1316 DOES INTENSITY OF FOLLOW-UP IMAGING AFTER PARTIAL OR RADICAL NEPHRECTOMY IMPACT SURVIVAL

Abstract

You have accessJournal of UrologyKidney Cancer: Localized (II)1 Apr 20131316 DOES INTENSITY OF FOLLOW-UP IMAGING AFTER PARTIAL OR RADICAL NEPHRECTOMY IMPACT SURVIVAL Goutham Vemana, Gurdarshan Sandhu, Yu Tao, Jack Baty, and Seth Strope Goutham VemanaGoutham Vemana St. Louis, MO More articles by this author , Gurdarshan SandhuGurdarshan Sandhu St. Louis, MO More articles by this author , Yu TaoYu Tao St. Louis, MO More articles by this author , Jack BatyJack Baty St. Louis, MO More articles by this author , and Seth StropeSeth Strope St. Louis, MO More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2670AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES After partial or radical nephrectomy (P/RNx) for renal cell carcinoma (RCC), patients enter a period of survivorship care characterized by monitoring for disease recurrence. Central to this monitoring is use of imaging studies. However, the survival benefit of the follow-up imaging remains unexplored. We evaluated the survival benefit of follow-up chest and abdominal imaging after P/RNx in nationally representative data. METHODS Using Surveillance, Epidemiology, End Results - Medicare data, we identified patients with RCC treated with P/RNx who were diagnosed from 1997-2007 with follow up through 2009 (N=5905). Patients were assessed for overall and recurrence-free survival ≥ 3 years. Postoperative chest (chest roentgenogram or computed tomography [CT]) or abdominal imaging (ultrasound or CT) for 3 years following P/RNx was identified for all patients. Imaging was ascertained through the year of cancer recurrence (algorithm based on receipt of secondary therapy for RCC or visits to medical or radiation oncology providers). Multivariable Cox proportional hazard regression models, stratified by chest and abdominal imaging, adjusting for demographic, comorbidity, and pathologic factors were used to estimate the hazard ratio for overall mortality (OM) by postoperative imaging utilization. RESULTS OM hazard ratios stratified by chest and abdominal imaging are shown in the table. No benefit was seen with yearly use of chest imaging compared to no use (HR 1.20 CI 0.9-1.54). Yearly use of abdominal imaging was associated with lower overall mortality compared to no use of imaging (HR 0.73 CI 0.62-0.85). CONCLUSIONS Surveillance after P/RNx that includes first-year abdominal imaging with subsequent abdominal imaging at two or three years post operatively appears to be associated with improved survival. Performance of such imaging reflects known patterns of tumor recurrence. Our results support established recommendations such as that of the National Comprehensive Cancer Network calling for abdominal imaging at least in the first year of follow up. Effect of Postoperative Chest and Abdominal Imaging on Overall and Recurrence Free Survival ≥ 3 years Following Partial or Radical Nephrectomy (Multivariable Cox Model) Imaging Modality Type and Pattern Hazard Ratio 95% Hazard Ratio Confidence Interval - Lower Limit 95% Hazard Ratio Confidence Interval - Upper Limit No chest imaging in 3 years Referent – – Chest imaging only in year 1 1.01 0.75 1.37 Chest imaging only in year 2 0.92 0.61 1.38 Chest imaging only in year 3 1.22 0.87 1.71 Chest imaging only in year 1 and 2 1.08 0.80 1.46 Chest imaging only in year 1 and 3 1.37 1.03 1.83 Chest imaging only in year 2 and 3 1.34 1.00 1.79 Chest imaging only in all 3 years 1.20 0.93 1.54 No abdominal imaging in 3 years Referent – – Abdominal imaging only in year 1 0.89 0.73 1.07 Abdominal imaging only in year 2 1.00 0.79 1.25 Abdominal imaging only in year 3 1.21 0.96 1.52 Abdominal imaging only in year 1 and 2 0.69 0.57 0.85 Abdominal imaging only in year 1 and 3 0.83 0.67 1.03 Abdominal imaging only in year 2 and 3 0.96 0.78 1.19 Abdominal imaging only in all 3 years 0.73 0.62 0.85 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e537-e538 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Goutham Vemana St. Louis, MO More articles by this author Gurdarshan Sandhu St. Louis, MO More articles by this author Yu Tao St. Louis, MO More articles by this author Jack Baty St. Louis, MO More articles by this author Seth Strope St. Louis, MO More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...