You have accessJournal of UrologyKidney Cancer: Surgical Therapy I1 Apr 2015PD29-06 ONCOLOGIC SURVEILLANCE FOLLOWING SURGICAL RESECTION FOR RENAL CELL CARCINOMA: A NOVEL RISK-BASED APPROACH Suzanne Stewart, R. Houston Thompson, Stephen Boorjian, Sarah Psutka, Christine Lohse, John Cheville, Bradley Leibovich, and Igor Frank Suzanne StewartSuzanne Stewart More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , Sarah PsutkaSarah Psutka More articles by this author , Christine LohseChristine Lohse More articles by this author , John ChevilleJohn Cheville More articles by this author , Bradley LeibovichBradley Leibovich More articles by this author , and Igor FrankIgor Frank More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1793AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The appropriate duration of surveillance for renal cell carcinoma (RCC) following radical or partial nephrectomy remains unknown. Uniform adherence to current guidelines has the potential for over utilization of resources in some patients and deficiency of testing in others. Herein, we provide an age-, stage-, and relapse site-specific duration for the oncologic surveillance of RCC, balancing the risks of recurrence versus non-RCC death. METHODS We identified 3651 patients who underwent surgery for M0 RCC between 1970 and 2008. Patients were stratified by pathologic stage: pT0Nx-0, pT2Nx-0, pT3/4Nx-0, and pTanyN1; relapse site (abdomen-locoregional, abdomen-visceral, chest, bone, and other); and age (< 50, 50-59, 60-69, 70-79 and ≥80yrs). Recurrence risk stratified by stage and relapse site along with risk of non-RCC death by age were estimated using parametric models for time-to-failure data using a Weibull distribution. Time points when the risk of non-RCC death exceeded the risk of recurrence were determined. RESULTS At a median follow-up of 9.5yrs (IQR 6.6-14.1), a total of 1088 patients developed a recurrence. As shown in the Table, we found significant differences in the duration of site-specific follow-up needed for various stage and age groups before risk of non-RCC death exceeded the risk of recurrence. For example, we found that the risk of non-RCC death for patients ≥80 years with pT1Nx-0 disease remained greater than their risk of recurrence at any site and at any time point following surgery, indicating that prolonged RCC surveillance for this age and stage group may not be of high utility. In contrast, for patients <50 years with pTanyN1 disease, the risk of recurrence at any site remained greater than the risk of non-RCC death for 20 years or longer, suggesting that continued surveillance for this patient group remains valuable for decades. CONCLUSIONS Using a novel statistical approach, we present age-, stage- and relapse site-specific surveillance options following surgery for RCC. This individualized strategy may optimize the capturing of recurrences while improving resource allocation. Table. Age-, stage- and relapse site-specific time points when risk of non-cancer related death exceeds risk of recurrence of renal cell carcinoma in years. Stage Group Relapse Site Age (years) < 50 50-59 60-69 70-79 ≥ 80 pT1Nx-0 Abdomen–Locoregional 1.5 1.5 0.5 – – Abdomen–Visceral – – – – – Chest 0.5 1 – – – Bone 1.5 1.5 1 0.5 – Other – – – – – pT2Nx-0 Abdomen–Locoregional 5 3 1 0.5 – Abdomen–Visceral 1.5 1.5 0.5 – – Chest 13.5 5 2 1 0.5 Bone 14 6 2.5 1 0.5 Other 1.5 1.5 0.5 – – pT3/4Nx-0 Abdomen–Locoregional 10 4.5 1.5 1 0.5 Abdomen–Visceral 8 4 1.5 1 0.5 Chest > 20 10.5 5 2.5 1 Bone > 20 10 5 2.5 1 Other 7 3.5 1.5 1 0.5 pTanyN1 Abdomen–Locoregional > 20 17.5 10 5 2 Abdomen–Visceral 19.5 7 3 1.5 1 Chest > 20 > 20 16 7 3 Bone > 20 > 20 13 6.5 3 Other > 20 18 9 4 1.5 Dash mark indicates that risk of non-renal cell carcinoma death exceeded the risk of recurrence starting at 30 days following surgical resection suggesting surveillance may not be necessary. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e650-e651 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Suzanne Stewart More articles by this author R. Houston Thompson More articles by this author Stephen Boorjian More articles by this author Sarah Psutka More articles by this author Christine Lohse More articles by this author John Cheville More articles by this author Bradley Leibovich More articles by this author Igor Frank More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...