AUA and NCCN surveillance guidelines for RCC: Do they effectively capture recurrences following nephrectomy?

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 402-402
Author(s):  
Suzanne B. Stewart ◽  
Christine M. Lohse ◽  
Sarah P. Psutka ◽  
John C. Cheville ◽  
Stephen A. Boorjian ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Surgical Treatment ◽  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Clear Cell ◽  
Risk Groups ◽  
Site Specific ◽  
American Urological Association ◽  
Cancer Network

402 Background: The American Urological Association (AUA) and the National Comprehensive Cancer Network (NCCN) are highly utilized sources for surveillance strategies following surgical treatment for renal cell carcinoma (RCC). However, the duration of follow-up may be inadequate to capture the majority of recurrences. Herein, we assess the ability of these guidelines to effectively capture recurrences of RCC following primary surgical resection. Methods: We reviewed our institutional database of 3,725 patients treated with radical or partial nephrectomy for M0 sporadic RCC between 1970-2008. For comparison to the AUA guidelines, patients were stratified into low risk following partial nephrectomy (LRp) or radical nephrectomy (LRr) = pT1N0, and moderate/high risk (M/HR) = pT2-4 N0-1. Guideline effectiveness was assessed by calculating the percentage of recurrences detected within the prescribed follow-up periods given for site-specific recurrence: AUA—LRp: 3yrs for all sites; LRr: 1yr for abdominal and 3yrs for chest/bone/other sites; M/HR: 5yrs for all sites; NCCN—6 months for abdominal/chest sites and 5yrs for bone/other sites. Results: Of the 3,725 patients, 2721 (73.1%) underwent radical nephrectomy, 2,210 (59.3%) were classified as pT1 NX-0 and 2,910 (78.1%) as clear cell RCC. Median postoperative follow-up was 8.9yrs (IQR 5.5-14.2) during which 1,114 (29.9%) patients developed recurrence. Of these recurrences, 760 (68.2%) would have been detected using the AUA guidelines and 432 (38.8%) by NCCN recommendations. Within AUA risk groups, 37.2% recurrences were captured in LRp, 31.4% in LRr and 80.2% in M/HR. Capture of 90% of recurrences in the abdomen and chest would require surveillance for 9yrs and 8 yrs, respectively in LRp, 15yrs and 12yrs in LRr and 11yrs and 10yrs in M/HR. Conclusions: Duration of follow-up recommended by current surveillance algorithms by the AUA and NCCN do not adequately capture many recurrences in RCC following radical or partial nephrectomy. Guidelines using risk stratification and site-specific recurrence parameters to assign length of surveillance may allow providers to better individualize surveillance regimens.

scholarly journals Comparative effectiveness of adrenal sparing radical nephrectomy and non-adrenal sparing radical nephrectomy in clear cell renal cell carcinoma: Observational study of survival outcomes

2015 ◽  
Vol 9 (9-10) ◽  
pp. 583 ◽  
Author(s):  
Gregory J. Nason ◽  
Leon G. Walsh ◽  
Ciaran E. Redmond ◽  
Niall P. Kelly ◽  
Barry B. McGuire ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Observational Study ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Radical Nephrectomy ◽  
Clear Cell ◽  
Risk Groups ◽  
Survival Outcomes ◽  
Cell Renal Cell Carcinoma

Introduction: We compare the survival outcomes of patients with clear cell renal cell carcinoma (RCC) treated with adrenal sparing radical nephrectomy (ASRN) and non-adrenal sparing radical nephrectomy (NASRN).Methods: We conducted an observational study based on a composite patient population from two university teaching hospitals who underwent RN for RCC between January 2000 and December 2012. Only patients with pathologically confirmed RCC were included. We excluded patients undergoing cytoreductive nephrectomy, with loco-regional lymph node involvement. In total, 579 patients (ASRN = 380 and NASRN = 199) met our study criteria. Patients were categorized by risk groups (all stage, early stage and locally advanced RCC). Overall survival (OS) and cancer-specific survival (CSS) were analyzed for risk groups. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards regression.Results: The median follow-up was 41 months (range: 12–157). There were significant benefits in OS (ASRN 79.5% vs. NASRN 63.3%; p = 0.001) and CSS (84.3% vs.74.9%; p = 0.001), with any differences favouring ASRN in all stage. On multivariate analysis, there was a trend towards worse OS (hazard ratio [HR] 1.759, 95% confidence interval [CI] 0.943–2.309, p = 0.089) and CSS (HR 1.797, 95% CI 0.967–3.337, p = 0.064) in patients with NASRN (although not statistically significant). Of these patients, only 11 (1.9%) had adrenal involvement.Conclusions: The inherent limitations in our study include the impracticality of conducting a prospective randomized trial in this scenario. Our observational study with a 13-year follow-up suggests ASRN leads to better survival than NASRN. ASRN should be considered the gold standard in treating patients with RCC, unless it is contraindicated.

Pattern of recurrence after partial and total nephrectomy in non-metastatic renal cell carcinoma (RCC) of low, intermediate and high risk: Implications for follow-up.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 601-601
Author(s):  
Axel Bex ◽  
Yvette Kuijpers ◽  
Allard Noe ◽  
Ruud Bosch ◽  
Simon Horenblas ◽  
...  
Keyword(s):  
High Risk ◽  
Partial Nephrectomy ◽  
Clear Cell ◽  
Local Therapy ◽  
Risk Groups ◽  
Cross Sectional ◽  
Risk Patients ◽  
The Impact ◽  
Metastatic Rcc

601 Background: Guidelines recommend risk-adapted follow-up (FUP) after (partial) nephrectomy in non-metastatic RCC. VEGF-targeted therapy does not cure multiple metastatic RCC. FUP should therefore focus on local recurrences or single-/-oligometastases that may potentially be cured by local therapy. The rate of potentially curable recurrences per risk group is unknown and their pattern and management were analyzed in this study. Methods: From an IRB approved database non-metastatic RCC patients who underwent (partial) nephrectomy from 2004 to 2011 with a minimum FUP of ≥4 years and regular cross-sectional imaging were identified. Risk stratification was assigned to Leibovich- (clear-cell ) or UICC-stage- (non-clear cell) risk groups . Local recurrence, solitary and oligometastases defined as < 3 lesions at a single site were considered potentially curable by local therapy modalities. Recurrences were recorded as was the time to detection of recurrence (TDR) and their management. Results: From 230 patients identified, 191 (clear-cell) and 39 (non-clear cell) were assigned to the Leibovich- or UICC-risk groups respectively. Together, 69 developed recurrences (30 %), of whom 29 (42 %) were potentially curable. Of low-risk patients (32.6 %), only 9 (12 %) had recurrences of which 5 (55.6 %) were potentially curable. In high-risk (19.1 %), of 26 (59.1%) recurrences, the majority were multiple and rapid at a median TDR of 8.4 months (IQR 13.7) with only 6 (23.1 %) potentially curable at a median TDR of 17.6 (IQR 53.8) months. Of 24 recurrences (33.8 %) in intermediate risk, 12 (50 %) potentially curable lesions were detected after a median TDR of 26 (IQR 36.2) months. Together, of 29 potentially curable lesions 15 (51.7 %) were not treated because of comorbidity, poor performance or prognosis and irresectability. Conclusions: High-risk patients predominantly develop multiple metastases early during FUP. A benefit of FUP might derive from identifying potentially curable lesions which develop with latency especially in intermediate and high risk. With only 48 % of potentially curable lesions treated locally the impact of FUP on OS remains controversial.

scholarly journals Surgical treatment of renal cell carcinoma recurrence at the renal fossa following radical nephrectomy

2008 ◽  
Vol 126 (3) ◽  
pp. 194-196 ◽  
Author(s):  
Carlos Márcio Nóbrega de Jesus ◽  
Filemón Anastásio Silva Casafus ◽  
Aparecido Donizetti Agostinho
Keyword(s):  
Renal Cell Carcinoma ◽  
Surgical Treatment ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Radical Nephrectomy ◽  
Left Lung ◽  
Rare Event ◽  
Good Method ◽  
Rare Situation

CONTEXT: Isolated renal cell carcinoma recurrence at the renal fossa is a rare event. This condition occurs in 1 to 2% of radical nephrectomy cases. It is usually seen in postoperative follow-up imaging examinations such as abdominal computed tomography or abdominal ultrasound. There is controversy among urologists and oncologists regarding the best way to treat this rare situation, because of the few cases in the literature. CASE REPORT: We report on a case of isolated recurrence at the renal fossa due to renal cell carcinoma (RCC), four and a half years after radical nephrectomy, without evidence of metastases in other organs. The diagnosis was made from abdominal tomography performed during outpatient follow-up, in which a retroperitoneal mass was observed in the renal fossa. Excision was carried out by means of a subcostal transversal incision, without complications. One and a half years after the procedure, there was evidence of metastasis in the left lung and, six months later, another recurrence at the ninth anterior right rib, while the patient remained asymptomatic. Aggressive surgical treatment is a good method for controlling this rare situation of single retroperitoneal RCC recurrence. Abdominal tomography must continue to be performed over long periods of follow-up, to monitor for RCC following radical nephrectomy, in order to diagnose any late retroperitoneal recurrences. These must be treated as single RCC metastases.

scholarly journals OUTCOME OF STAGE T1 RENAL CELL CARCINOMA TREATED WITH PARTIAL NEPHRECTOMY: INITIAL EXPERIENCES FROM A TEACHING HOSPITAL IN BANGLADESH

2018 ◽  
Vol 4 (3) ◽  
pp. 91-99
Author(s):  
Md. Selim Morshed ◽  
Hafiz Al-Asad ◽  
Mohammad Saruar Alam ◽  
Abu Naser Md. Lutful Hasan ◽  
Md. Towhid Belal ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Clinical Outcome ◽  
Cell Carcinoma ◽  
Partial Nephrectomy ◽  
Renal Cell ◽  
Radical Nephrectomy ◽  
Tumour Size ◽  
Eligibility Criteria ◽  
College Hospital

Background: Renal cell carcinoma accounts for 85% of all solid tumors of the kidney. For many years, radical nephrectomy was the stan­dard treatment for RCC. Partial nephrectomy has gradual­ly replaced radical nephrectomy over the past decade, es­pecially for T1 stage renal cell carcinoma. However, the benefit of partial nephrectomy on oncolog­ic outcomes is not well known.Objective: to investigate the clinical outcome of partial nephrectomy on T1 renal cell carcinoma. Methods: This prospective observational study was conducted in a single unit of urology department of Dhaka Medical College Hospital, Bangladesh from the period September 2014 to September 2017. Fourteen patients underwent partial nephrectomy during this period with renal mass based on eligibility criteria. Two follow up was done at three months and six months. Result: Mean age of the patients undergoing surgery was 52.0± 3.8 (46.0 to 57.0 years) years. For the majority of the patients, tumour size was in a range of 3-7 cm. Average operative time was 90 minutes and mean ischaemic time was 16.5 ± 4.6 minutes (14.5 to 21.0 minutes). Histopathological reports correlated with clinical diagnosis and showed adequate surgical clear margin in every case.  There was no recurrence of tumour noticed during the two follow up periods. The different investigation did not reveal the impaired renal functional test during the follow-up period. Conclusion: The clinical outcome of partial nephrectomy was found better in this study. Partial nephrectomy has the potential to replace radical nephrectomy for managing T1 tumours. However, there are some controversies regarding the post-operative oncological outcome. More studies are recommended to investigate the effect of partial nephrectomy for T1 tumours.

scholarly journals Renal function after nephron-sparing surgery versus radical nephrectomy in localized renal cell carcinoma (T1)

10.52786/j.1 ◽  
2020 ◽  
Vol 41 (2) ◽  
pp. 1-8
Author(s):  
Siros Jitpraphai ◽  
Chaiyong Nualyong ◽  
Tawatchai Taweemonkongsap ◽  
Sittiporn Srinualnad ◽  
Teerapon Amornwesukit ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Function ◽  
Cell Carcinoma ◽  
Partial Nephrectomy ◽  
Recurrence Rate ◽  
Renal Cell ◽  
Radical Nephrectomy ◽  
Tumor Recurrence ◽  
Tumor Recurrence Rate

Objective: To evaluate renal function (GFR) after radical nephrectomy compared to partial nephrectomy in stage T1 renal cell carcinoma patients between 2005 and 2015. Material and Method: Retrospective chart review of 409 patients who were diagnosed with renal cell carcinoma (T1) and treated with radical nephrectomy (RN) or partial nephrectomy (PN) between 2005 and 2015 (RN=136, PN=92); 228 patients with pathologically confirmed pT1 remained for analysis and were then evaluated for their estimated glomerular filtration rate (eGFR) after the surgery. Results: There were a total of 228 (149 males and 79 females) T1 RCC patients; 136 patients were T1a with RN (57.8%) and 92 with PN (42.2%). Median follow-up was 58 months and 35 months for the RN and PN groups. From the analysis, post-operative eGFR of the RN group was decreased from 77.49 to 59.61 ml/min/1.73m2 and the PN group was decreased from 78.85 to 69.9 ml/min/1.73m2. The comparative eGFR between the 2 groups at 1 month had a significant difference (p-value<0.05). eGFR at 3 months (50.24 in RN vs 64.67 in PN), 6 months (47.98 vs 64.51), 3 years (48.79 vs 67.22) and 5 years (52.63 vs 73.59) were also significantly altered between the 2 groups. The tumor recurrence rate was not significantly different between RN and PN. Conclusion: We found that patients treated with PN had superior post-operative renal function compared with RN. However, there was no difference in the tumor recurrence rate between the 2 groups after a follow-up of 10 years.

scholarly journals Very late locally recurrent chromophobe renal cell carcinoma: 15 years following radical nephrectomy for low-stage disease

2019 ◽  
Vol 2019 (8) ◽  
Author(s):  
Asmaa Ismail ◽  
Hazem Elmansy ◽  
Walid Shahrour ◽  
Owen Prowse ◽  
Ahmed Kotb
Keyword(s):  
Renal Cell Carcinoma ◽  
Local Recurrence ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Radical Nephrectomy ◽  
Clear Cell ◽  
Stage Disease ◽  
Histological Variants ◽  
Locally Recurrent

Abstract The majority of patients with renal cell carcinoma develop recurrence within 5 years following radical nephrectomy. Very late sole local recurrence beyond 10 years is rare, and all reported cases had clear cell histology. Surgical resection of local recurrence remains the best option for disease management. This case opens the way for further studying the rare histological variants of renal cancer and to encourage prolonged follow-up and offering surgery as the best option for managing these cases.

scholarly journals Solitary Metastasis in the Mediastinal Lymph Node After Radical Nephrectomy for Clear Cell Renal Cell Carcinoma: A Case Report and Literature Review

2020 ◽  
Vol 10 ◽  
Author(s):  
Hang Lin ◽  
Heng Zhang ◽  
Yuanda Cheng ◽  
Chunfang Zhang
Keyword(s):  
Renal Cell Carcinoma ◽  
Lymph Node ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Radical Nephrectomy ◽  
Clear Cell ◽  
Mediastinal Lymph Node ◽  
Cell Renal Cell Carcinoma ◽  
Posterior Mediastinal

BackgroundRenal cell carcinoma can metastasize to virtually any anatomical site throughout the body, especially the lung, bone, lymph nodes, liver, and brain. However, it is extremely rare for renal cell carcinoma to metastasize solely to the mediastinal lymph node more than 15 years after radical nephrectomy.Case PresentationThe case we present here is that of a 50-year-old Chinese male with an isolated posterior mediastinal lymph node metastasis of clear cell renal cell carcinoma 16 years after radical nephrectomy. However, based on imaging examination, the mass was clinically misdiagnosed as Castleman’s disease before operation. Following surgical excision of the mass, it was finally judged to be a metastasis from clear cell renal cell carcinoma according to the patient’s medical history and immunohistochemical findings. Currently, there is no clinical or radiological finding the recurrence of metastasis after 10 months of follow-up.ConclusionWe report a case of solitary metastasis in the posterior mediastinal lymph node 16 years after radical nephrectomy for clear cell renal cell carcinoma. Given the long disease-free interval between primary renal cell carcinoma to isolated mediastinal lymph node metastasis, it is important to conduct a lifelong regular follow-up, including thoracic computed tomography. In addition, surgical resection remains the best method of treatment for mediastinal lymph node metastases from clear cell renal cell carcinoma if the metastatic lesion is limited.

scholarly journals Evaluation of the National Comprehensive Cancer Network and American Urological Association Renal Cell Carcinoma Surveillance Guidelines

2014 ◽  
Vol 32 (36) ◽  
pp. 4059-4065 ◽  
Author(s):  
Suzanne B. Stewart ◽  
R. Houston Thompson ◽  
Sarah P. Psutka ◽  
John C. Cheville ◽  
Christine M. Lohse ◽  
...  
Keyword(s):  
Health Care ◽  
Renal Cell Carcinoma ◽  
National Comprehensive Cancer Network ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
American Urological Association ◽  
Cancer Network ◽  
Medicare Costs ◽  
Care Costs

Purpose The National Comprehensive Cancer Network (NCCN) and American Urological Association (AUA) provide guidelines for surveillance after surgery for renal cell carcinoma (RCC). Herein, we assess the ability of the guidelines to capture RCC recurrences and determine the duration of surveillance required to capture 90%, 95%, and 100% of recurrences. Patients and Methods We evaluated 3,651 patients who underwent surgery for M0 RCC between 1970 and 2008. Patients were stratified as AUA low risk (pT1Nx-0) after partial (LR-partial) or radical nephrectomy (LR-radical) or as moderate/high risk (M/HR; pT2-4Nx-0/pTanyN1). Guidelines were assessed by calculating the percentage of recurrences detected when following the 2013 and 2014 NCCN and AUA recommendations, and associated Medicare costs were compared. Results At a median follow-up of 9.0 years (interquartile range, 5.7 to 14.4 years), a total of 1,088 patients (29.8%) experienced a recurrence. Of these, 390 recurrences (35.9%) were detected using 2013 NCCN recommendations, 742 recurrences (68.2%) were detected using 2014 NCCN recommendations, and 728 recurrences (66.9%) were detected using AUA recommendations. All protocols missed the greatest amount of recurrences in the abdomen and among pT1Nx-0 patients. To capture 95% of recurrences, surveillance was required for 15 years for LR-partial, 21 years for LR-radical, and 14 years for M/HR patients. Medicare surveillance costs for one LR-partial patient were $1,228.79 using 2013 NCCN, $2,131.52 using 2014 NCCN, and $1,738.31 using AUA guidelines. However, if 95% of LR-partial recurrences were captured, costs would total $9,856.82. Conclusion If strictly followed, the 2014 NCCN and AUA guidelines will miss approximately one third of RCC recurrences. Improved surveillance algorithms, which balance patient benefits and health care costs, are needed.

Delayed Pancreatic Metastasis of Renal Clear Cell Carcinoma

2013 ◽  
Vol 13 (2) ◽  
pp. 79-80
Author(s):  
Zane Simtniece ◽  
Gatis Kirsakmens ◽  
Ilze Strumfa ◽  
Andrejs Vanags ◽  
Maris Pavars ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Surgical Treatment ◽  
Cell Carcinoma ◽  
Clear Cell ◽  
Clear Cell Carcinoma ◽  
Primary Tumour ◽  
Renal Clear Cell Carcinoma ◽  
Pancreatic Metastasis ◽  
Distal Pancreatic Resection

Abstract Here, we report surgical treatment of a patient presenting with pancreatic metastasis (MTS) of renal clear cell carcinoma (RCC) 11 years after nephrectomy. RCC is one of few cancers that metastasise in pancreas. Jaundice, abdominal pain or gastrointestinal bleeding can develop; however, asymptomatic MTS can be discovered by follow-up after removal of the primary tumour. The patient, 67-year-old female was radiologically diagnosed with a clinically silent mass in the pancreatic body and underwent distal pancreatic resection. The postoperative period was smooth. Four months after the surgery, there were no signs of disease progression.

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