Skip to main content

Advertisement

SpringerLink
Log in

The blind spots in follow-up after nephrectomy or nephron-sparing surgery for localized renal cell carcinoma

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

This study was conducted to identify time to and type of recurrence in relation to scheduled follow-up (FU) imaging after nephrectomy or nephron-sparing surgery for localized renal cell carcinoma (RCC). Using this information, future guidelines could improve the early detection of metastases.

Methods

Measured from moment of treatment, all recurrences after (partial) nephrectomy performed between 2000 and 2010 were categorized as being detected early (<6 months), late (>5 year for T1/T2 and >10 year for T3/T4), or intermediate (time within those two) based on European Association of Urology (EAU) guidelines. Also symptomatic presentation was screened.

Results

Recurrent disease developed in 80 of 396 patients after (partial) tumor nephrectomy. Mean time to recurrence in months was 56 (n = 21) for T1, 24 (n = 18) for T2, 21 (n = 38) for T3, and 11 (n = 2) for T4 tumors. Detection of early recurrence occurred in 22 patients (28 %), of which 20 (91 %) were T2–T4 tumors. In 10 (48 %) of T1 tumors, late recurrence was found. Of the patients with symptoms due to recurrence, 65 % (17/26) were detected outside the FU surveillance protocol (P = 0.01).

Conclusion

A more intensive FU the first 6 months after nephrectomy for T2–T4 and FU imaging ≥5 years after surgery for T1 tumors might improve early and asymptomatic detection of recurrent disease after nephrectomy for RCC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Rini BI, Campbell SC, Escudier B (2009) Renal cell carcinoma. Lancet 373(9669):1119–1132

    Article  CAS  PubMed  Google Scholar 

  2. Levi F et al (2008) The changing pattern of kidney cancer incidence and mortality in Europe. BJU Int 101(8):949–958

    Article  PubMed  Google Scholar 

  3. Chow WH, Dong LM, Devesa SS (2010) Epidemiology and risk factors for kidney cancer. Nat Rev Urol 7(5):245–257

    Article  PubMed Central  PubMed  Google Scholar 

  4. Lightfoot N et al (2000) Impact of noninvasive imaging on increased incidental detection of renal cell carcinoma. Eur Urol 37(5):521–527

    Article  CAS  PubMed  Google Scholar 

  5. Chow WH et al (1999) Rising incidence of renal cell cancer in the United States. JAMA 281(17):1628–1631

    Article  CAS  PubMed  Google Scholar 

  6. Leibovich BC et al (2003) Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer 97(7):1663–1671

    Article  PubMed  Google Scholar 

  7. Ljungberg B et al (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58(3):398–406

    Article  PubMed  Google Scholar 

  8. Donat SM et al (2013) Follow-up for clinically localized renal neoplasms: AUA guideline. J Urol 190(2):407–416

    Article  PubMed  Google Scholar 

  9. Escudier B et al (2012) Renal cell carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(Suppl 7):vii65–vii71

    Article  PubMed  Google Scholar 

  10. Bruno JJ et al (2006) Renal cell carcinoma local recurrences: impact of surgical treatment and concomitant metastasis on survival. BJU Int 97(5):933–938

    Article  PubMed  Google Scholar 

  11. Margulis V et al (2009) Predictors of oncological outcome after resection of locally recurrent renal cell carcinoma. J Urol 181(5):2044–2051

    Article  PubMed  Google Scholar 

  12. Kavolius JP et al (1998) Resection of metastatic renal cell carcinoma. J Clin Oncol 16(6):2261–2266

    CAS  PubMed  Google Scholar 

  13. Eggener SE et al (2008) Risk score and metastasectomy independently impact prognosis of patients with recurrent renal cell carcinoma. J Urol 180(3):873–878 discussion 878

    Article  PubMed Central  PubMed  Google Scholar 

  14. Kwak C et al (2007) Metastasectomy without systemic therapy in metastatic renal cell carcinoma: comparison with conservative treatment. Urol Int 79(2):145–151

    Article  PubMed  Google Scholar 

  15. Alt AL et al (2011) Survival after complete surgical resection of multiple metastases from renal cell carcinoma. Cancer 117(13):2873–2882

    Article  PubMed  Google Scholar 

  16. Zerbi A et al (2008) Pancreatic metastasis from renal cell carcinoma: which patients benefit from surgical resection? Ann Surg Oncol 15(4):1161–1168

    Article  PubMed  Google Scholar 

  17. Staehler MD et al (2010) Liver resection for metastatic disease prolongs survival in renal cell carcinoma: 12-year results from a retrospective comparative analysis. World J Urol 28(4):543–547

    Article  PubMed  Google Scholar 

  18. Piltz S et al (2002) Long-term results after pulmonary resection of renal cell carcinoma metastases. Ann Thorac Surg 73(4):1082–1087

    Article  PubMed  Google Scholar 

  19. Hofmann HS et al (2005) Prognostic factors and survival after pulmonary resection of metastatic renal cell carcinoma. Eur Urol 48(1):77–82

    Article  PubMed  Google Scholar 

  20. Murthy SC et al (2005) Can we predict long-term survival after pulmonary metastasectomy for renal cell carcinoma? Ann Thorac Surg 79(3):996–1003

    Article  PubMed  Google Scholar 

  21. Ljungberg B et al (1999) Follow-up guidelines for nonmetastatic renal cell carcinoma based on the occurrence of metastases after radical nephrectomy. BJU Int 84(4):405–411

    Article  CAS  PubMed  Google Scholar 

  22. Sandock DS, Seftel AD, Resnick MI (1995) A new protocol for the followup of renal cell carcinoma based on pathological stage. J Urol 154(1):28–31

    Article  CAS  PubMed  Google Scholar 

  23. Stephenson AJ et al (2004) Guidelines for the surveillance of localized renal cell carcinoma based on the patterns of relapse after nephrectomy. J Urol 172(1):58–62

    Article  PubMed  Google Scholar 

  24. Levy DA et al (1998) Stage specific guidelines for surveillance after radical nephrectomy for local renal cell carcinoma. J Urol 159(4):1163–1167

    Article  CAS  PubMed  Google Scholar 

  25. Kim SP et al (2011) Outcomes and clinicopathologic variables associated with late recurrence after nephrectomy for localized renal cell carcinoma. Urology 78(5):1101–1106

    Article  PubMed  Google Scholar 

  26. Adamy A et al (2011) Clinical characteristics and outcomes of patients with recurrence 5 years after nephrectomy for localized renal cell carcinoma. J Urol 185(2):433–438

    Article  PubMed  Google Scholar 

  27. Kroeger N et al (2014) Survival outcome and treatment response of patients with late relapse from renal cell carcinoma in the era of targeted therapy. Eur Urol 65(6):1086–1092

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

The Institutional Review Board of both centers approved this retrospective case cohort study and issued a waiver for patient informed consent; therefore, the study has been performed in accordance with the ethical standards laid down in most recent version of the Declaration of Helsinki.

Author information

Authors and Affiliations

  1. Department of Urology, Radboud University Medical Center, P.O. box 9101, 6525 GA, Nijmegen, The Netherlands

    Tim J. van Oostenbrugge

  2. Department of Urology, Jeroen Bosch Hospital, ’s Hertogenbosch, The Netherlands

    Stephanie G. C. Kroeze

  3. Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands

    J. L. H. Ruud Bosch

  4. Department of Urology, St Antonius Hospital, Utrecht/Nieuwegein, The Netherlands

    Harm H. E. van Melick

Authors
  1. Tim J. van Oostenbrugge
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephanie G. C. Kroeze
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. L. H. Ruud Bosch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harm H. E. van Melick
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tim J. van Oostenbrugge.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van Oostenbrugge, T.J., Kroeze, S.G.C., Bosch, J.L.H.R. et al. The blind spots in follow-up after nephrectomy or nephron-sparing surgery for localized renal cell carcinoma. World J Urol 33, 881–887 (2015). https://doi.org/10.1007/s00345-014-1390-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-014-1390-6

Keywords

Search

Navigation