Surveillance strategies for renal cell carcinoma patients following nephrectomy

Abstract

Renal cell carcinoma (RCC) is the most lethal of urologic malignancies, accounting for an estimated 36,000 new cases of carcinoma and 12,000 deaths in 2005. Nephrectomy is the usual treatment; however, after nephrectomy, RCC recurs in 20% to 40% of patients with clinically localized disease. A consensus surveillance protocol does not exist for follow-up of RCC after nephrectomy. In this article, available protocols are reviewed with a goal of developing an evidence-based system including the prognostic factors for recurrent disease, chronology and sites of recurrence, available treatment options if recurrent disease is found, and modalities of diagnostic testing available to urologists. New surveillance recommendations are presented based on prognostic factors as well as the University of California, Los Angeles Integrated Staging System for RCC.

Figure 1

Kaplan-Meier survival analysis of 661 patients based on prognostic indicators incorporated into University of California Los Angeles Integrated Staging System for renal cell carcinoma. (A) Survival curves based on 1997 tumor, nodes, metastasis (TNM) stages I–IV; (B) Survival curves based on Fuhrman grades 1–4. (C) Survival curves based on Eastern Cooperative Oncology Group performance status. Reproduced with permission from Zisman A et al.

Figure 2

University of California Los Angeles Integrated Staging for patients with localized renal cell carcinoma. Using the T stage, Fuhrman grade, and Eastern Cooperative Oncology Group performance status (ECOG PS), patients are stratified into low-, intermediate-, and high-risk groups. Adapted from Zisman A et al.

Figure 3

Kaplan-Meier survival analysis of 3119 patients based on University of California Los Angeles Integrated Staging with localized renal cell carcinoma. CT, computerized tomography; LR, low risk; IR, intermediate risk; HR, high risk. Reproduced with permission from Patard JJ et al.

Figure 4

Surveillance protocol following nephrectomy for localized renal cell carcinoma using the University of California Los Angeles Integrated Staging System.