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Purpose <p>Local recurrence after partial nephrectomy with negative margins (R0) remains a clinical concern in the management of non-metastatic renal cell carcinoma (RCC). We aimed to quantify its incidence and to identify independent predictors of recurrence in a large, contemporary, multicenter cohort.</p> Methods <p>We retrospectively analyzed 2,438 patients from the UroCCR database who underwent R0 nephron-sparing surgery for cT1–cT3a/N0/M0 RCC between 2007 and 2022 across 24 French centers. The primary endpoint was histologically confirmed local recurrence (tumor bed or ipsilateral renal recurrence). Fine‑and‑Gray competing‑risk regression, with death treated as a competing event, was applied to determine independent predictors.</p> Results <p>After a median follow-up of 66 months (IQR:26–86), local recurrence occurred in 97 patients (3.9%). Independent predictors included open surgery (sHR 2.25 [95% CI, 1.02–4.97]), intraoperative complications (sHR 4.00 [95% CI, 1.65–9.68]), longer delay between diagnosis and surgery (sHR 1.02 [95% CI, 1.003–1.04]), clear cell histology (sHR 4.12 [2.18–7.79]), higher RENAL score, vascular emboli (sHR 3.90 [95% CI, 1.67–9.08]), and tumor necrosis (sHR 2.62 [95% CI, 1.54–4.47]). Robotic assistance was associated with a reduced recurrence risk (sHR 0.50 [95% CI, 0.28–0.88]).</p> Conclusion <p>Local recurrence after R0 partial nephrectomy, though infrequent, is associated with clinical, surgical, and pathological factors. Open surgery, intra‑operative complications, treatment delay, tumor complexity, vascular emboli, necrosis and clear‑cell histology were correlated with an increase risk of recurrence.</p>

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Local recurrence after R0 partial nephrectomy for RCC: insights from a large multicenter cohort (PREPARE study – UroCCR 140)

  • 期刊论文

  • 发表日期：

    2025年11月26日

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  • Lucas Deluegue,
  • Gaëlle Margue,
  • Laurine Cadart,
  • Jean-Christophe Bernhard,
  • Karim Bensalah,
  • Pierre Bigot,
  • Nicolas Doumerc,
  • Franck Bruyere,
  • Morgan Roupret,
  • Nicolas Branger,
  • Louis Surlemont,
  • Cécile Champy,
  • Bastient Parier,
  • Philippe Paparel,
  • Thibaut Waeckel,
  • Hervé Lang,
  • Constance Michel,
  • Alexis Fontenil,
  • Jean-Baptiste Beauval,
  • Jean-Jacques Patard,
  • Maxime Vallee,
  • Julien Guillotreau,
  • Olivier Traxer,
  • Laurent Guy,
  • François Audenet,
  • Benjamin Rouget,
  • Jonathan Olivier,
  • Jean-Christophe Fantoni

摘要

Purpose

Local recurrence after partial nephrectomy with negative margins (R0) remains a clinical concern in the management of non-metastatic renal cell carcinoma (RCC). We aimed to quantify its incidence and to identify independent predictors of recurrence in a large, contemporary, multicenter cohort.

Methods

We retrospectively analyzed 2,438 patients from the UroCCR database who underwent R0 nephron-sparing surgery for cT1–cT3a/N0/M0 RCC between 2007 and 2022 across 24 French centers. The primary endpoint was histologically confirmed local recurrence (tumor bed or ipsilateral renal recurrence). Fine‑and‑Gray competing‑risk regression, with death treated as a competing event, was applied to determine independent predictors.

Results

After a median follow-up of 66 months (IQR:26–86), local recurrence occurred in 97 patients (3.9%). Independent predictors included open surgery (sHR 2.25 [95% CI, 1.02–4.97]), intraoperative complications (sHR 4.00 [95% CI, 1.65–9.68]), longer delay between diagnosis and surgery (sHR 1.02 [95% CI, 1.003–1.04]), clear cell histology (sHR 4.12 [2.18–7.79]), higher RENAL score, vascular emboli (sHR 3.90 [95% CI, 1.67–9.08]), and tumor necrosis (sHR 2.62 [95% CI, 1.54–4.47]). Robotic assistance was associated with a reduced recurrence risk (sHR 0.50 [95% CI, 0.28–0.88]).

Conclusion

Local recurrence after R0 partial nephrectomy, though infrequent, is associated with clinical, surgical, and pathological factors. Open surgery, intra‑operative complications, treatment delay, tumor complexity, vascular emboli, necrosis and clear‑cell histology were correlated with an increase risk of recurrence.