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Local Recurrence Following Resection of Intermediate-High Risk Nonmetastatic Renal Cell Carcinoma: An Anatomical Classification and Analysis of the ASSURE (ECOG-ACRIN E2805) Adjuvant Trial.

  • Lee, Ziho1
  • Jegede, Opeyemi A2
  • Haas, Naomi B3
  • Pins, Michael R4
  • Messing, Edward M5
  • Manola, Judith2
  • Wood, Christopher G6
  • Kane, Christopher J7
  • Jewett, Michael A S8
  • Flaherty, Keith T9
  • Dutcher, Janice P10
  • DiPaola, Robert S11
  • Uzzo, Robert G1
  • 1 Fox Chase Cancer Center-Temple Health System, Philadelphia, Pennsylvania.
  • 2 ECOG-ACRIN Biostatistics Center, Dana-Farber Cancer Institute, Boston, Massachusetts.
  • 3 University of Pennsylvania, Philadelphia, Pennsylvania.
  • 4 Advocate Lutheran General Hospital, Park Ridge, Illinois.
  • 5 University of Rochester, Rochester, New York.
  • 6 MD Anderson Cancer Center, Houston, Texas.
  • 7 University of California-San Diego, La Jolla, California.
  • 8 University of Toronto, Toronto, Ontario, Canada. , (Canada)
  • 9 Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
  • 10 Cancer Research Foundation of New York, Chappaqua, New York.
  • 11 University of Kentucky College of Medicine, Lexington, Kentucky.
Published Article
The Journal of urology
Publication Date
Apr 01, 2020
DOI: 10.1097/JU.0000000000000588
PMID: 31596672


We describe what is to our knowledge a novel classification system for local recurrence after surgery of renal cell carcinoma. We assessed its prognostic implications using prospective, randomized controlled data. We queried the ASSURE (Sunitinib Malate or Sorafenib Tosylate in Treating Patients With Kidney Cancer That Was Removed By Surgery) (ECOG-ACRIN [Eastern Cooperative Oncology Group-American College of Radiology Imaging Network] E2805) trial data for patients with fully resected, intermediate-high risk, nonmetastatic renal cell carcinoma with local recurrence. We used certain definitions, including type I-single recurrence in a remnant kidney or ipsilateral renal fossa, type II-single recurrence in the ipsilateral vasculature, the ipsilateral adrenal gland or a lymph node, type III-single recurrence in other intra-abdominal soft tissues or organs and type IV-any combination of types I-III or multiple recurrences of a single type. Multivariable logistic regression and the log rank test were performed to identify clinicopathological predictors and compare survival, respectively. Of the 1,943 patients 300 (15.4%) had local recurrence, which was type I, II, III and IV in 66 (22.0%), 97 (32.3%), 87 (29.0%) and 50 (16.7%), respectively. Surgical modality (minimally invasive vs open) and type of surgery (partial vs radical) did not predict any local recurrence. Five-year cancer specific survival and overall survival were worse in patients with type IV recurrence (each p <0.001). There was no difference in survival among patients with types I to III recurrence. In patients with intermediate-high risk nonmetastatic renal cell carcinoma local recurrence appears to be a function of biology more than of surgical modality or surgery type. The prognosis for solitary intra-abdominal local recurrences appear similar regardless of location (types I-III). Local recurrences involving multiple sites and/or subdivisions are associated with worse survival (type IV).

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