Skip to main content

Advertisement

SpringerLink
Log in

Low yield of surveillance imaging after surgery for T1 kidney cancer

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To examine the mode of relapse detection and subsequent treatment after partial or radical nephrectomy in patients with low-risk (pT1, N0, Nx) kidney cancer.

Methods

Retrospective study on 1404 patients treated with partial or radical nephrectomy for low-risk kidney cancer from the years 2000–2012. Scans for chest imaging (X-ray or CT) and abdominal imaging (CT, MRI, or ultrasound) are tabulated. For those patients with relapse, the site, mode of detection, and symptoms were recorded.

Results

Twenty-one patients relapsed with a median follow-up of 4.1 years for patients who did not relapse. In 17 (81 %) patients, relapse was detected by imaging alone, while 4 (19 %) patients presented with symptoms. Of the patients who relapsed by imaging, 13 (76 %) were treated immediately, while 4 (24 %) continued observation. During the first 3 years of follow-up, 5762 imaging studies were performed to detect 8 relapses, with 6 patients receiving immediate treatment. The median number of imaging studies per patient per year for the first 3 years was 1.7 (interquartile range 1.0, 2.3) including 30 % CT, 3 % MRI, 36 % X-ray, and 31 % ultrasounds.

Conclusion

We found a low yield of surveillance imaging in the first 3 years for pT1 kidney cancer. Nearly 1000 imaging studies were performed to detect one relapse that required treatment. Further studies are needed to evaluate the clinical impact of imaging surveillance according to recent guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Campbell SC, Novick AC, Belldegrun A, Blute ML, Chow GK, Derweesh IH et al (2009) Guideline for management of the clinical T1 renal mass. J Urol 182:1271–1279

    Article  PubMed  Google Scholar 

  2. Motzer RJ (2015) NCCN clinical practice guidelines in oncology. Kidney cancer. Version 1.2016. http://www.nccn.org/professionals/physician_gls/pdf/kidney.pdf. Accessed 26 Oct 2015

  3. Donat SM, Diaz M, Bishoff JT, Coleman JA, Dahm P, Derweesh IH et al (2013) Follow-up for clinically localized renal neoplasms: AUA guideline. J Urol 190(2):407–416

    Article  Google Scholar 

  4. Hafez KS, Novick AC, Campbell SC (1997) Patterns of tumor recurrence and guidelines for followup after nephron sparing surgery for sporadic renal cell carcinoma. J Urol 157:2067–2070

    Article  CAS  PubMed  Google Scholar 

  5. Levy DA, Slaton JW, Swanson DA, Dinney CP (1998) Stage specific guidelines for surveillance after radical nephrectomy for local renal cell carcinoma. J Urol 159:1163–1167

    Article  CAS  PubMed  Google Scholar 

  6. Ljungberg B, Alamdari FI, Rasmuson T, Roos G (1999) Follow-up guidelines for nonmetastatic renal cell carcinoma based on the occurrence of metastases after radical nephrectomy. BJU Int 84:405–411

    Article  CAS  PubMed  Google Scholar 

  7. Sandock DS, Seftel AD, Resnick MI (1995) A new protocol for the followup of renal cell carcinoma based on pathological stage. J Urol 154:28–31

    Article  CAS  PubMed  Google Scholar 

  8. Stephenson AJ, Chetner MP, Rourke K, Gleave ME, Signaevsky M, Palmer B 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

    Article  PubMed  Google Scholar 

  9. Lam JS, Shvarts O, Leppert JT, Pantuck AJ, Figlin RA, Belldegrun AS (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 (discussion 72; quiz 801)

    Article  PubMed  Google Scholar 

  10. Feuerstein MA, Atoria CL, Pinheiro LC, Huang WC, Russo P, Elkin EB (2014) Patterns of surveillance imaging after nephrectomy in the medicare population. BJU Int. doi:10.1111/bju.12980

    Google Scholar 

  11. Kowalczyk KJ, Harbin AC, Choueiri TK, Hevelone ND, Lipsitz SR, Trinh QD et al (2013) Use of surveillance imaging following treatment of small renal masses. J Urol 190:1680–1685

    Article  PubMed  Google Scholar 

  12. Stewart SB, Thompson RH, Psutka SP, Cheville JC, Lohse CM, Boorjian SA et al (2014) Evaluation of the national comprehensive cancer network and american urological association renal cell carcinoma surveillance guidelines. J Clin Oncol 32:4059–4065

    Article  PubMed  PubMed Central  Google Scholar 

  13. Smaldone MC, Uzzo RG (2013) Balancing process and risk: standardizing posttreatment surveillance for renal cell carcinoma. J Urol. doi:10.1016/j.juro.2013.05.033

    PubMed Central  Google Scholar 

  14. Eggener SE, Yossepowitch O, Pettus JA, Snyder ME, Motzer RJ, Russo P (2006) Renal cell carcinoma recurrence after nephrectomy for localized disease: predicting survival from time of recurrence. J Clin Oncol 24:3101–3106

    Article  PubMed  Google Scholar 

  15. Preston DL, Ron E, Tokuoka S, Funamoto S, Nishi N, Soda M et al (2007) Solid cancer incidence in atomic bomb survivors: 1958–1998. Radiat Res 168:1–64

    Article  CAS  PubMed  Google Scholar 

  16. Lin YK, Gettle L, Raman JD (2013) Significant variability in 10-year cumulative radiation exposure incurred on different surveillance regimens after surgery for pT1 renal cancers: yet another reason to standardize protocols? BJU Int 111(6):891–896

    Article  PubMed  Google Scholar 

  17. Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R et al (2009) Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 169:2078–2086

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lee DW, Levy F (2012) The sharp slowdown in growth of medical imaging: an early analysis suggests combination of policies was the cause. Health Aff (Millwood) 31:1876–1884

    Article  Google Scholar 

  19. Dinan MA, Curtis LH, Hammill BG, Patz EF Jr, Abernethy AP, Shea AM et al (2010) Changes in the use and costs of diagnostic imaging among Medicare beneficiaries with cancer, 1999–2006. JAMA 303:1625–1631

    Article  CAS  PubMed  Google Scholar 

  20. Hillman BJ, Goldsmith J (2010) Imaging: the self-referral boom and the ongoing search for effective policies to contain it. Health Aff (Millwood) 29:2231–2236

    Article  Google Scholar 

  21. Loprinzi CL, Hayes D, Smith T (2003) Doc, shouldn’t we be getting some tests? J Clin Oncol 21:108s–111s

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This investigation was supported by the Hanson Family Renal Cancer Research Fund, the Sidney Kimmel Center for Prostate and Urologic Cancers, and the National Cancer Institute/National Institutes of Health under Ruth L. Kirschstein National Research Service Award Institutional Research Training Grant T32 CA082088 and Cancer Center Support Grant P30CA008748. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Author’s contribution

Feuerstein involved in protocol/project development, data collection, and data analysis, wrote the manuscript, and edited the manuscript; Musser involved in protocol/project development, data collection, and data analysis, wrote the manuscript, and edited the manuscript; Kent involved in protocol/project development and data analysis, wrote the manuscript, and edited the manuscript; Chevinsky involved in data collection and edited the manuscript; Cha involved in data collection and edited the manuscript; Kimm involved in data collection and edited the manuscript; Hilton involved in data collection; Sjoberg involved in data analysis and wrote and edited the manuscript; Donahue involved in data collection edited the manuscript; Vargas involved in protocol/project development edited the manuscript; Coleman involved in protocol/project development; Russo involved in protocol/project development and wrote and edited the manuscript.

Author information

Authors and Affiliations

  1. Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Michael A. Feuerstein, John E. Musser, Michael Chevinsky, Eugene K. Cha, Simon Kimm, William M. Hilton, Timothy F. Donahue, Jonathan A. Coleman & Paul Russo

  2. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Hebert A. Vargas

  3. Department of Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Matthew Kent & Daniel D. Sjoberg

  4. Department of Urology, Lenox Hill Hospital, 170 E. 77th St, New York, NY, 10075, USA

    Michael A. Feuerstein

Authors
  1. Michael A. Feuerstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John E. Musser
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew Kent
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Chevinsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eugene K. Cha
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Simon Kimm
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. William M. Hilton
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Daniel D. Sjoberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Timothy F. Donahue
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hebert A. Vargas
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jonathan A. Coleman
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Paul Russo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael A. Feuerstein.

Ethics declarations

This investigation received approval from our institution’s ethical review board and was conducted in accordance with the 1964 Declaration of Helsinki and its later amendments. Informed consent was not required (waived) by our ethical review board.

Conflict of interest

Michael Feuerstein was supported by the National Cancer Institute/National Institutes of Health under Ruth L. Kirschstein National Research Service Award Institutional Research Training Grant T32 CA082088. Matthew Kent was supported by the Cancer Center Support Grant P30 CA008748. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Paul Russo was supported by the Hanson Family Renal Cancer Research Fund, the Sidney Kimmel Center for Prostate and Urologic Cancers.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feuerstein, M.A., Musser, J.E., Kent, M. et al. Low yield of surveillance imaging after surgery for T1 kidney cancer. World J Urol 34, 949–953 (2016). https://doi.org/10.1007/s00345-015-1719-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-015-1719-9

Keywords

Search

Navigation