Multi-institutional analysis of clinical risk factors for disease recurrence in locally advanced renal cell carcinoma

Abstract Introduction:This study aimed to identify clinical risk factors associated with disease recurrence in patients with locally advanced renal cell carcinoma (RCC). Materials and Methods: Patients diagnosed with locally advanced RCC (T3–T4N0M0 or TxN1M0) from the Turkish Urooncology Association Kidney Cancer Database were included. Demographic and clinical variables (age, sex, body mass index [BMI], performance status, Charlson Comorbidity Index [CCI], symptomatic status, hematologic parameters) and tumor-related characteristics (stage, grade, size, vascular invasion, necrosis, surgical margin status, and lymph node involvement) were analyzed. Results: A total of 749 patients were evaluated, including 216 women and 533 men. The mean age was 59.9 ± 11.6 years (range: 18–86), and the median follow-up was 25.9 ± 31 months (range: 1–180). Disease recurrence occurred in 192 patients (25.6%), with a mean time to recurrence of 9.4 ± 17.8 months (range: 1–84). On univariate and multivariate analyses, Fuhrman grade 3–4 (OR = 0.169, 95% CI: 0.032–0.899, p = 0.037) and platelet count (OR = 1.012, 95% CI: 1.005–1.020, p = 0.001) emerged as independent predictors of recurrence. ROC curve analysis identified a platelet count cut-off of 363,000/µL (AUC = 0.642, 95% CI: 0.600–0.683, p < 0.001; sensitivity: 38.8%, specificity: 86.2%). Conclusions: High Fuhrman grade (3–4) and elevated platelet count were identified as independent risk factors for disease recurrence in patients with locally advanced RCC. These findings may contribute to risk stratification and help guide follow-up strategies and adjuvant treatment considerations in both clinical practice and clinical trial design.