Survival outcome and treatment response of patients with late relapse from renal cell carcinoma in the era of targeted therapy

Nils Kroeger, Toni K. Choueiri, Jae Lyn Lee, Georg A. Bjarnason, Jennifer J. Knox, Mary J. Mackenzie, Lori Wood, Sandy Srinivas, Ulka N. Vaishamayan, SunYoung Rha, Sumanta K. Pal, Takeshi Yuasa, Frede Donskov, Neeraj Agarwal, Min Han Tan, Aristotelis Bamias, Christian K. Kollmannsberger, Scott A. North, Brian I. Rini, Daniel Y.C. Heng

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Abstract

Background A subset of primarily localized renal cell carcinoma (RCC) patients will experience disease recurrence ≤5 yr after initial nephrectomy. Objective To characterize the clinical outcome of patients with late recurrence beyond 5 yr. Design, setting, and participants Patients with metastatic RCC (mRCC) treated with targeted therapy were retrospectively characterized according to time to relapse. Relapse was defined as the diagnosis of recurrent metastatic disease >3 mo after initial curative-intent nephrectomy. Patients with synchronous metastatic disease at presentation were excluded. Patients were classified as early relapsers (ERs) if they recurred within 5 yr; late relapsers (LRs) recurred after 5 yr. Outcome measurements and statistical analysis Demographics were compared with the Student t test, the chi-square test, or the Fisher exact test. The survival time was estimated with the Kaplan-Meier method, and associations with survival outcome were assessed with univariable and multivariable Cox regression analyses. Results and limitations Among 1210 mRCC patients treated with targeted therapy after surgery for localized disease, 897 (74%) relapsed within the first 5 yr and 313 (26%) (range: 5-35 yr) after 5 yr. LRs presented with younger age (p < 0.0001), fewer with sarcomatoid features (p < 0.0001), more clear cell histology (p = 0.001), and lower Fuhrman grade (p < 0.0001). Overall objective response rates to targeted therapy were better in LRs versus ERs (31.8% vs 26.5%; p = 0.004). LRs had significantly longer progression-free survival (10.7 mo vs 8.5 mo; p = 0.005) and overall survival (OS; 34.0 mo vs 27.4 mo; p = 0.004). The study is limited by its retrospective design, noncentralized imaging and pathology review, missing information on metastatectomy, and nonstandardized follow-up protocols. Conclusions A quarter of patients who eventually developed metastatic disease and were treated with targeted therapy relapsed over 5 yr from initial nephrectomy. LRs have more favorable prognostic features and consequently better treatment response and OS.

Original languageEnglish
Pages (from-to)1086-1092
Number of pages7
JournalEuropean Urology
Volume65
Issue number6
DOIs
Publication statusPublished - 2014 Jan 1

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Renal Cell Carcinoma
Recurrence
Survival
Nephrectomy
Therapeutics
Chi-Square Distribution
Disease-Free Survival
Histology
Regression Analysis
Demography
Pathology
Students

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Kroeger, N., Choueiri, T. K., Lee, J. L., Bjarnason, G. A., Knox, J. J., Mackenzie, M. J., ... Heng, D. Y. C. (2014). Survival outcome and treatment response of patients with late relapse from renal cell carcinoma in the era of targeted therapy. European Urology, 65(6), 1086-1092. https://doi.org/10.1016/j.eururo.2013.07.031
Kroeger, Nils ; Choueiri, Toni K. ; Lee, Jae Lyn ; Bjarnason, Georg A. ; Knox, Jennifer J. ; Mackenzie, Mary J. ; Wood, Lori ; Srinivas, Sandy ; Vaishamayan, Ulka N. ; Rha, SunYoung ; Pal, Sumanta K. ; Yuasa, Takeshi ; Donskov, Frede ; Agarwal, Neeraj ; Tan, Min Han ; Bamias, Aristotelis ; Kollmannsberger, Christian K. ; North, Scott A. ; Rini, Brian I. ; Heng, Daniel Y.C. / Survival outcome and treatment response of patients with late relapse from renal cell carcinoma in the era of targeted therapy. In: European Urology. 2014 ; Vol. 65, No. 6. pp. 1086-1092.
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abstract = "Background A subset of primarily localized renal cell carcinoma (RCC) patients will experience disease recurrence ≤5 yr after initial nephrectomy. Objective To characterize the clinical outcome of patients with late recurrence beyond 5 yr. Design, setting, and participants Patients with metastatic RCC (mRCC) treated with targeted therapy were retrospectively characterized according to time to relapse. Relapse was defined as the diagnosis of recurrent metastatic disease >3 mo after initial curative-intent nephrectomy. Patients with synchronous metastatic disease at presentation were excluded. Patients were classified as early relapsers (ERs) if they recurred within 5 yr; late relapsers (LRs) recurred after 5 yr. Outcome measurements and statistical analysis Demographics were compared with the Student t test, the chi-square test, or the Fisher exact test. The survival time was estimated with the Kaplan-Meier method, and associations with survival outcome were assessed with univariable and multivariable Cox regression analyses. Results and limitations Among 1210 mRCC patients treated with targeted therapy after surgery for localized disease, 897 (74{\%}) relapsed within the first 5 yr and 313 (26{\%}) (range: 5-35 yr) after 5 yr. LRs presented with younger age (p < 0.0001), fewer with sarcomatoid features (p < 0.0001), more clear cell histology (p = 0.001), and lower Fuhrman grade (p < 0.0001). Overall objective response rates to targeted therapy were better in LRs versus ERs (31.8{\%} vs 26.5{\%}; p = 0.004). LRs had significantly longer progression-free survival (10.7 mo vs 8.5 mo; p = 0.005) and overall survival (OS; 34.0 mo vs 27.4 mo; p = 0.004). The study is limited by its retrospective design, noncentralized imaging and pathology review, missing information on metastatectomy, and nonstandardized follow-up protocols. Conclusions A quarter of patients who eventually developed metastatic disease and were treated with targeted therapy relapsed over 5 yr from initial nephrectomy. LRs have more favorable prognostic features and consequently better treatment response and OS.",
author = "Nils Kroeger and Choueiri, {Toni K.} and Lee, {Jae Lyn} and Bjarnason, {Georg A.} and Knox, {Jennifer J.} and Mackenzie, {Mary J.} and Lori Wood and Sandy Srinivas and Vaishamayan, {Ulka N.} and SunYoung Rha and Pal, {Sumanta K.} and Takeshi Yuasa and Frede Donskov and Neeraj Agarwal and Tan, {Min Han} and Aristotelis Bamias and Kollmannsberger, {Christian K.} and North, {Scott A.} and Rini, {Brian I.} and Heng, {Daniel Y.C.}",
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Kroeger, N, Choueiri, TK, Lee, JL, Bjarnason, GA, Knox, JJ, Mackenzie, MJ, Wood, L, Srinivas, S, Vaishamayan, UN, Rha, S, Pal, SK, Yuasa, T, Donskov, F, Agarwal, N, Tan, MH, Bamias, A, Kollmannsberger, CK, North, SA, Rini, BI & Heng, DYC 2014, 'Survival outcome and treatment response of patients with late relapse from renal cell carcinoma in the era of targeted therapy', European Urology, vol. 65, no. 6, pp. 1086-1092. https://doi.org/10.1016/j.eururo.2013.07.031

Survival outcome and treatment response of patients with late relapse from renal cell carcinoma in the era of targeted therapy. / Kroeger, Nils; Choueiri, Toni K.; Lee, Jae Lyn; Bjarnason, Georg A.; Knox, Jennifer J.; Mackenzie, Mary J.; Wood, Lori; Srinivas, Sandy; Vaishamayan, Ulka N.; Rha, SunYoung; Pal, Sumanta K.; Yuasa, Takeshi; Donskov, Frede; Agarwal, Neeraj; Tan, Min Han; Bamias, Aristotelis; Kollmannsberger, Christian K.; North, Scott A.; Rini, Brian I.; Heng, Daniel Y.C.

In: European Urology, Vol. 65, No. 6, 01.01.2014, p. 1086-1092.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Survival outcome and treatment response of patients with late relapse from renal cell carcinoma in the era of targeted therapy

AU - Kroeger, Nils

AU - Choueiri, Toni K.

AU - Lee, Jae Lyn

AU - Bjarnason, Georg A.

AU - Knox, Jennifer J.

AU - Mackenzie, Mary J.

AU - Wood, Lori

AU - Srinivas, Sandy

AU - Vaishamayan, Ulka N.

AU - Rha, SunYoung

AU - Pal, Sumanta K.

AU - Yuasa, Takeshi

AU - Donskov, Frede

AU - Agarwal, Neeraj

AU - Tan, Min Han

AU - Bamias, Aristotelis

AU - Kollmannsberger, Christian K.

AU - North, Scott A.

AU - Rini, Brian I.

AU - Heng, Daniel Y.C.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background A subset of primarily localized renal cell carcinoma (RCC) patients will experience disease recurrence ≤5 yr after initial nephrectomy. Objective To characterize the clinical outcome of patients with late recurrence beyond 5 yr. Design, setting, and participants Patients with metastatic RCC (mRCC) treated with targeted therapy were retrospectively characterized according to time to relapse. Relapse was defined as the diagnosis of recurrent metastatic disease >3 mo after initial curative-intent nephrectomy. Patients with synchronous metastatic disease at presentation were excluded. Patients were classified as early relapsers (ERs) if they recurred within 5 yr; late relapsers (LRs) recurred after 5 yr. Outcome measurements and statistical analysis Demographics were compared with the Student t test, the chi-square test, or the Fisher exact test. The survival time was estimated with the Kaplan-Meier method, and associations with survival outcome were assessed with univariable and multivariable Cox regression analyses. Results and limitations Among 1210 mRCC patients treated with targeted therapy after surgery for localized disease, 897 (74%) relapsed within the first 5 yr and 313 (26%) (range: 5-35 yr) after 5 yr. LRs presented with younger age (p < 0.0001), fewer with sarcomatoid features (p < 0.0001), more clear cell histology (p = 0.001), and lower Fuhrman grade (p < 0.0001). Overall objective response rates to targeted therapy were better in LRs versus ERs (31.8% vs 26.5%; p = 0.004). LRs had significantly longer progression-free survival (10.7 mo vs 8.5 mo; p = 0.005) and overall survival (OS; 34.0 mo vs 27.4 mo; p = 0.004). The study is limited by its retrospective design, noncentralized imaging and pathology review, missing information on metastatectomy, and nonstandardized follow-up protocols. Conclusions A quarter of patients who eventually developed metastatic disease and were treated with targeted therapy relapsed over 5 yr from initial nephrectomy. LRs have more favorable prognostic features and consequently better treatment response and OS.

AB - Background A subset of primarily localized renal cell carcinoma (RCC) patients will experience disease recurrence ≤5 yr after initial nephrectomy. Objective To characterize the clinical outcome of patients with late recurrence beyond 5 yr. Design, setting, and participants Patients with metastatic RCC (mRCC) treated with targeted therapy were retrospectively characterized according to time to relapse. Relapse was defined as the diagnosis of recurrent metastatic disease >3 mo after initial curative-intent nephrectomy. Patients with synchronous metastatic disease at presentation were excluded. Patients were classified as early relapsers (ERs) if they recurred within 5 yr; late relapsers (LRs) recurred after 5 yr. Outcome measurements and statistical analysis Demographics were compared with the Student t test, the chi-square test, or the Fisher exact test. The survival time was estimated with the Kaplan-Meier method, and associations with survival outcome were assessed with univariable and multivariable Cox regression analyses. Results and limitations Among 1210 mRCC patients treated with targeted therapy after surgery for localized disease, 897 (74%) relapsed within the first 5 yr and 313 (26%) (range: 5-35 yr) after 5 yr. LRs presented with younger age (p < 0.0001), fewer with sarcomatoid features (p < 0.0001), more clear cell histology (p = 0.001), and lower Fuhrman grade (p < 0.0001). Overall objective response rates to targeted therapy were better in LRs versus ERs (31.8% vs 26.5%; p = 0.004). LRs had significantly longer progression-free survival (10.7 mo vs 8.5 mo; p = 0.005) and overall survival (OS; 34.0 mo vs 27.4 mo; p = 0.004). The study is limited by its retrospective design, noncentralized imaging and pathology review, missing information on metastatectomy, and nonstandardized follow-up protocols. Conclusions A quarter of patients who eventually developed metastatic disease and were treated with targeted therapy relapsed over 5 yr from initial nephrectomy. LRs have more favorable prognostic features and consequently better treatment response and OS.

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