Following the 2013 American Urological Association (AUA) guidelines on surveillance after partial nephrectomy (PN) can improve metastasis-free survival, according to a study presented at IKCS North America 2022.
The 2013 AUA guidelines introduced risk-adjusted follow-up recommendations after PN. Investigators sought to evaluate whether these guidelines affected patient outcomes at a single center.
The study included 3255 patients with kidney cancer who underwent PN between January 2000 and March 2017. The median age at PN was 60 (interquartile range, 52-68) years, and 63% of patients were men.
There were 2289 patients who underwent post-PN imaging surveillance prior to implementation of the AUA guidelines and 966 who underwent surveillance after the guidelines were implemented.
In both groups, the median tumor size at baseline was 2.9 cm. Most patients in both groups had pT1 disease (79% in the pre-guideline group and 80% in the post-guideline group), and few had positive surgical margins (5.8% and 5.1%, respectively).
A total of 296 patients died, 24 of whom died from kidney cancer.
Overall, 47 patients had biopsy-proven metastases — 44 that occurred before guideline implementation and 3 that occurred after.
In the post-guideline period, all metastatic tumors were detected by surveillance. In the pre-guideline period, 53% of metastatic tumors were detected by surveillance, 36% were symptomatic, and 11% were found incidentally.
AUA guideline-directed surveillance was associated with significantly better metastasis-free survival (hazard ratio [HR], 0.34; 95% CI, 0.13-0.87; P =.024). However, there was no significant difference between the pre- and post-guideline groups for cancer-specific survival (HR, 0.28; 95% CI, 0.06-1.20; P =.086) or overall survival (HR, 0.75; 95% CI, 0.51-1.12; P =.2).
The study authors concluded that metastatic events following PN were rare, but AUA guideline-directed surveillance may improve metastasis-free survival.
Disclosures: The study authors did not provide disclosures.
Yip W, Tracey AT, Nogueira LM, et al. Survival outcomes following adoption of risk-adjusted AUA surveillance guidelines after partial nephrectomy. Presented at IKCS North America 2022. November 4-5, 2022. Abstract 15.