Introduction

The last years have been marked by a growth in the use of partial nephrectomy (PN) for complex renal masses. This has led to an overall increase in the number of tumors found to have adverse pathological features. The aim of this study was to identify patterns and predictors of recurrence in patients with clinically localized renal cell carcinoma managed with PN._x000D_

Methods

Retrospective study of 830 consecutive cases of PN done between 2007 and 2015 at a single institution. Patient demographics, and pathological characteristics were correlated with recurrence patterns (overall, local and distant) and overall survival (OS) using Kaplan-Meier and cox regression analyses. Differences in the recurrence patterns were evaluated.

Results

Median age was 61 years, and median tumor size was 3.1 cm. Overall, 11.6% of tumors were pT3 stage, 39.3% were high grade, 2.9% had lymphovascular invasion, and 7.1% had positive margins. Median follow up was 36 months. There were 5.8% of patients diagnosed with recurrence. Grade, stage, surgical margins, and R.E.N.A.L score were associated with shorter disease-free survival (DFS). In multivariable regression pT (p<0.01), grade (p<0.01), and R.EN.A.L score (p=0.02) remain independent predictors of DFS. pT stage (HR 4.9, p<0.01) and grade (HR 3.9, p<0.01) were predictors of metastasis, while R.E.N.A.L score (HR 3.86, p=0.03) was the single predictor of local recurrence. Positive surgical margin did not predict recurrence. Five-year DFS and OS probabilities were 91% and 94%, respectively. Local recurrence emerged and developed earlier than metastasis (median 13 vs. 22 months, p<0.01).

Conclusions

High pT stage, high grade, and high R.E.N.A.L. score increase the risk of disease recurrence after partial nephrectomy. pT stage and grade are predictors of metastasis while R.E.N.A.L. score predicts local recurrence. Surgical margin status did not predict disease recurrence. The relapse features and risk factors are different between the 2 recurrence patterns.

Funding

none