Introduction

Stage II Renal Cell Carcinoma (RCC) is characterized by varied oncological outcomes, as the risk of progression and recurrence can vary widely. We analyzed clinical and pathological risk factors associated with oncological outcomes in a multicenter, international cohort.

Methods

Retrospective multicenter analysis of patients who underwent surgical excision of clinically localized stage 2 (T2) renal mass from 1987-2015. Patients with tumors amenable to nephron-sparing surgery, baseline chronic kidney disease, or bilateral renal masses were provided an option for partial nephrectomy (PN), otherwise radical nephrectomy (RN) was performed. Lymphadenectomy (LND) was performed when clinically indicated. Primary endpoint was Recurrence Free Survival (RFS). Secondary outcome was overall survival (OS). Kaplan-Meier (KM) log-rank test and multivariable analysis (MVA) for factors related to RFS and OS were performed.

Results

1328 patients were analyzed (mean age 59.2 years, median follow up 62.7 months, 66.4% male/33.6% female, 20% PN/80% RN). Overall recurrence rate was 22.3%. MVA for factors associated with recurrence was significant for RN (OR 4.68, p=0.010), positive margin (OR 34.19, p=0.012), tumor grade 3/4 (OR 2.35, p=0.001), and lymphovascular invasion (LVI, OR 2.03, p=0.018). MVA for tumor related factors associated with worsened OS was significant only for RN (OR 4.16, p=0.001). KM analysis revealed 5 year RFS of 78.7% for LVI negative and 49.9% for LVI positive patients (p<0.001), as well as a 5 year RFS of 81.8% for tumor grade 1/2 and 62.1% for tumor grade 3/4 (p<0.001, figure).

Conclusions

For Stage II RCC, LVI and tumor grade 3/4 are independently associated with increased risk of recurrence. Stage II RCC patients with these pathological findings represent a high risk subgroup that requires close follow up and has implications for clinical trial design.

Funding

Stephen Weissman Kidney Cancer Research Fund. NIH grants UL1TR000100 and UL1TR001442.