Abstract
BACKGROUND AND OBJECTIVE: Chromophobe renal cell carcinoma (chRCC) is a rare renal malignancy with a generally favourable prognosis. However, a subset of patients experiences recurrence, which remains poorly characterised. This study aims to identify the clinicopathological factors associated with recurrence in chRCC, describe the timing and anatomical patterns of recurrence, and develop a predictive model to guide surveillance strategies. METHODS: We conducted a multicentre retrospective cohort study using data from the French UroCCR database, including patients treated surgically for nonmetastatic chRCC between 2010 and 2024. Clinicopathological features, recurrence-free survival (RFS), cancer-specific survival, and overall survival were analysed. Kaplan-Meier survival curves and multivariable Cox proportional-hazard models were used to assess prognostic factors. KEY FINDINGS AND LIMITATIONS: Among the included 683 patients, 43 (6.3%) developed recurrence, with median RFS of 142 mo (95% confidence interval [CI] 121-not reached). Local recurrence was observed in 30 patients, while 18 developed distant metastases, predominantly in the retroperitoneal lymph nodes and lungs. Male sex (hazard ratio [HR] 3.1, 95% CI 1.27-7.54, p = 0.01), locally advanced disease (HR 1.94, 95% CI 1.02-3.84, p = 0.05), positive surgical margins (HR 3.03, 95% CI 1.4-6.56, p = 0.005), and lymphovascular invasion (HR 2.08, 95% CI 1.01-4.38, p = 0.05) were independently associated with recurrence. Limitations include the absence of a central pathological review and of standardised recurrence management strategies across centres. CONCLUSIONS AND CLINICAL IMPLICATIONS: This study provides novel insights into the recurrence patterns of chRCC, highlighting the key prognostic factors. The proposed predictive model was designed to aid clinicians in identifying high-risk patients, optimising follow-up intensity, and guiding therapeutic decisions. PATIENT SUMMARY: We studied a rare kidney cancer type, called chromophobe renal cell carcinoma (chRCC), to understand why some patients experience recurrence. We found that being male, having advanced disease, or some aggressive pathological characteristics increased the risk of cancer coming back. Our results suggest that doctors should monitor certain patients more closely after surgery. This research may help improve long-term follow-up and treatment plans for patients with chRCC. While certain factors are associated with a higher risk of recurrence, it is important to note that chromophobe renal cell carcinoma generally has a favourable prognosis, and the absolute risk of recurrence remains low for most patients.