Patients who undergo surgery for small renal cell carcinomas (RCCs) require long-term follow-up because of the risk of recurrence and RCC-related death even 10 years after treatment, according to researchers.

Tetsuya Shindo, MD, and colleagues at Sapporo Medical University in Japan, included 172 patients (133 men, 39 women) who were treated for small, organ-confined RCC (pT1a). Of these, 18 (10.5%) experienced recurrence and eight of them (4.7%) died from their cancer during a median follow-up of 10.4.5 months (range 8-308 months), the investigators reported online ahead of print in BJU International. The median time to recurrence was 59 months.

In a multivariate analysis, microvascular invasion (MVI) was associated with a significant eightfold increased risk of cancer-specific death compared with the absence of MVI. The 10-year cancer-specific survival rates were 85.1% and 96.5% in patients with and without MVI, respectively.

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“Early detection of recurrent disease may provide a chance for disease control with surgical treatment,” the authors wrote. “Therefore, careful follow-up is necessary for patients with RCC with MVI even though the disease is small and organ-confined.”

The authors observed that there is no consensus on surveillance for small and organ-confined RCC later than five years postoperatively, but the data from their study suggest that long-term follow-up may be needed for possible cancer recurrence and death. “Indeed, late recurrence of RCC after the initial treatment is not rare, which indicates that lifelong follow-up may be mandatory,” they wrote.

The researchers pointed out that the widespread use of routine abdominal imaging enables detection of small, organ-confined RCC, which generally has favorable pathologic characteristics and a good prognosis. Tumor size alone, however, is not sensitive enough to precisely predict long-term clinical behavior, they noted.

Dr. Shindo’s group added that the development of molecular-targeted therapy has changed the therapeutic approaches for treatment of metastatic RCC. Their study included data from before the development of targeted therapy. “Therefore, we have no information on patients with small, organ-confined RCC who received molecular-targeted therapy,” they stated.

With respect to study limitations, the researchers noted that they relied on retrospective data from a single institution.