Predictors Of Recurrence After Nephron-sparing Surgery For Renal Cell Carcinoma

Objective: To investigate predictors of recurrence after nephron-sparing surgery for renal cell carcinoma.And to optimize our follow-up program for patients after surgery.Methods and materials: We retrospectively investigated the medical records of 409 patients diagnosed with renal cell carcinoma who underwent nephron-sparing surgery in the First Affiliated Hospital of Fujian Medical University between January 2012 and December 2015.Among the 409 cases,324 of them had conducted standardized follow-up of at least 24 months.We analyzed the patient's clinical data,the pathology report and imaging data(mainly abdominal CT scan)to evaluate their association with recurrence in Cox regression analyses.Results: The average age of 324 patients was 54.65(18~85),214 males and 110 females,and median tumor size was 4.12 cm.Overall,81.5% of tumors were p T1 a stage,12.3% were p T1 b stage,6.6% were p T2 a stage,0.6% were p T2 b stage.18.5%were high grade,and 2.5% had positive margins.Higher grade,larger tumor size,higher stage,tumor necrosis,and increased R.E.N.A.L score were associated with shorter disease-free survival(DFS)on Kaplan-Meier analysis.In multivariable regression,grade(p=0.03),large tumor size(>4cm),and increased R.E.N.A.L score(p=0.03)are independent prognostic risk factors.Conclusion: High grade,large tumor size,high stage,tumor necrosis,and high R.E.N.A.L score increase the risk of recurrence after nephron-sparing surgery for renal cell carcinoma.And High grade,large tumor size,and high R.E.N.A.L score are independent prognostic risk factors of recurrence.This conclusion may help improve follow-up program which is not detailed in the guide.