Article title: long-term outcomes of treatment for locally advanced kidney cancer: experience from the samara regional clinical oncology center

Objective. To evaluate long-term outcomes of surgical treatment in patients with locally advanced renal cell carcinoma and to identify clinicopathological factors associated with overall and recurrence-free survival.
Materials and Methods. A retrospective cohort study enrolled 97 patients with stage T3a-cN0M0G1–3 renal cell carcinoma who underwent surgery at the Samara Regional Clinical Oncology Dispensary between 2016 and 2017. Clinical, morphological, and metabolic parameters were analyzed. Survival was estimated using the Kaplan–Meier method with log-rank testing for between-group comparisons.
Results. Five-year overall survival was 78% and recurrence-free survival was 86%. Statistically significant adverse prognostic factors for both endpoints included: tumor size greater than 7 cm, poor differentiation (G3), tumor thrombus (particularly with inferior vena cava extension), grade III obesity, diabetes mellitus, and anemia. Patient age and side of lesion had no significant effect on prognosis; grade I–II obesity did not worsen survival outcomes.
Conclusion. Risk stratification in locally advanced renal cell carcinoma should incorporate not only tumor morphology (size, grade, thrombus extension) but also the patient's metabolic profile (grade III obesity, diabetes, anemia). The identified factors may serve as a basis for individualized postoperative surveillance planning.

1. World health organization. Cancer TODAY | IARC. https://gco.iarc.who.int

2. Zlokachestvennyye novoobrazovaniya v Rossii v 2023 godu (zabolevayemost′ i smertnost′). Pod red. A.D. Kaprina [i dr.].M.: MNIOI im. P.A. Gertsena − filial FGBU «NMITS radiologii» Minzdrava Rossii, 2024. (In Russ.)

3. Risk-based surveillance after surgical treatment of renal cell carcinoma. J Urol. 2018 July;200(1):61–67. https://doi.org/10.1016/j.juro.2018.01.072

4. Capogrosso P, Capitanio U, La Croce G, et al. Follow-up after treatment for renal cell carcinoma: The evidence beyond the guidelines. Eur Urol Focus. 2016;1:272–81. [PubMed: 28723399]

5. American Urological Association: Follow-up for clinically localized renal neoplasms: AUA guideline 2013 http://www.auanet.org/education/guidelines/renalcancer-follow-up.cfm

6. National Comprehensive Cancer Network: NCCN Clinical Practice Guidelines in Oncology: Kidney Cancer 2 2014 http://www.nccn.org/professionals/physician_gls/pdf/kidney.pdf

7. Клинические рекомендации Рак паренхимы почки. Ассоциация онкологов России https://cr.minzdrav.gov.ru/preview-cr/10_4

8. Capogrosso P, Capitanio U, La Croce G, et al. Follow-up after treatment for renal cell carcinoma: The evidence beyond the guidelines. Eur Urol Focus. 2016;1(3):272–281. https://doi.org/10.1016/j.euf.2016.05.004

9. Stewart SB, Thompson RH, Psutka SP, et al. Evaluation of the National Comprehensive Cancer Network and American Urological Association renal cell carcinoma surveillance guidelines. J Urol. 2018;200(1):61–67. https://doi.org/10.1016/j.juro.2018.01.072

10. Bhindi B, Abel EJ, Albiges L, et al. Body mass index and metastatic renal cell carcinoma: clinical and biological correlations. Eur Urol. 2017;72(6):873–881. https://doi.org/10.1016/j.eururo.2017.05.024

11. Leibovich BC, Blute ML, Cheville JC, et al. Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. J Clin Oncol. 2003;21(12):2364–2371. https://doi.org/10.1200/JCO.2003.11.141

12. Sun M, Shariat SF, Cheng C, et al. Prognostic factors and predictive models in renal cell carcinoma: a contemporary review. Cancer. 2011;117(10):2132–2140. https://doi.org/10.1002/cncr.25744

13. Mason RJ, Wood CG, Karam JA. Renal cell carcinoma with venous tumor thrombus: biology, clinical significance, and surgical management. Eur Urol. 2010;57(5): 911–921. https://doi.org/10.1016/j.eururo.2010.01.014

14. Delahunt B, Cheville JC, Martignoni G, Humphrey PA, Magi-Galluzzi C, Egevad L. The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters. Am J Surg Pathol. 2013;37(10):1490–1504. https://doi.org/10.1097/PAS.0b013e318299f0fb