In patients with paraneoplastic syndrome (PNS) and non-metastatic renal cell carcinoma, complete tumor resection/non-recurrence should theoretically result in PNS resolution. This study aims to evaluate whether postoperative PNS resolution/non-resolution is associated with recurrence and/or survival in non-metastatic renal cell carcinoma (RCC).
Following institutional review board approval, the nephrectomy database at our institution was reviewed for patients with non-metastatic RCC and at least 1 documented laboratory-based PNS undergoing nephrectomy between 2000 and 2022. PNS resolution was defined as the normalization of ≥1 PNS-related laboratory abnormality within 30 days to 1-year post-nephrectomy. Primary endpoints were 5-year and all-time disease-free survival (DFS) and overall survival (OS). Kaplan-Meier curves were illustrated and multivariable Cox proportional hazards models adjusted for relevant confounders.
A total of 473 patients met inclusion criteria, 303 (64.1%) of which demonstrated postoperative PNS resolution. PNS non-resolution was associated with a 1.60-fold (HR 1.60, 95%CI 1.01-2.55, P = 0.046) increased in 5-year recurrence and a 2.64-fold (HR 2.64, 95%CI 1.47-4.75, P = 0.001) increase in 5-year all-cause mortality. PNS non-resolution was associated with a 1.40-fold (HR 1.40, 95%CI 1.01-1.93, P = 0.041) increase in study period recurrence and a 1.63-fold (HR 1.63, 95%CI 1.14-2.32, P = 0.008) increase in study period all-cause mortality.
In this analysis of patients with paraneoplastic syndrome and non-metastatic RCC, paraneoplastic syndrome non-resolution was independently associated with poor 5-year/all-time DFS and OS. This association maintained significance despite patients with PNS resolution demonstrating higher grade/stage tumors. Validation of our findings and further research into these associations is encouraged.
Urologic oncology. 2026 Apr 04 [Epub ahead of print]
Reza Lahiji, Luke L Son, Susan Mumford, Ethan J Kearns, Dattatraya Patil, Sriram Ambadi, Jocelyn T Nguyen, Baris Esen, William Luke, Lorenzo Storino Ramacciotti, Taylor Goodstein, Ernest A Morton, Adam Braunschweig, Reza Nabavizadeh, Vikram N Narayan, Valentina Grajales, Shreyas S Joshi, Mohammad Hajiha, Kenneth Ogan, Viraj A Master
Department of Urology, Emory University School of Medicine, Atlanta, GA., Department of Urology, Medical College of Georgia, Augusta, GA., Department of Urology, University of California San Diego, San Diego, CA., Department of Urology, Emory University School of Medicine, Atlanta, GA; Department of Urology, Koc University School of Medicine, Istanbul, Turkey., Department of Urology, Duke Cancer Center, Durham, NC., Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA. Electronic address: .