145 LIMITED USE OF FOLLOW-UP IMAGING AMONG PATIENTS AFTER PARTIAL OR RADICAL NEPHRECTOMY FOR RENAL CELL CARCINOMA

Abstract

INTRODUCTION AND OBJECTIVES: While many recommended stage-specific and risk-adapted algorithms for postoperative surveillance in renal cell carcinoma (RCC) are available, utilization of these recommendations remains unexplored. We evaluated use of follow-up imaging after partial or radical nephrectomy (P/RNx) in nationally representative data. METHODS: Using Surveillance, Epidemiology, End Results data linked to Medicare records, we identified patients with RCC treated with P/RNx who were diagnosed from 1997-2007 with follow up through 2009 (N 5905). Patients were stratified by pathologic tumor stage (T1a n 1917, T1b n 1588, T2 n 1006, T3/4 n 1394) and overall survival ( 2 years, 2 to 3 years and 3 years). Postoperative abdominal (ultrasound or computed tomography [CT]) and chest (chest roentgenogram or CT) imaging 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). Intensity of postoperative imaging, stratified by overall survival, was compared between patients with low (T1a) and high risk (T3/4) disease (Chisquare test). RESULTS: Abdominal and chest imaging stratified by tumor stage and overall survival are shown in figures 1 and 2. Across all survival strata, there were no differences in postoperative abdominal imaging between patients with T1a and T3/4 disease (p 0.05 for all). Use of postoperative chest imaging was different between patients with T1a and T3/4 disease only for those patients with an overall survival of 3 years (p 0.01). CONCLUSIONS: Our analysis reveals that, contrary to suggested algorithms, most patients with RCC have limited use of follow-up imaging after surgery with less than 50% of patients receiving annual abdominal and chest imaging at 3 years. Further, we also found that the risk of disease recurrence was unlikely to affect the intensity of postoperative imaging. Source of Funding: 1. Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources (NCRR) at the National Institutes of Health (NIH) Grant Numbers UL1 RR024992 and KL2 RR024994. 2. American Cancer Society Institutional Review Grant IRG-58010-53.