Predicting recurrence in patients with localised renal cell carcinoma after nephrectomy

Although most patients who undergo nephrectomy for clear cell renal cell carcinoma for cT1–T3 N0 disease achieve a complete response, up to 30% will recur. 1 Rini BI Campbell SC Escudier B Renal cell carcinoma. Lancet. 2009; 373: 1119-1132 Summary Full Text Full Text PDF PubMed Scopus (1156) Google Scholar Targeted agents and immune checkpoint inhibitors exist that are clinically beneficial for the treatment of metastatic disease and thus there is a motivation to ascertain whether these also provide a benefit in the adjuvant setting. 2 Lalani AA McGregor BA Albiges L et al. Systemic treatment of metastatic clear cell renal cell carcinoma in 2018: current paradigms, use of immunotherapy, and future directions. Eur Urol. 2019; 75: 100-110 Summary Full Text Full Text PDF PubMed Scopus (124) Google Scholar However, successful use of adjuvant therapy depends on several premises. The first is that the benefits of treating those who need therapy (ie, patients with micrometastatic disease) outweigh the risks of treating those whose disease was organ confined and in whom nephrectomy alone had already been successful. The second consideration is that a survival benefit with adjuvant therapy is only possible if early therapy results in improved survival compared with delayed treatment when the patient already manifests metastatic disease. Although these two steps are crucial for adjuvant therapies to be accepted, identification of patients who should have adjuvant therapy is also an important component to spare unnecessary toxicity in patients who are already likely to be cured by surgery alone. Predictive value of single-nucleotide polymorphism signature for recurrence in localised renal cell carcinoma: a retrospective analysis and multicentre validation studyOur six-SNP-based classifier could be a practical and reliable predictor that can complement the existing staging system for prediction of localised renal cell carcinoma recurrence after surgery, which might enable physicians to make more informed treatment decisions about adjuvant therapy. Intratumour heterogeneity does not seem to hamper the accuracy of the six-SNP-based classifier as a reliable predictor of recurrence. The classifier has the potential to guide treatment decisions for patients at differing risks of recurrence. Full-Text PDF