: A total of 747 patients who had undergone curative surgery for RCC with follow-up of >5 years or recurrence within 5 years were included in the study. The patients were stratified into four groups based on cancer-free intervals: no recurrence (no recurrence >5 years after surgery, n= 425), synchronous metastasis (n= 138), early recurrence (recurrence within 5 years, n= 143), and late recurrence (recurrence after 5 years, n= 41). Multivariate analysis was performed to identify the clinicopathological factors affecting late recurrence and its clinical outcome. Results: The subgroups were significantly different in clinicopathological variables, including age, preoperative haemoglobin, platelet count, high-sensitivity C-reactive protein (hs-CRP) levels, pT stage and nuclear grade. In multiple logistic regression analysis, age (odds ratio [OR] 1.085, 95% confidence interval [CI] 1.012-1.163, P = 0.022), and preoperative hs-CRP levels (OR 6.211, 95% CI 1.590-24.270, P = 0.009) were independent predictive factors for late recurrence. In patients with synchronous metastasis, early recurrence and late recurrence, 5-year cancer-specific survival rates after recurrence were 27.0%, 41.1% and 73.7%, respectively (P <0.001). Multivariate Cox analysis indicated that cancer-free interval, as well as body mass index, initial symptoms, Fuhrman's nuclear grade, sarcomatoid differentiation, lymphovascular invasion and metastasectomy, were independent predictive factors for cancer-related death. Conclusions: Late recurrence of RCC is not a rare event. Patients with late recurrence had more favourable clinicopathological features and better prognosis with long cancer-specific survival after recurrence. Age and preoperative hs-CRP levels may be independent predictive factors for late recurrence of RCC.