Surgical management of patients with local recurrence of renal cancer. Prognostic factors of survival

Treatment of local recurrence of renal cell carcinoma (RCC) is a serious surgical and therapeutic problem. Currently, there is no single standardized treatment strategy for patients in this group. Objective. Determination of prognostic factors for overall and tumor-specific survival (OS and NSV, respectively) of patients after surgical treatment for RCC local recurrence to assess its efficacy. Material and methods. From May 2007 to April 2024, 53 patients with local recurrence of RCC were operated on in the oncourology department of the P.A. Herzen Moscow Oncology Research Institute. Of them, 18 (34%) were operated on for primary kidney tumor (12 cases underwent nephrectomy, 6 –kidney resection) at the P.A. Herzen Moscow Scientific Research Institute, 35 (66%) — at their place of residence (16 underwent nephrectomy, 14 — kidney resection, 5 — radiofrequency thermoablation). During single- and multivariate analyses of a number of pre- and intraoperative parameters, as well as the results of pathomorphological examination, the main prognostic factors of overall (OS) and cancer-specific survival (CSS) of patients were determined. Results. In multivariate analysis, the most significant factors for OS were the number of tumor nodes (HR=3.201, p=0.003), microvascular invasion (HR=103.330, p=0.002), and for CSS — the number of recurrent tumor nodes (HR=3.201, p=0.003) and high tumor malignancy (G3—4) (HR=6.304, p=0.025). Conclusion. The distant oncologic outcomes of surgical treatment of patients with local recurrence of RCC are influenced by a number of factors: microvascular invasion of the tumor, the number of recurrent tumor nodes, and the high degree of tumor malignancy.