Recommended stopping points for postsurgical surveillance for renal cell carcinoma (RCC) are oversimplified and should be replaced with a new, more risk-stratified approach, according to Mayo Clinic researchers: a risk-based, individualized surveillance regimen that balances surveillance benefits with a patient’s risk of non-recurrence mortality.
Post-nephrectomy surveillance of patients treated for RCC is crucial for early detection of tumor recurrence, but the best duration for surveillance “remains unknown, and evidence to support current guidelines are lacking,” according to a team of researchers at the Mayo Clinic in Rochester, MN, led by Igor Frank, MD.1
“The most prominent reason for missed recurrences among current guidelines appears to be the short duration of recommended follow-up,” the Mayo team noted.1 “For example, the longest surveillance duration advocated by either the NCCN [National Comprehensive Cancer Network]2 or AUA [American Urological Association]3 is 5 years.”
Those recommendations are based on the cumulative incidence of recurrence, but “fail to account for how a patient’s risk of recurrence changes with time and how competing comorbid conditions may ultimately influence this risk,” they noted.1
What’s needed is an approach that incorporates other risks into surveillance guidelines to better balance the risk of RCC recurrence with other causes of mortality, they wrote.
Therefore, they conducted an analysis of 2511 patients who underwent surgical resection for nonmetastatic RCC between 1990 and 2008, stratifying patients by tumor pathologic stage and relapse location, patient age, and Charleston comorbidity index (CCI).1
“By using age, CCI, pathologic tumor stage, and relapse location-specific data, we identified the points in time at which a patient’s risk of non-RCC death exceeds the risk of recurrence,” they wrote.1 “This method revealed diverse durations of oncologic surveillance among patient groups when taking into account competing risk factors.”