• European urology · Sep 2013

    Multicenter Study

    Features associated with recurrence beyond 5 years after nephrectomy and nephron-sparing surgery for renal cell carcinoma: development and internal validation of a risk model (PRELANE score) to predict late recurrence based on a large multicenter database (CORONA/SATURN Project).

    • Sabine Brookman-May, Matthias May, Shahrokh F Shariat, Evanguelos Xylinas, Christian Stief, Richard Zigeuner, Thomas Chromecki, Maximilian Burger, Wolf F Wieland, Luca Cindolo, Luigi Schips, Ottavio De Cob... more elli, Bernardo Rocco, Cosimo De Nunzio, Bogdan Feciche, Michael Truss, Christian Gilfrich, Sascha Pahernik, Markus Hohenfellner, Stefan Zastrow, Manfred P Wirth, Giacomo Novara, Marco Carini, Andrea Minervini, Claudio Simeone, Alessandro Antonelli, Vincenzo Mirone, Nicola Longo, Alchiede Simonato, Giorgio Carmignani, Vincenzo Ficarra, and Members of the CORONA project and the SATURN project. less
    • Ludwig-Maximilians-University Munich, Klinikum Grosshadern, Department of Urology, Munich, Germany. Electronic address: sabine.brookman-may@email.de
    • Eur. Urol. 2013 Sep 1;64(3):472-7.

    BackgroundApproximately 10-20% of recurrences in patients treated with nephrectomy for renal cell carcinoma (RCC) develop beyond 5 yr after surgery (late recurrence).ObjectiveTo determine features associated with late recurrence.Design, Setting, And ParticipantsA total of 5009 patients from a multicenter database comprising 13 107 RCC patients treated surgically had a minimum recurrence-free survival of 60 mo (median follow-up [FU]: 105 mo [range: 78-135]); at last FU, 4699 were disease free (median FU: 103 mo [range: 78-134]), and 310 patients (6.2%) experienced disease recurrence (median FU: 120 mo [range: 93-149]).InterventionsPatients underwent radical nephrectomy or nephron-sparing surgery.Outcome Measurements And Statistical AnalysisMultivariable regression analyses identified features associated with late recurrence. Cox regression analyses evaluated the association of features with cancer-specific mortality (CSM).Results And LimitationsLymphovascular invasion (LVI) (odds ratio [OR]: 3.07; p<0.001), Fuhrman grade 3-4 (OR: 1.60; p=0.001), and pT stage >pT1 (OR: 2.28; p<0.001) were significantly associated with late recurrence. Based on accordant regression coefficients, these parameters were weighted with point values (LVI: 2 points; Fuhrman grade 3-4: 1 point, pT stage >1: 2 points), and a risk score was developed for the prediction of late recurrences. The calculated values (0 points: late recurrence risk 3.1%; 1-3 points: 8.4%; 4-5 points: 22.1%) resulted in a good-, intermediate- and poor-prognosis group (area under the curve value for the model: 70%; 95% confidence interval, 67-73). Multivariable Cox regression analysis showed LVI (HR: 2.75; p<0.001), pT stage (HR: 1.24; p<0.001), Fuhrman grade (HR: 2.40; p<0.001), age (HR: 1.01; p<0.001), and gender (HR: 0.71; p=0.027) to influence CSM significantly. Limitations are based on the multicenter and retrospective study design.ConclusionsLVI, Fuhrman grade 3/4, and a tumor stage >pT1 are independent predictors of late recurrence after at least 5 yr from surgery in patients with RCC. We developed a risk score that allows for prognostic stratification and individualized aftercare of patients with regard to counseling, follow-up scheduling, and clinical trial design.Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

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