Oncologic surveillance after surgical resection for renal cell carcinoma: A novel risk-based approach

Suzanne B. Stewart-Merrill, R. Houston Thompson, Stephen A. Boorjian, Sarah P. Psutka, Christine M. Lohse, John C. Cheville, Bradley C. Leibovich, Igor Frank

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Purpose: The appropriate duration of surveillance for renal cell carcinoma (RCC) after radical or partial nephrectomy remains unknown, and evidence to support current guidelines are lacking. Herein, we provide an approach to surveillance that balances the risk of recurrence versus the risk of non-RCC death. Patients and Methods: We identified 2,511 patients who underwent surgery for M0 RCC between 1990 and 2008. Patients were stratified for analysis by pathologic stage (pT1Nx-0, pT2Nx-0, pT3/4Nx-0, and pTanyN1), relapse location (abdomen, chest, bone, and other), age (<50, 50 to 59, 60 to 69, 70-79 and ≥ 80 years), and Charlson comorbidity index (CCI; ≤ 1 and ≥ 2). Risks of disease recurrence and non-RCC death were estimated by using parametric models for time-to-failure with Weibull distributions. Surveillance duration was estimated at the point when the risk of non-RCC death exceeded the risk of recurrence. Results: At a median follow-up of 9.0 years (interquartile range, 6.4 to 12.7 years), a total of 676 patients developed recurrence. By using a competing-risk model, vastly different surveillance durations were appreciated. Specifically, among patients with pT1Nx-0 disease and a CCI ≤ 1, risk of non-RCC death exceeded that of abdominal recurrence risk at 6 months in patients age 80 years and older but failed to do so for greater than 20 years in patients younger than age 50 years. For patients with pT1Nx-0 disease but a CCI ≥ 2, the risk of non-RCC death exceeded that of abdominal recurrence risk already at 30 days after surgery, regardless of patient age. Conclusion: We present an individualized approach to RCC surveillance that bases the duration of follow-up on the interplay between competing risk factors of recurrence and non-RCC death. This strategy may improve the balance between the derived benefit from surveillance and medical resource allocation.

Original languageEnglish (US)
Pages (from-to)4151-4157
Number of pages7
JournalJournal of Clinical Oncology
Volume33
Issue number35
DOIs
StatePublished - Dec 10 2015

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Renal Cell Carcinoma
Recurrence
Cell Death
Carcinoma
Resource Allocation
Nephrectomy
Ambulatory Surgical Procedures
Abdomen
Comorbidity
Thorax
Guidelines
Bone and Bones

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Stewart-Merrill, S. B., Thompson, R. H., Boorjian, S. A., Psutka, S. P., Lohse, C. M., Cheville, J. C., ... Frank, I. (2015). Oncologic surveillance after surgical resection for renal cell carcinoma: A novel risk-based approach. Journal of Clinical Oncology, 33(35), 4151-4157. https://doi.org/10.1200/JCO.2015.61.8009

Oncologic surveillance after surgical resection for renal cell carcinoma : A novel risk-based approach. / Stewart-Merrill, Suzanne B.; Thompson, R. Houston; Boorjian, Stephen A.; Psutka, Sarah P.; Lohse, Christine M.; Cheville, John C.; Leibovich, Bradley C.; Frank, Igor.

In: Journal of Clinical Oncology, Vol. 33, No. 35, 10.12.2015, p. 4151-4157.

Research output: Contribution to journalArticle

Stewart-Merrill, SB, Thompson, RH, Boorjian, SA, Psutka, SP, Lohse, CM, Cheville, JC, Leibovich, BC & Frank, I 2015, 'Oncologic surveillance after surgical resection for renal cell carcinoma: A novel risk-based approach', Journal of Clinical Oncology, vol. 33, no. 35, pp. 4151-4157. https://doi.org/10.1200/JCO.2015.61.8009
Stewart-Merrill SB, Thompson RH, Boorjian SA, Psutka SP, Lohse CM, Cheville JC et al. Oncologic surveillance after surgical resection for renal cell carcinoma: A novel risk-based approach. Journal of Clinical Oncology. 2015 Dec 10;33(35):4151-4157. https://doi.org/10.1200/JCO.2015.61.8009
Stewart-Merrill, Suzanne B. ; Thompson, R. Houston ; Boorjian, Stephen A. ; Psutka, Sarah P. ; Lohse, Christine M. ; Cheville, John C. ; Leibovich, Bradley C. ; Frank, Igor. / Oncologic surveillance after surgical resection for renal cell carcinoma : A novel risk-based approach. In: Journal of Clinical Oncology. 2015 ; Vol. 33, No. 35. pp. 4151-4157.
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AU - Psutka, Sarah P.

AU - Lohse, Christine M.

AU - Cheville, John C.

AU - Leibovich, Bradley C.

AU - Frank, Igor

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