Late recurrence of renal cell carcinoma >5 years after surgery: clinicopathological characteristics and prognosis

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Late recurrence more than five years after the initial treatment is one of the biological behaviours specific for RCC. In our study, late recurrence was observed in 8.8% of the patients. Also, patients with late recurrence had more favorable 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. 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.