A Review on Follow-Up Strategies for Renal Cell Carcinoma after Nephrectomy (original) (raw)
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Guideline of Guidelines: follow-up after nephrectomy for renal cell carcinoma
BJU international, 2015
AIM; To review and compare the international guidelines and surveillance protocols for post-nephrectomy renal cell carcinoma (RCC) METHOD; PubMed database searches were conducted according to the PRISMA statement in order to identify current international surveillance guidelines and surveillance protocols for surgically treated and clinically localized RCC. RESULTS; 17 articles were reviewed with 3 urological endorsed guidelines, 3 oncological and 11 proposed strategies. Guidelines and strategies varied significantly in relation to follow-up, specifically the frequency and timing of radiological imaging. CONCLUSION; Although there is currently no consensus within the literature regarding surveillance protocols, various guidelines and strategies have been developed using both patient and tumour characteristics. KEY WORDS; Kidney Neoplasms, Nephrectomy, Guideline, Recurrence, Outcomes This article is protected by copyright. All rights reserved.
Changing prognosis of renal cell carcinoma: a single-centre experience over 25 years
Journal of Clinical Urology, 2013
The objective of this research is to examine renal cancer nephrectomies over 25 years in our centre and the factors underlying changes in disease-specific survival. Patients and methods: Retrospective data analysis was performed on all patients undergoing nephrectomies at our institution for renal cell carcinoma (RCC) from 1983 to 2007. Data extracted from the Cancer Research Uro-Oncology Database (CRUD©) provided survival, clinical and prognostic information including tumour diameter, Fuhrman grade, WHO staging and age. Results: Analysis of 664 RCCs demonstrated a clear change in kidney cancer-specific survival over the past 25 years, with five-year survival improving from 42% (1983-1986) to 73% (1999-2002). The number of RCC nephrectomies has increased 10 fold. There was no significant change in operative mortality, age, grade, stage or mean tumour size. However, there was a five-fold increase in tumours <6 cm, corresponding to an equal-fold decrease in tumours 6-8 cm, but no change in tumours >8 cm. Tumour size >8 cm was a significant adverse prognostic marker. Conclusions: A 30% improvement in RCC cancer-specific survival has been seen in our centre over the last 25 years. This change relates to a shift to smaller tumours, lower histological grades and a higher volume of cases.
Recurrent renal cell cancer: 10 years or more after nephrectomy
2010
Localized renal cell carcinoma (RCC) responds well to surgery. Patients often question how long they have to be on surveillance after their surgery. Several follow-up patterns have been described in the literature. Until 2009, no published established Canadian guidelines existed to assist Canadian health-care practitioners in the surveillance of these patients. We present 3 cases of RCC that recurred 10
Recurrence of renal cell carcinoma more than 5 years after nephrectomy
International Journal of Urology, 2002
Objectives: We evaluated clinical features and predictive factors for the recurrence of renal cell carcinoma (RCC) developing more than 5 years after nephrectomy. Methods: We retrospectively reviewed 239 patients with RCC who underwent surgery for the primary lesion. To identify factors that affected recurrence more than 5 years after nephrectomy (delayed recurrence) and its clinical outcomes, we performed a multivariate analysis using Cox's proportional hazards model and a survival study. Results: Recurrence developing within 5 years after nephrectomy (early recurrence) was found in 57 patients and delayed recurrence in 11 patients. The multivariate analysis revealed no clinical and pathologic features influencing delayed recurrence in 114 patients who survived more than 5 years after nephrectomy without having early recurrence. The patients with delayed recurrence showed better clinical outcomes than those with early recurrence when the rate was determined from the time of recurrence. Conclusions: Although delayed recurrence is not a rare event for patients with RCC, no clinical and pathologic factors at the time of the initial treatment can predict the recurrence. Patients who are free of recurrence for more than 5 years after surgery for a primary lesion should be carefully followed up for delayed recurrence.
Clinical Radiology, 2006
To determine the follow-up protocol for interval assessment of patients following radical nephrectomy for renal cell cancer and to compare them with the recommendations proposed in the literature. METHODS: Consultant urologists across Britain and Ireland completed a postal questionnaire. One follow-up mailing was used to encourage non-responders. The responses were analysed in the light of the recommendations from European Association of Urology and American guidelines. Also information was collected from the respondents on the choice of follow-up investigations for renal cell cancer and the total duration of follow-up. RESULTS: Of the 480 urologists surveyed 292 (60.8%) responded. Most respondents recommended regular follow-up with chest radiography (CR), ultrasound and computed tomography (CT). For T1 disease CR was requested by 28, 62 and 55%; for T2 disease by 30, 66 and 51%; for T3 disease by 39, 63, and 48% at 3, 6 and 12 months, respectively. For T1 disease US was requested by 5, 23 and 30%; for T2 disease 6, 27 and 30%; for T3 disease 8, 25, and 26% at 3, 6 and 12 months, respectively. For T1 disease an abdominal CT was requested by 2, 17 and 21%; for T2 disease 3.7, 19.5 and 26%; for T3 disease 10, 31, and 33% at 3, 6 and 12 months, respectively. Only one respondent followed the guidelines suggested in the literature. Further follow-up after 12 months for 5 and 10 years was suggested by 58.2 and 21.3% for T1, 53 and 24.73% for T2, and 45.5 and 25.5% for T3, respectively. There is appreciable variation in the frequency of use and timing of imaging. CONCLUSIONS: Most respondents perform follow-up after radical nephrectomy in patients with renal cancer, with considerable variability in their practices. In the current increasingly cost-conscious healthcare industry a scientifically justified follow-up should be considered.
Guidelines on renal cell cancer
European urology, 2001
On behalf of the European Association of Urology (EAU), Guidelines for Diagnosis, Therapy and Follow-Up of Renal Cell Carcinoma Patients were established. Criteria for recommendations were evidence based and included aspects of cost-effectiveness and clinical feasibility. A systematic literature research using Medline Services was conducted. References were weighted by a panel of experts on renal cell carcinoma (RCC). RCC is characterised by a constant rise in incidence over the last 50 years, with a predominance of men over women and an incidence peak in the 6th and 7th decade. There is no risk factor established and the current TNM system (UICC, 1997) is endorsed for staging purposes. Clinical signs and symptoms of RCC are becoming less frequent, incidental discovery constitutes already a majority of cases. Diagnosis is established by ultrasound and abdominal CT, extension assessment in routine cases is done by chest X-ray. Additional examinations may be required in select cases. ...
Renal Cell Carcinoma: Prognostic Significance of Incidentally Detected Tumors
The Journal of Urology, 2000
Purpose: We determined the prognostic significance of incidentally discovered renal cell carcinoma in the era of increased incidental detection. Materials and Methods: We reviewed the records of 633 consecutive patients who underwent radical or partial nephrectomy for renal cell carcinoma at our institution between 1987 and 1998. Patients were divided into those who were asymptomatic and tumor was diagnosed incidentally and those diagnosed after presenting with any of the classic symptoms of renal cell carcinoma or subsequent metastasis. All renal cell carcinoma lesions were assigned a stage and grade according to 1997 TNM criteria. All patients were followed postoperatively to assess survival rates, and monitor recurrence and metastasis. Results: Of the 633 patients 95 (15%) were treated for incidentally discovered renal cell carcinoma and 538 (85%) presented with symptoms secondary to renal cell carcinoma at diagnosis. Patient age and sex distribution were similar in the 2 groups. Stage I lesions were observed in 62.1% of patients with incidental renal cell carcinoma and in 23% with symptomatic renal cell carcinoma. In contrast, stage IV lesions were present in 27.4% of patients with incidental versus 54% with symptomatic renal cell carcinoma. Thus, incidental lesions were of significantly lower stage than those causing symptoms (p Ͻ0.001). Similarly 15.8% of incidental but 42.4% of symptomatic lesions were grade 3 or 4 (p ϭ 0.006). Patients were followed postoperatively for a mean of 47 months plus or minus 40 months. The 5-year cancer specific survival rate was significantly higher for incidental than for symptomatic tumors (85.3% versus 62.5%). Likewise, the local and distal recurrence rates were higher for symptomatic lesions. When adjusted for stage, no difference in survival was noted in the 2 groups for stages I to III disease and a minimally significant difference was noted for stage IV cancer. Multivariate analysis of stage and grade attributed the survival difference in stage IV disease to the significantly higher grade of symptomatic lesions. Conclusions: At presentation incidental tumors are of significantly lower stage and grade than tumors producing symptoms. Subsequently these clinically and histologically less aggressive lesions lead to better patient survival and decreased recurrence. Thus, the detection of renal cell carcinoma before symptom onset enables treatment of less aggressive tumors and provides a better prognosis for patients. Given these data efforts should be directed toward the development of a screening protocol to detect these lesions early, so that they may be prevented from progressing to the point when symptoms are apparent and prognosis becomes worse. In addition, the significant correlation of tumor grade with survival in our study further demonstrates the prognostic value of tumor grade and molecular markers for the future evaluation and treatment of renal cell carcinoma.