Patient Reported Weight Loss Predicts Recurrence Rate in Renal Cell Cancer Cases after Nephrectomy

Background: Recurrence of renal cell cancer (RCC) affects approximately one-third of patients after curative nephrectomy. However, studies from the Indian subcontinent have been scarce. We here ddetermine relapse rates and patterns in an Indian cohort. Methods: This study included all patients with RCC who underwent nephrectomy from 2004 to 2013 at our centre. Recurrence-free survival (RFS) was calculated from the date of surgery to date of recurrence or death. The Cox regression model was applied to identify significant prognostic factors. Results: Overall a total of 292 patients were included. Median age was 50 years (range 19-84 years), with a male:female ratio of 3:1. Radical and partial nephrectomy were performed for 276 (94.5%) and 16 (5.5%) patients, respectively. Clear cell was most common histological subtype (71.2%) and T1, T2, T3 and T4 stages accounted for 89 (30.5%), 86 (29.5%), 105 (36%) and 12 (4.1%) patients, respectively. One hundred and thirty-six patients (46.6%) demonstrated recurrence. Eighty-six (63.2%) relapsed at distant sites, 14 (10.3%) and at locoregional sites whereas 36(26.5%) had both distant and locoregional recurrence. Median time to recurrence was 18 months. Approximately 17.7% of cases had disease reappearance after five years. Factors predicting shorter RFS on multivariate analysis were patient reported weight loss (p=0.004), Fuhrman grade 3 or 4 (p<0.0001), presence of necrosis (p<0.0001) and higher tumour stage (p=0.005). Conclusion: Compared to previous studies, our patients had higher rates of recurrence in general and locoregional recurrence in particular. However, except for weight loss, other predictive factors remain similar. Finding weight loss as the marker of recurrence emphasises the importance of the simple task of history taking.