Intensive Imaging-based Follow-up of Surgically Treated Localised Renal Cell Carcinoma Does Not Improve Post-recurrence Survival: Results from a European Multicentre Database (RECUR)

Saeed Dabestani ¹,
Christian Beisland ²,
Grant D. Stewart ³,
Karim Bensalah ⁴,
Eirikur Gudmundsson ⁵,
Thomas B. Lam ⁶,
William Gietzmann ⁷,
Paimaun Zakikhani ⁸,
Lorenzo Marconi ⁹,
Sergio Fernandéz-Pello ¹⁰,
Serenella Monagas ¹¹,
Samuel Paul Williams ¹²,
Christian Torbrand ¹,
Thomas Powles ¹³,
Erik Van Werkhoven ¹⁴,
Richard Meijer ¹⁵,
Alessandro Volpe ¹⁶,
Michael Staehler ¹⁷,
Börje Ljungberg ¹⁸,
Axel Bex ¹⁹

¹ Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden ² Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway ³ Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK ⁴ Department of Urology, University of Rennes, Rennes, France ⁵ Department of Urology, Landspitali University Hospital, Reykjavik, Iceland ⁶ Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK ⁷ Academic Urology Unit, University of Aberdeen, Aberdeen, UK ⁸ Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK ⁹ Department of Urology, Coimbra University Hospital, Coimbra, Portugal ¹⁰ Department of Urology, Cabueñes University Hospital, Gijón, Spain ¹¹ Department of Urology, San Agustin University Hospital, Aviles, Spain ¹² Medical School, University of Edinburgh, Edinburgh, UK ¹³ Barts Cancer Institute, Queen Mary University of London, London, UK ¹⁴ Department of Bioinformatics and Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands ¹⁵ Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands ¹⁶ Department of Urology, University of Eastern Piedmont, Novara, Italy ¹⁷ Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany ¹⁸ Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden ¹⁹ Division of Surgical Oncology, Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

Publication: European Urology 2018 Oct 11

DOI: https://doi.org/10.1016/j.eururo.2018.10.007

https://www.europeanurology.com/article/S0302-2838(18)30748-6/fulltext

The optimal follow-up (FU) strategy for patients treated for localised renal cell carcinoma (RCC) remains unclear. Using the RECUR database, we studied imaging intensity utilised in contemporary FU to evaluate its association with outcome after detection of disease recurrence. Consecutive patients with nonmetastatic RCC (n = 1612) treated with curative intent at 12 institutes across eight European countries between 2006 and 2011 were included. Recurrence occurred in 336 patients. Cross-sectional (computed tomography, magnetic resonance imaging) and conventional (chest X-ray, ultrasound) methods were used in 47% and 53%, respectively. More intensive FU imaging (more than twofold) than recommended by the European Association of Urology (EAU) was not associated with improved overall survival (OS) after recurrence. Overall, per patient treated for recurrence remaining alive with no evidence of disease, the number of FU images needed was 542, and 697 for high-risk patients. The study results suggest that use of more imaging during FU than that recommended in the 2017 EAU guidelines is unlikely to improve OS after recurrence. Prospective studies are needed to design optimal FU strategies for the future.

Patient summary

After curative treatment for localised kidney cancer, follow-up is necessary to detect any recurrence. This study illustrates that increasing the imaging frequency during follow-up, even to double the number of follow-up imaging procedures recommended by the European Association of Urology guidelines, does not translate into improved survival for those with recurrence.

Prof. Christian Beisland and Dr. Saeed Dabestani

The RECUR consortium, involving 15 institutes across 11 European countries, aims to determine the best follow-up strategy for RCC recurrence detection. Towards this goal we analysed the frequency of imaging performed during follow-up after curative intent surgery for RCC and compared real world data with those recommended by the EAU guidelines. We found that increased frequency of follow-up imaging (even more than twice than that recommended by the EAU guidelines), irrespective of risk of recurrence, did not improve survival for those who relapsed. The implications of our results are that overuse of follow-up imaging results in unnecessary radiation exposure as well as costs. There is a need for prospective studies aiming to use follow-up protocols based on prognostic parameters and risk scores rather than expert opinion.

Tags: Radical surgery