Local salvage therapy for late (≥2 years) metastatic and local relapse of renal cell cancer is a potentially curative treatment irrespective of the site of recurrence

•Comparison of treatment outcome of patients relapsing with renal cell carcinoma after ≥2 years from resection of the primary.•Favorable prognosis of local treatment group mainly consisting of surgery with long-term survivors compared to systemic therapy and best supportive care.•Results irrespective of metastatic site or multiple organ involvement.•Especially favorable group are local relapses.

ObjectiveThe primary treatment approach to locoregional renal cell carcinoma (RCC) is surgical resection. Most relapses occur within the first 2 years but some patients experience late recurrences. Surgical resection of oligometastatic disease may be considered a curative option for relapsed RCC. However, limited data are available of long-term follow-up of late relapse regarding treatment choice.Patients and methodsWe identified 104 patients with RCC from our database, who relapsed after≥2 years from resection of their primary tumor. Median age at primary diagnosis was 61 years and sex distribution was F:M = 40:64. Histology was clear cell, n = 103 and papillary, n = 1. Sites of relapse were local, n = 14 (13.4%); lung only, n = 25 (24.0%); or extrapulmonary, n = 65 (62.5%). Treatment at first relapse was local therapy (LT) in n = 60 (57.7%) patients, of these, n = 55 patients had surgery done and n = 5 patients had underwent radiotherapy. Systemic therapy was used in n = 9 (8.7%) patients. Overall, 35 patients received best supportive care (33.7%).ResultsWe found a median overall survival (OS) of 49.8 months (95% CI: 29.3-70.2) and a progression-free survival (PFS) of 21.6 months (95% CI: 12.6-30.5) for all patients. Patients receiving LT had a median OS of 99.9 months (95% CI: 77.2-122.6) and a PFS of 31.1 months (95% CI: 21.5-40.7). Patients treated with systemic therapy, in turn, had an OS of 21.1 months (95% CI: 8.4-33.8) and a PFS of 4 months (95% CI: 1.0-6.2). Patients who received best supportive care had an OS of 10 months (95% CI: 1.3-18.7). This difference was highly significant (log rank for PFS: P<0.001; log rank for OS: P<0.003). Subgroup analysis of the LT group showed a superior outcome for local relapses (OS: not reached, PFS: 61.4 mo [95% CI: 28.5-9.2]) compared to visceral relapses (OS: 35.5 mo [95% CI: 17.9-53.1], PFS: 21.1 mo [95% CI: 19.2-22.9]).ConclusionLocal salvage therapy should be considered the first therapeutic option in late relapse of RCC irrespective of the site of relapse.