• 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 Cobelli, 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.
• 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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