RCC Surveillance Guidelines Need Improvement

Following AUA and NCCN guidelines would miss many cases of disease recurrence.
Following AUA and NCCN guidelines would miss many cases of disease recurrence.

ORLANDO—Follow-up durations recommended by surveillance algorithms by the American Urological Association (AUA) and the National Comprehensive Cancer Network (NCCN) miss many recurrences of renal cell carcinoma following radical or partial nephrectomy, researchers concluded in a study presented at the AUA 2014 annual meeting.

Suzanne Stewart, MD, and collaborators at the Mayo Clinic in Rochester, Minn., reviewed the Mayo Clinic Nephrectomy Registry and identified 3,651 patients treated with radical or partial nephrectomy. Based on AUA guidelines, the researchers stratified patients into low risk (pT1 N0) following partial nephrectomy (LRpartial) or radical nephrectomy (LRradical) and moderate/high risk (M/HR) (pT2-4 N0-1). The investigators assessed guideline effectiveness by calculating the percentage of recurrences detected within the prescribed follow-up periods given for site-specific recurrence. For AUA, LRpartial: 3 years for all sites; LRradical: 1 year for abdominal and 3 years for chest/bone/other sites; M/HR: 5 years for all sites. For NCCN, 6 months for abdominal/chest sites and 5 years for bone/other sites.

Of the 3,651 patients, 2,181 (59.7%) had pT1 NX-0 disease, 2,719 (74.5%) had clear-cell RCC, and 2,661 (72.9%) and 990 (27.1%) underwent radical and partial nephrectomy, respectively. The median post-operative follow-up was 9 years, during which 1,088 patients (29.8%) experienced disease recurrence. Of these recurrences, 728 (66.9%) would have been detected using AUA guidelines and 390 (35.8%) by the NCCN guidelines, Dr. Stewart's team concluded. Following the AUA guidelines, 62.7% of recurrences would have been missed in the LRpartial group, 70.5% in the LRradical group, and 20.8% in the M/HR group. To capture 90% of recurrences in the abdomen and chest using these AUA risk groups, surveillance would be required for 9 years and 8 years, respectively, in the LRpartial group, 15 years and 12 years in the LRradical group, and 11 years and 10 years in the dM/HR group.

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