Optimal Surveillance Strategies After Surgery for Renal Cell Carcinoma

Restricted access

One in 5 patients who undergo surgical resection for clinically localized renal cell carcinoma (RCC) develop local and/or distant recurrences which, when detected early, may be amenable to salvage local and systemic therapies. When considering that approximately half of these recurrences will occur during the first 2 years, a clear rationale exists for optimizing surveillance strategies after surgery. Although there is a notable dearth of high-quality data on this subject, clinical principles can guide clinicians as they attempt to balance the burden of surveillance strategies with potential clinical benefit. The objective of this review is to summarize the evidence regarding optimal surveillance protocols after surgery for RCC. We provide an overview of the rationale supporting surveillance after surgery, a summary of the American Urological Association and NCCN guidelines, reasons against routine long-term surveillance, surveillance costs, and ancillary issues, such as the utility of bone scan, PET/CT scan, and surveillance after thermoablation.

Correspondence: Mark D. Tyson, MD, Vanderbilt University Medical Center, Department of Urologic Surgery, A1302 Medical Center North, Nashville, TN 37232-2765. E-mail: mark.tyson@vanderbilt.edu
  • 1.

    TysonMDHumphreysMRParkerAS. Age-period-cohort analysis of renal cell carcinoma in United States adults. Urology2013;82:4347.

  • 2.

    MotzerRJJonaschEAgarwalN. NCCN Clinical Practice Guidelines in Oncology: Kidney Cancer. Version 2.2017. Accessed April 17 2017. To view the most recent version of these guidelines visitNCCN.org.

    • Search Google Scholar
    • Export Citation
  • 3.

    LeibovichBCBluteMLChevilleJC. Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer2003;97:16631671.

    • Search Google Scholar
    • Export Citation
  • 4.

    CindoloLPatardJJChiodiniP. Comparison of predictive accuracy of four prognostic models for nonmetastatic renal cell carcinoma after nephrectomy: a multicenter European study. Cancer2005;104:13621371.

    • Search Google Scholar
    • Export Citation
  • 5.

    EggenerSEYossepowitchOPettusJA. Renal cell carcinoma recurrence after nephrectomy for localized disease: predicting survival from time of recurrence. J Clin Oncol2006;24:31013106.

    • Search Google Scholar
    • Export Citation
  • 6.

    SohnWGravesAJTysonMD. An empiric evaluation of the effect of variation in intensity of followup for surgically treated renal neoplasms on cancer specific survival. J Urol2017;197:3743.

    • Search Google Scholar
    • Export Citation
  • 7.

    BrennanMF. Follow-up is valuable and effective: true, true and unrelated?Ann Surg Oncol2000;7:23.

  • 8.

    LevyDASlatonJWSwansonDADinneyCP. Stage specific guidelines for surveillance after radical nephrectomy for local renal cell carcinoma. J Urol1998;159:11631167.

    • Search Google Scholar
    • Export Citation
  • 9.

    HafezKSNovickACCampbellSC. Patterns of tumor recurrence and guidelines for followup after nephron sparing surgery for sporadic renal cell carcinoma. J Urol1997;157:20672070.

    • Search Google Scholar
    • Export Citation
  • 10.

    LjungbergBAlamdariFIRasmusonTRoosG. Follow-up guidelines for nonmetastatic renal cell carcinoma based on the occurrence of metastases after radical nephrectomy. BJU Int1999;84:405411.

    • Search Google Scholar
    • Export Citation
  • 11.

    AdamyAChongKTChadeD. Clinical characteristics and outcomes of patients with recurrence 5 years after nephrectomy for localized renal cell carcinoma. J Urol2011;185:433438.

    • Search Google Scholar
    • Export Citation
  • 12.

    MiyaoNNaitoSOzonoS. Late recurrence of renal cell carcinoma: retrospective and collaborative study of the Japanese Society of Renal Cancer. Urology2011;77:379384.

    • Search Google Scholar
    • Export Citation
  • 13.

    StewartSBThompsonRHPsutkaSP. Evaluation of the National Comprehensive Cancer Network and American Urological Association renal cell carcinoma surveillance guidelines. J Clin Oncol2014;32:40594065.

    • Search Google Scholar
    • Export Citation
  • 14.

    RichstoneLScherrDSReuterVR. Multifocal renal cortical tumors: frequency, associated clinicopathological features and impact on survival. J Urol2004;171:615620.

    • Search Google Scholar
    • Export Citation
  • 15.

    HerrHW. Partial nephrectomy for incidental renal cell carcinoma. Br J Urol1994;74:431433.

  • 16.

    GillISKavoussiLRLaneBR. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol2007;178:4146.

    • Search Google Scholar
    • Export Citation
  • 17.

    DonatSMDiazMBishoffJT. Follow-up for clinically localized renal neoplasms: AUA guideline. J Urol2013;190:407416.

  • 18.

    AntonelliACozzoliAZaniD. The follow-up management of non-metastatic renal cell carcinoma: definition of a surveillance protocol. BJU Int2007;99:296300.

    • Search Google Scholar
    • Export Citation
  • 19.

    BeckerFSiemerSTzavarasA. Long-term survival in bilateral renal cell carcinoma: a retrospective single-institutional analysis of 101 patients after surgical treatment. Urology2008;72:349353.

    • Search Google Scholar
    • Export Citation
  • 20.

    WiklundFTretliSChoueiriTK. Risk of bilateral renal cell cancer. J Clin Oncol2009;27:37373741.

  • 21.

    SternJMSvatekRParkS. Intermediate comparison of partial nephrectomy and radiofrequency ablation for clinical T1a renal tumours. BJU Int2007;100:287290.

    • Search Google Scholar
    • Export Citation
  • 22.

    KlatteTPatardJJWunderlichH. Metachronous bilateral renal cell carcinoma: risk assessment, prognosis and relevance of the primary-free interval. J Urol2007;177:20812086; discussion 2086–2087.

    • Search Google Scholar
    • Export Citation
  • 23.

    FeatherstoneJMBassPCummingJSmartCJ. Solitary, late metastatic recurrence of renal cell carcinoma: two extraordinary cases. Int J Urol2006;13:15251527.

    • Search Google Scholar
    • Export Citation
  • 24.

    TapperHKleinHRubensteinW. Recurrent renal cell carcinoma after 45 years. Clin Imaging1997;21:273275.

  • 25.

    FryRJGrosovskyAHanawaltPC. The impact of biology on risk assessment--workshop of the National Research Council's Board on Radiation Effects Research. July 21-22, 1997, National Academy of Sciences, Washington, DC. Radiat Res1998;150:695705.

    • Search Google Scholar
    • Export Citation
  • 26.

    HengDYXieWReganMM. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol2009;27:57945799.

    • Search Google Scholar
    • Export Citation
  • 27.

    MotzerRJBacikJMarianiT. Treatment outcome and survival associated with metastatic renal cell carcinoma of non-clear-cell histology. J Clin Oncol2002;20:23762381.

    • Search Google Scholar
    • Export Citation
  • 28.

    LeeSEByunSSHanJH. Prognostic significance of common preoperative laboratory variables in clear cell renal cell carcinoma. BJU Int2006;98:12281232.

    • Search Google Scholar
    • Export Citation
  • 29.

    BosSDPiersDAMensinkHJ. Routine bone scan and serum alkaline phosphatase for staging in patients with renal cell carcinoma is not cost-effective. Eur J Cancer1995;31A:24222423.

    • Search Google Scholar
    • Export Citation
  • 30.

    KritemanLSandersWH. Normal alkaline phosphatase levels in patients with bone metastases due to renal cell carcinoma. Urology1998;51:397399.

    • Search Google Scholar
    • Export Citation
  • 31.

    BlacherEJohnsonDEHaynieTP. Value of routine radionuclide bone scans in renal cell carcinoma. Urology1985;26:432434.

  • 32.

    LindnerAGoldmanDGdeKernionJB. Cost effective analysis of prenephrectomy radioisotope scans in renal cell carcinoma. Urology1983;22:127129.

    • Search Google Scholar
    • Export Citation
  • 33.

    KogaSTsudaSNishikidoM. The diagnostic value of bone scan in patients with renal cell carcinoma. J Urol2001;166:21262128.

  • 34.

    YoungRJSillsAKBremSKnoppEA. Neuroimaging of metastatic brain disease. Neurosurgery2005;57:S1023; discussion S1–4.

  • 35.

    KunkleDAEglestonBLUzzoRG. Excise, ablate or observe: the small renal mass dilemma—a meta-analysis and review. J Urol2008;179:12271233; discussion 1233–1234.

    • Search Google Scholar
    • Export Citation
  • 36.

    KlatteTGrubmüllerBWaldertM. Laparoscopic cryoablation versus partial nephrectomy for the treatment of small renal masses: systematic review and cumulative analysis of observational studies. Eur Urol2011;60:435443.

    • Search Google Scholar
    • Export Citation
  • 37.

    WeightCJKaoukJHHegartyNJ. Correlation of radiographic imaging and histopathology following cryoablation and radio frequency ablation for renal tumors. J Urol2008;179:12771281; discussion 1281–1283.

    • Search Google Scholar
    • Export Citation
  • 38.

    LoboJMNelsonMNandananNKrupskiTL. Comparison of renal cell carcinoma surveillance guidelines: competing trade-offs. J Urol2016;195:16641670.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 187 187 27
PDF Downloads 53 53 1
EPUB Downloads 0 0 0