Renal cell carcinoma recurrences and metastases in primary non-metastatic patients: a population-based study

• Published in: World journal of urology Vol. 34; no. 8; pp. 1081 - 1086
• Main Authors: Dabestani, Saeed, Thorstenson, Andreas, Lindblad, Per, Harmenberg, Ulrika, Ljungberg, Börje, Lundstam, Sven
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2016; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Renal Cell - epidemiology; Carcinoma, Renal Cell - secondary; Carcinoma, Renal Cell - therapy; Child; Female; Follow-Up Studies; Humans; Kidney Neoplasms - pathology; Kidney Neoplasms - therapy; Local recurrence; Male; Medicine; Medicine & Public Health; Metastases; Middle Aged; Minimal invasive therapy; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - therapy; Nephrectomy; Nephrology; Oncology; Partial nephrectomy; Prospective Studies; Recurrent disease; Renal cell carcinoma; Surgery; Sweden; Topic Paper; Urology; Young Adult; Recurrent disease; Partial nephrectomy; Nephrectomy; Renal cell carcinoma; Local recurrence; Surgery; Minimal invasive therapy; Metastases
• ISSN: 0724-4983; 1433-8726; 1433-8726
• DOI: 10.1007/s00345-016-1773-y

Purpose
To present the occurrence of metastases and local recurrences in primary non-metastatic patients with renal cell carcinoma (RCC) in a contemporary Swedish population-based cohort.
Methods
Between 2005 and 2009, a total of 4527 patients were included in the prospective National Swedish Kidney Cancer Register accounting for nearly all RCC patients in Sweden. Among M0 patients, 472 (13 %) had no follow-up data registered within 5-year follow-up time and were excluded from the analysis.
Results
In total, 939 (21 %) had distant metastases at presentation with a decrease from 23 to 18 % during the inclusion period. Of 3107 patients with follow-up data and with M0 disease, 623 (20 %) were diagnosed with a tumor recurrence during 5-year follow-up. Mean time to recurrence was 24 months (SD ± 20 months). Among these, 570 patients (92 %) were at primary diagnosis treated with radical nephrectomy, 23 patients (3.7 %) with partial nephrectomy and 12 patients (1.9 %) with minimally invasive treatments. The most frequent sites of metastases were lung (54 %), lymph nodes (22 %) and bone (20 %). The treatment of recurrence was in 50 % systemic treatments, while metastasectomy was performed in 17 % of the patients, out of which 68 % were with a curative intention.
Conclusions
In this population-based study, 21 % of the patients had metastatic disease at presentation, with a decreasing trend over the study period. During 5-year follow-up, 20 % of the primary non-metastatic patients had recurrent disease. Of the patients with recurrence, half were given systemic oncological treatment and 17 % underwent metastasectomy.