To investigate whether pT1-renal cell carcinoma (RCC) should be followed differently after partial (PN) or radical nephrectomy (RN) based on a retrospective analysis of a multi-centre database (RECUR).
Retrospective study of 3380 patients treated for nonmetastatic RCC between January-2006 and December-2011 across 15 centres from 10 countries, as part of the RECUR-database project. For patients with pT1 clear-cell RCC (ccRCC), patterns of recurrence were compared between RN and PN according to recurrence site. Univariate and multivariate models were used to evaluate the association between surgical approaches and recurrence-free survival (RFS) and cancer-specific mortality (CSM).
From the database 1995 patients were identified as low-risk patients (pT1,pN0,pNx), of whom 1055 (52.9%) underwent PN. On multivariate analysis, features associated with worse RFS included tumour size (HR1.32, 95%CI 1.14-1.39,p<0.001), nuclear grade (HR 2.31, 95% CI 1.73-3.08, p<0.001), tumour necrosis (HR 1.5, 95%CI 1.03-2.3, p=0.037), vascular invasion (HR: 2.4 95%CI 1.3-4.4, p=0.005) and positive surgical margins (HR 4.4, 95%CI 2.3-8.5, p<0.001). Kaplan-Meier analysis of CSM revealed that the survival of patients with recurrence after PN was significantly better than those recurring after RN (p=0.02). While the above-mentioned risk factors were associated with prognosis, the type of surgery alone was not an independent prognostic variable for RFS nor CSM. Limitations include the retrospective nature of the study.
Our results showed that follow-up protocols should not rely solely on stage and type of primary surgery. An optimized regimen should also include validated risk factors rather than the type of surgery alone, to select the best imaging modality and to avoid unnecessary imaging. A follow-up of more than three years should be considered in patients with pT1 tumours after RN. A novel follow-up strategy is proposed.

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