Abstract
The potential for an ultrasound-based screening programme for renal cell carcinoma (RCC) to improve survival through early detection has been the subject of much debate. The prevalence of ultrasound-detected asymptomatic RCC is an important first step to establishing whether a screening programme may be feasible. A systematic search of MEDLINE and Embase was performed up to March 2016 to identify studies reporting the prevalence of renal masses and RCC. Two populations of patients were chosen: asymptomatic individuals undergoing screening ultrasonography and patients undergoing ultrasonography for abdominal symptoms not related to RCC. A random-effects meta-analysis was performed. Study quality was evaluated using a validated eight-point checklist. Sixteen studies (413 551 patients) were included in the final analysis. The pooled prevalence of renal mass was 0·36 (95 per cent c.i. 0·23 to 0·52) per cent and the prevalence of histologically proven RCC was 0·10 (0·06 to 0·15) per cent. The prevalence of RCC was more than double in studies from Europe and North America than in those from Asia: 0·17 (0·09 to 0·27) versus 0·06 (0·03 to 0·09) per cent respectively. Data on 205 screen-detected RCCs showed that 84·4 per cent of tumours were stage T1-T2 N0, 13·7 per cent were T3-T4 N0, and only 2·0 per cent had positive nodes or metastases at diagnosis. At least one RCC would be detected per 1000 individuals screened. The majority of tumours identified are early stage (T1-T2).
Highlights
Overall survival from renal cell carcinoma (RCC) is poor, with a 5-year age-standardized relative survival rate of 47 per cent in the UK1
It has been postulated that early detection of asymptomatic RCC through a targeted national screening programme may potentially downstage the disease, reducing the prevalence of metastatic tumours and associated expenditure relating to systemic therapies
Studies were included in the analysis if the prevalence of renal masses and/or RCC was reported in asymptomatic individuals undergoing abdominal ultrasonography, patients undergoing abdominal ultrasonography for a medical reason not related to RCC or the study comprised a combination of both screened as well as non-screened individuals
Summary
Overall survival from renal cell carcinoma (RCC) is poor, with a 5-year age-standardized relative survival rate of 47 per cent in the UK1. Patients with metastases have a 5-year age-standardized relative survival rate of 6 per cent, compared with 84 per cent in patients with stage I disease[1]. A screening programme consisting of abdominal ultrasonography, potentially in a selected higher-risk population, in theory could improve survival outcomes through early detection and treatment of RCC. It has been postulated that early detection of asymptomatic RCC through a targeted national screening programme may potentially downstage the disease, reducing the prevalence of metastatic tumours and associated expenditure relating to systemic therapies. The potential for an ultrasound-based screening programme for renal cell carcinoma (RCC) to improve survival through early detection has been the subject of much debate. The majority of tumours identified are early stage (T1–T2)
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