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Risk-Based Approach to Guide Surveillance After Resection for Renal Cell Carcinoma

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Key Points

  • A competing-risk analysis was used to determine when risk of non–renal cell carcinoma death exceeded risk of recurrence to estimate optimal surveillance durations.
  • Surveillance durations varied widely according to disease stage, comorbidity index, and age.

As reported in the Journal of Clinical Oncology, Stewart-Merrill et al at Mayo Clinic, Rochester, have developed an approach to determining surveillance duration that attempts to balance risk of recurrence vs risk of non–renal cell carcinoma death after resection for renal cell carcinoma.

Study Details

The study involved data from 2,511 patients who underwent surgery for M0 renal cell carcinoma between 1990 and 2008 at Mayo Clinic. Patients were stratified by pathologic stage (pT1Nx-0, pT2Nx-0, pT3/4Nx-0, and pTanyN1), relapse location (abdomen, chest, bone, and other), age (< 50, 50–59, 60–69, 70–79, and ≥ 80 years), and Charlson comorbidity index (CCI, ≤ 1 and ≥ 2).

Risk of disease recurrence and non–renal cell carcinoma death were estimated (using parametric models for time to failure) according to stage, relapse location, age, and CCI. Surveillance duration was estimated at the point at which risk of non–renal cell carcinoma death exceeded risk of recurrence.

Examples of Estimated Surveillance Durations

At a median follow-up of 9.0 years (interquartile range = 6.4–12.7 years), recurrence was observed in 676 patients. The competing-risk model identified widely different surveillance durations at which risk of non–renal cell carcinoma death exceeded risk of recurrence. For example, among patients with pT1Nx-0 disease and CCI ≤ 1, risk of non–renal cell carcinoma death exceeded that of abdominal recurrence risk at 6 months after surgery in patients aged ≥ 80 years but did not exceed risk of abdominal recurrence for > 20 years in patients aged < 50 years.

Among patients with pT1Nx-0 disease and CCI ≥ 2, risk of non–renal cell carcinoma death exceeded that of abdominal recurrence at 30 days after surgery regardless of age. Among patients with pT1Nx-0 disease, risk of non–renal cell carcinoma death exceeded that of abdominal recurrence at 7 years and at 30 days among those aged 50 to 59 years with CCI ≤ 1 and CCI ≥ 2 and at 2.5 years and at 30 days among those aged 60 to 69 years with CCI ≤ 1 and CCI ≥ 2.

The investigators concluded: “We present an individualized approach to [renal cell carcinoma] surveillance that bases the duration of follow-up on the interplay between competing risk factors of recurrence and [non–renal cell carcinoma] death. This strategy may improve the balance between the derived benefit from surveillance and medical resource allocation.”

Igor Frank, MD, of Mayo Clinic, Rochester, is the corresponding author for the Journal of Clinical Oncology article.

For full disclosures of the study authors, visit jco.ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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