Which Patients Should We Follow up beyond 5 Years after Definitive Therapy for Localized Renal Cell Carcinoma?

PURPOSE Up to 10% of recurrences develop beyond 5 years after curative treatment of localized renal cell carcinoma (RCC). Clinicopathologic features were evaluated to determine which factors are associated with late recurrence. MATERIALS AND METHODS A total of 753 patients were diagnosed with localized RCC from January 2000 to June 2008. We enrolled 225 patients who were treated surgically and had a minimal recurrence-free survival of 60 months. Patients who had recurrence beyond 5 years after nephrectomy were defined as the late recurrence group and the remaining patients as the recurrence-free group. Multivariate logistic regression analyses and the Cox proportional hazard model were used for determination of features associated with late recurrence. RESULTS In multivariate analyses, age older than 60 (p=0.030), Fuhrman grade ≥ 3 (p=0.042), and pT stage ≥ pT2 (p=0.010) showed statistical association with late recurrence. The Cox proportional hazard model showed significant differences in recurrence-free survival when we classified the patients based on pT2 (p=0.007) and on patient age ≥ 60 years (p=0.039). CONCLUSION Patient age greater than 60 years, Fuhrman grade ≥ 3, and tumor stage ≥ pT2 are independent risk factors of recurrence more than 5 years after surgery in patients with RCC. Therefore, close lifelong follow-up is recommended for patients with these risk factors.