Predictors of oncological outcome after resection of locally recurrent renal cell carcinoma.

PURPOSE: Local renal cell carcinoma recurrence is rare after radical nephrectomy with curative intent. We examined our experience to describe the natural history of isolated local recurrence and characterize important prognostic factors that predict the outcome in patients treated with aggressive resection.

MATERIALS AND METHODS: In an institutional database of 4,800 patients with renal cell carcinoma, of whom 2,945 underwent radical nephrectomy with curative intent, 54 were subsequently found to have isolated local recurrence in the renal fossa, ipsilateral adrenal gland or ipsilateral retroperitoneal lymph nodes, which was managed by surgical resection. In 69% of patients perioperative systemic therapy was done as an adjunct to surgical resection of local recurrence.

RESULTS: Estimated median recurrence-free and cancer specific survival was 11 and 61 months, respectively. A positive surgical margin after resection of local recurrence, recurrent tumor size, sarcomatoid features in the recurrence specimen, abnormal serum alkaline phosphatase and increased lactate dehydrogenase at local recurrence were adverse risk factors associated with an increased risk of cancer specific death after resection for recurrent renal cell carcinoma. Patients with 0, 1 and greater than 1 adverse risk features demonstrated cancer specific survival times of 111, 40 and 8 months, respectively.

CONCLUSIONS: Aggressive resection of isolated local recurrence offers durable local tumor control and cancer specific survival in a significant proportion of patients with renal cell carcinoma. Clinical and pathological prognostic features at local recurrence can be used for patient selection for surgery and also the thoughtful integration of systemic therapy with surgical extirpation.