Surveillance chest imaging for patients following surgical excision for localized renal cell carcinoma (RCC) is not warranted, investigators reported during the AUA2021 Virtual Experience.
“There seems to be minimal clinical value in surveillance for pulmonary recurrence after resection of T1a renal cell carcinoma,” investigator David K. Charles, MD, of the Medical College of Wisconsin in Milwaukee, said during an oral presentation.
Cancer recurs in 20% to 30% of these patients, with 50% to 60% of recurrences being lung metastases, according to the investigators. Previous studies have revealed an extremely low incidence of lung metastases in T1-T3 RCC following surgical excision, they noted. Still, clinical guidelines from the National Comprehensive Cancer Network and the AUA recommend that patients who undergo surgical excision of localized RCC have surveillance chest X-rays performed at least annually for 5 years.
Dr Charles and his collaborators retrospectively analyzed 463 patients who underwent surgical excision of T1a RCC from January 2000 to January 2020. The study excluded patients with pathology other than RCC and those with pulmonary nodules on baseline imaging. The patients had a mean age of 58.3 years. The mean follow-up duration was 47.6 months.
On the most recent pulmonary surveillance imaging, 335 patients (72.4%) had a chest X-ray and 128 (27.6%) had chest computed tomography scans. Regardless of imaging modality, pulmonary recurrence was not detected in any patient.
Charles D, Fitzgerald J, Cooper B, et al. Is chest imaging needed as part of T1a renal cell carcinoma surveillance after surgical resection? Presented at: AUA2021 Virtual Experience held September 10-13, 2021. Abstract PD16-12.