The follow‐up management of non‐metastatic renal cell carcinoma: definition of a surveillance protocol

• DOI: 10.1111/j.1464-410x.2006.06616.x
• Publication Date: 2006-11-24T09:10:20Z
• Authors: Alessandro Antonelli; Alberto Cozzoli; Danilo Zani; Tiziano Zanotelli; Maria Nicolai; Sergio Cosciani C...; Claudio Simeone
• Keywords: Adult; Male; renal cell carcinoma; recurrence; Nephrectomy; Disease-Free Survival; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; follow-up; Humans; Neoplasm Metastasis; Carcinoma, Renal Cell; Aged; Retrospective Studies; Aged, 80 and over; UCLA integrated staging system; Middle Aged; Prognosis; Follow-up; Recurrence; Renal cell carcinoma; UCLA integrated staging system; Adult; Aged; Aged, 80 and over; Carcinoma, Renal Cell; Disease Progression; Disease-Free Survival; Female; Follow-Up Studies; Humans; Kidney Neoplasms; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Nephrectomy; Prognosis; Retrospective Studies; Risk Factors; Survival Rate; Kidney Neoplasms; 3. Good health; Survival Rate; Disease Progression; Female; Neoplasm Recurrence, Local; Follow-Up Studies

OBJECTIVETo define a follow‐up protocol based on the University of California Los Angeles Integrated Staging System (UISS) for patients undergoing surgery for N0M0 renal cell carcinoma (RCC).PATIENTS AND METHODSThe clinical records of patients treated with radical surgery for N0/NXM0 RCC and monitored through periodic follow‐up studies (≥24 months in disease‐free patients) were reviewed retrospectively from 1399 patients surgically treated for renal neoplasms between 1983 and 2005. Each case was assigned a UISS risk category; recurrence features, time and site were recorded. In particular, recurrence sites were categorized into local, renal (ipsilateral or contralateral) and distant (single‐site or disseminated).RESULTSThe records were reviewed of 814 patients with a mean follow‐up of 75.6 months. UISS risk categories were distributed as follows: high‐risk (HR) 17.2%, intermediate‐risk (IR) 51.6% and low‐risk (LR) 31.2%. Disease‐free survival rates at 5 years were 63.9%, 88.3% and 96.5% (log‐rank test P < 0.001), respectively. The disease recurred in 193 patients (23.7%), at distant sites (73.0% of recurrences), locally (11.9%), in the contralateral kidney (10.9%) and in the ipsilateral kidney (4.1%). There was a significant correlation between UISS category and risk of distant or local (both P < 0.001) recurrences, whereas there was no correlation of recurrences in the operated kidney (P = 0.372) or contralateral kidney (P = 0.898).CONCLUSIONSThe prognostic accuracy and applicability of the UISS for distant and local recurrences is confirmed, whereas renal relapses have an independent course. A follow‐up scheme tailored to the recurrence patterns observed in each UISS risk group is recommended.