Advertisement

World Journal of Urology

, Volume 37, Issue 12, pp 2727–2736 | Cite as

Impact of routine imaging in the diagnosis of recurrence for patients with localized and locally advanced renal tumor treated with nephrectomy

  • Baptiste GiresEmail author
  • Zine-Eddine Khene
  • Pierre Bigot
  • Quentin Alimi
  • Benoit Peyronnet
  • Grégory Verhoest
  • Andrea Manunta
  • Karim Bensalah
  • Romain Mathieu
Original Article
  • 62 Downloads

Abstract

Objective

Modalities of surveillance to detect recurrence after nephrectomy for localized or locally advanced renal tumor are not standardized. The aim was to assess the impact of surveillance scheme on oncological outcomes.

Methods

Patients treated for localized or locally advanced renal tumor with total or partial nephrectomy between 2006 and 2010 in an academic institution were included retrospectively. According to the University of California Los Angeles Integrated Staging System (UISS) protocol, follow-up was considered adequate or not. Symptoms, location and number of lesions at recurrence diagnosis were collected. Recurrence-free, cancer-specific and overall survivals were estimated using the Kaplan–Meier method and compared with the log-rank test. Cox proportional hazards regression models were calculated to identify prognostic factors.

Results

A total of 267 patients were included. Median follow-up was 72 months. Recurrence rate was 23.2% (62/267 patients). Recurrences were local (16%), single metastatic (23%), oligo-metastatic (15%) or multi-metastatic (46%). 72.6% of the recurrences occurred within the 3 years after surgery. No recurrence was diagnosed by chest X-ray or abdominal ultrasound. One hundred and twenty-one patients had inadequate follow-up. They had similar recurrence-free survival, cancer-specific survival and overall survival as patients with adequate follow-up. In multivariable analysis, the presence of multi-metastatic lesions was an independent prognostic factor of worse cancer-specific mortality after recurrence diagnosis (HR = 10.15, 95% CI: 2.29–44.82, p = 0.002).

Conclusion

Role of chest X-ray and abdominal ultrasound for the detection of recurrences is limited. Rigorous follow-up according to the UISS protocol does not improve oncological outcomes. Follow-up schedules with less frequent imaging should be discussed.

Keywords

Renal tumor Follow-up Recurrence Survival Tomography 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

345_2019_2724_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 15 kb)

References

  1. 1.
    Speed JM, Trinh Q-D, Choueiri TK, Sun M (2017) Recurrence in localized renal cell carcinoma: a systematic review of contemporary data. Curr Urol Rep 18:15.  https://doi.org/10.1007/s11934-017-0661-3 CrossRefPubMedGoogle Scholar
  2. 2.
    Kattan MW, Reuter V, Motzer RJ et al (2001) A postoperative prognostic nomogram for renal cell carcinoma. J Urol 166:63–67CrossRefGoogle Scholar
  3. 3.
    Leibovich BC, Blute ML, Cheville JC et al (2003) Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma. Cancer 97:1663–1671.  https://doi.org/10.1002/cncr.11234 CrossRefPubMedGoogle Scholar
  4. 4.
    Lam JS, Shvarts O, Leppert JT et al (2005) Postoperative surveillance protocol for patients with localized and locally advanced renal cell carcinoma based on a validated prognostic nomogram and risk group stratification system. J Urol 174:466–472.  https://doi.org/10.1097/01.ju.0000165572.38887.da(discussion 472; quiz 801) CrossRefPubMedGoogle Scholar
  5. 5.
    Karakiewicz PI, Briganti A, Chun FK-H et al (2007) Multi-institutional validation of a new renal cancer-specific survival nomogram. J Clin Oncol Off J Am Soc Clin Oncol 25:1316–1322.  https://doi.org/10.1200/JCO.2006.06.1218 CrossRefGoogle Scholar
  6. 6.
    Zisman A, Pantuck AJ, Wieder J et al (2002) Risk group assessment and clinical outcome algorithm to predict the natural history of patients with surgically resected renal cell carcinoma. J Clin Oncol Off J Am Soc Clin Oncol 20:4559–4566.  https://doi.org/10.1200/JCO.2002.05.111 CrossRefGoogle Scholar
  7. 7.
    Fuhrman SA, Lasky LC, Limas C (1982) Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 6:655–663CrossRefGoogle Scholar
  8. 8.
    Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–655CrossRefGoogle Scholar
  9. 9.
    Dabestani S, Thorstenson A, Lindblad P et al (2016) Renal cell carcinoma recurrences and metastases in primary non-metastatic patients: a population-based study. World J Urol 34:1081–1086.  https://doi.org/10.1007/s00345-016-1773-y CrossRefPubMedGoogle Scholar
  10. 10.
    van Oostenbrugge TJ, Kroeze SGC, Bosch JLHR, van Melick HHE (2015) The blind spots in follow-up after nephrectomy or nephron-sparing surgery for localized renal cell carcinoma. World J Urol 33:881–887.  https://doi.org/10.1007/s00345-014-1390-6 CrossRefPubMedGoogle Scholar
  11. 11.
    Couapel J-P, Bensalah K, Bernhard J-C et al (2014) Is there a volume-outcome relationship for partial nephrectomy? World J Urol 32:1323–1329.  https://doi.org/10.1007/s00345-013-1213-1 CrossRefPubMedGoogle Scholar
  12. 12.
    Mouracade P, Chavali JS, Kara O et al (2017) Imaging strategy and outcome following partial nephrectomy. Urol Oncol 35:660.e1–660.e8.  https://doi.org/10.1016/j.urolonc.2017.06.052 CrossRefGoogle Scholar
  13. 13.
    Volpe A, Patard JJ (2010) Prognostic factors in renal cell carcinoma. World J Urol 28:319–327.  https://doi.org/10.1007/s00345-010-0540-8 CrossRefPubMedGoogle Scholar
  14. 14.
    Golimbu M, Joshi P, Sperber A et al (1986) Renal cell carcinoma: survival and prognostic factors. Urology 27:291–301CrossRefGoogle Scholar
  15. 15.
    Levy DA, Slaton JW, Swanson DA, Dinney CP (1998) Stage specific guidelines for surveillance after radical nephrectomy for local renal cell carcinoma. J Urol 159:1163–1167CrossRefGoogle Scholar
  16. 16.
    Stephenson AJ, Chetner MP, Rourke K et al (2004) Guidelines for the surveillance of localized renal cell carcinoma based on the patterns of relapse after nephrectomy. J Urol 172:58–62.  https://doi.org/10.1097/01.ju.0000132126.85812.7d CrossRefPubMedGoogle Scholar
  17. 17.
    Kim SP, Weight CJ, Leibovich BC et al (2011) Outcomes and clinicopathologic variables associated with late recurrence after nephrectomy for localized renal cell carcinoma. Urology 78:1101–1106.  https://doi.org/10.1016/j.urology.2011.05.012 CrossRefPubMedGoogle Scholar
  18. 18.
    Antonelli A, Furlan M, Sodano M et al (2016) Features, risk factors and clinical outcome of “very late” recurrences after surgery for localized renal carcinoma: a retrospective evaluation of a cohort with a minimum of 10 years of follow up. Int J Urol Off J Jpn Urol Assoc 23:36–40.  https://doi.org/10.1111/iju.12962 CrossRefGoogle Scholar
  19. 19.
    Ljungberg B, Bensalah K, Canfield S et al (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67:913–924.  https://doi.org/10.1016/j.eururo.2015.01.005 CrossRefPubMedGoogle Scholar
  20. 20.
    Donat SM, Diaz M, Bishoff JT et al (2013) Follow-up for clinically localized renal neoplasms: AUA guideline. J Urol 190:407–416.  https://doi.org/10.1016/j.juro.2013.04.121 CrossRefPubMedGoogle Scholar
  21. 21.
    Canvasser NE, Stouder K, Lay AH et al (2016) The usefulness of chest X-rays for T1a renal cell carcinoma surveillance. J Urol 196:321–326.  https://doi.org/10.1016/j.juro.2016.02.068 CrossRefPubMedGoogle Scholar
  22. 22.
    Doornweerd BHJ, de Jong IJ, Bergman LM, Ananias HJK (2014) Chest X-ray in the follow-up of renal cell carcinoma. World J Urol 32:1015–1019.  https://doi.org/10.1007/s00345-013-1176-2 CrossRefPubMedGoogle Scholar
  23. 23.
    Tan M-H, Li H, Choong CV et al (2011) The Karakiewicz nomogram is the most useful clinical predictor for survival outcomes in patients with localized renal cell carcinoma. Cancer 117:5314–5324.  https://doi.org/10.1002/cncr.26193 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologyRennes University HospitalRennesFrance
  2. 2.Department of UrologyAngers University HospitalAngersFrance
  3. 3.CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) UMR_S 1085Univ RennesRennesFrance
  4. 4.Service d’urologieHôpital PontchaillouRennesFrance

Personalised recommendations