Skip to main content
SpringerLink
Log in

Posttreatment Surveillance for Renal Cell Carcinoma

  • Chapter
  • First Online:
Diagnosis and Surgical Management of Renal Tumors

  • 727 Accesses

Abstract

After definitive treatment of renal cell carcinoma (RCC), patients remain at risk of developing a local relapse or distant metastatic disease. Posttreatment surveillance includes routine clinical examination, laboratory studies, and radiographic assessments with the objective of identifying recurrent disease in a timely fashion. In this chapter, we review available posttreatment risk stratification tools for patients with RCC as well as guidelines for follow-up surveillance. In addition, we identify current knowledge gaps and explore recent research aimed at optimizing posttreatment surveillance.

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

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Zisman A, Pantuck AJ, Wieder J, Chao DH, Dorey F, Said JW, et al. Risk group assessment and clinical outcome algorithm to predict the natural history of patients with surgically resected renal cell carcinoma. J Clin Oncol. 2002;20:4559–66.

    Article  Google Scholar 

  2. Kuczyk MA, Anastasiadis AG, Zimmermann R, Merseburger AS, Corvin S, Stenzl A. Current aspects of the surgical management of organ-confined, metastatic, and recurrent renal cell cancer. BJU Int. 2005;96:721–7.

    Article  Google Scholar 

  3. Speed JM, Trinh QD, Choueiri TK, Sun M. Recurrence in localized renal cell carcinoma: a systematic review of contemporary data. Curr Urol Rep. 2017;18(2):15.

    Article  Google Scholar 

  4. Psutka SP, Heidenreich M, Boorjian SA, Bailey GC, Cheville JC, Stewart-Merrill SB, et al. Renal fossa recurrence after nephrectomy for renal cell carcinoma: prognostic features and oncological outcomes. BJU Int. 2016;119(1):116–27.

    Article  Google Scholar 

  5. Bruno JJ 2nd, Snyder ME, Motzer RJ, Russo P. Renal cell carcinoma local recurrences: impact of surgical treatment and concomitant metastasis on survival. BJU Int. 2006;97:933–8.

    Article  Google Scholar 

  6. Schrodter S, Hakenberg OW, Manseck A, Leike S, Wirth MP. Outcome of surgical treatment of isolated local recurrence after radical nephrectomy for renal cell carcinoma. J Urol. 2002;167:1630–3.

    Article  Google Scholar 

  7. Margulis V, McDonald M, Tamboli P, Swanson DA, Wood CG. Predictors of oncological outcome after resection of locally recurrent renal cell carcinoma. J Urol. 2009;181:2044–51.

    Article  Google Scholar 

  8. Adamy A, Chong KT, Chade D, Costaras J, Russo G, Kaag MG, et al. Clinical characteristics and outcomes of patients with recurrence 5 years after nephrectomy for localized renal cell carcinoma. J Urol. 2011;185:433–8.

    Article  Google Scholar 

  9. Stewart-Merrill SB, Thompson RH, Boorjian SA, Psutka SP, Lohse CM, Cheville JC, et al. Oncologic surveillance after surgical resection for renal cell carcinoma: a novel risk-based approach. J Clin Oncol. 2015;33:4151–7.

    Article  Google Scholar 

  10. Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. Solid renal tumors: an analysis of pathological features related to tumor size. J Urol. 2003;170:2217–20.

    Article  Google Scholar 

  11. Klatte T, Patard JJ, de Martino M, Bensalah K, Verhoest G, de la Taille A, et al. Tumor size does not predict risk of metastatic disease or prognosis of small renal cell carcinomas. J Urol. 2008;179:1719–26.

    Article  Google Scholar 

  12. Crispen PL, Boorjian SA, Lohse CM, Sebo TS, Cheville JC, Blute ML, et al. Outcomes following partial nephrectomy by tumor size. J Urol. 2008;180:1912–7.

    Article  Google Scholar 

  13. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. AJCC cancer staging manual. 8th ed. New York: Springer International Publishing; 2017.

    Google Scholar 

  14. Ficarra V, Schips L, Guille F, Li G, De La Taille A, Prayer Galetti T, et al. Multiinstitutional European validation of the 2002 TNM staging system in conventional and papillary localized renal cell carcinoma. Cancer. 2005;104:968–74.

    Article  Google Scholar 

  15. Frank I, Blute ML, Leibovich BC, Cheville JC, Lohse CM, Zincke H. Independent validation of the 2002 American Joint Committee on cancer primary tumor classification for renal cell carcinoma using a large, single institution cohort. J Urol. 2005;173:1889–92.

    Article  Google Scholar 

  16. Novara G, Ficarra V, Antonelli A, Artibani W, Bertini R, Carini M, et al. Validation of the 2009 TNM version in a large multi-institutional cohort of patients treated for renal cell carcinoma: are further improvements needed? Eur Urol. 2010;58:588–95.

    Article  Google Scholar 

  17. Kim SP, Alt AL, Weight CJ, Costello BA, Cheville JC, Lohse C, et al. Independent validation of the 2010 American Joint Committee on Cancer TNM classification for renal cell carcinoma: results from a large, single institution cohort. J Urol. 2011;185:2035–9.

    Article  Google Scholar 

  18. Chen L, Li H, Gu L, Ma X, Li X, Zhang F, et al. Prognostic role of urinary collecting system invasion in renal cell carcinoma: a systematic review and meta-analysis. Sci Rep. 2016;6:21325.

    Article  CAS  Google Scholar 

  19. Fuhrman SA, Lasky LC, Limas C. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol. 1982;6:655–63.

    Article  CAS  Google Scholar 

  20. Brookman-May S, May M, Shariat SF, Xylinas E, Stief C, Zigeuner R, et al. Features associated with recurrence beyond 5 years after nephrectomy and nephron-sparing surgery for renal cell carcinoma: development and internal validation of a risk model (PRELANE score) to predict late recurrence based on a large multicenter database (CORONA/SATURN Project). Eur Urol. 2013;64:472–7.

    Article  Google Scholar 

  21. Zucchi A, Novara G, Costantini E, Antonelli A, Carini M, Carmignani G, et al. Prognostic factors in a large multi-institutional series of papillary renal cell carcinoma. BJU Int. 2012;109:1140–6.

    Article  Google Scholar 

  22. Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H. An outcome prediction model for patients with clear cell renal cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score. J Urol. 2002;168:2395–400.

    Article  Google Scholar 

  23. Delahunt B, Cheville JC, Martignoni G, Humphrey PA, Magi-Galluzzi C, McKenney J, et al. The International Society of Urological Pathology (ISUP) grading system for renal cell carcinoma and other prognostic parameters. Am J Surg Pathol. 2013;37:1490–504.

    Article  Google Scholar 

  24. Muglia VF, Prando A. Renal cell carcinoma: histological classification and correlation with imaging findings. Radiol Bras. 2015;48:166–74.

    Article  Google Scholar 

  25. Keegan KA, Schupp CW, Chamie K, Hellenthal NJ, Evans CP, Koppie TM. Histopathology of surgically treated renal cell carcinoma: survival differences by subtype and stage. J Urol. 2012;188:391–7.

    Article  Google Scholar 

  26. Nguyen DP, Vertosick EA, Corradi RB, Vilaseca A, Benfante NE, Touijer KA, et al. Histological subtype of renal cell carcinoma significantly affects survival in the era of partial nephrectomy. Urol Oncol. 2016;34:259.e1–8.

    Article  Google Scholar 

  27. Huang H, Pan XW, Huang Y, Xu DF, Cui XG, Li L, et al. Microvascular invasion as a prognostic indicator in renal cell carcinoma: a systematic review and meta-analysis. Int J Clin Exp Med. 2015;8:10779–10,792.

    Google Scholar 

  28. Dall’Oglio MF, Ribeiro-Filho LA, Antunes AA, Crippa A, Nesrallah L, Goncalves PD, et al. Microvascular tumor invasion, tumor size and Fuhrman grade: a pathological triad for prognostic evaluation of renal cell carcinoma. J Urol. 2007;178:425–8.

    Article  Google Scholar 

  29. Keskin SK, Msaouel P, Hess KR, Yu KJ, Matin SF, Sircar K, et al. Outcomes of patients with renal cell carcinoma and sarcomatoid dedifferentiation treated with nephrectomy and systemic therapies over three decades: comparison between the cytokine (1987–2005) and the targeted therapy (2006–2015) eras. J Urol. 2017;198(3):530–7.

    Article  Google Scholar 

  30. Shuch B, Bratslavsky G, Linehan WM, Srinivasan R. Sarcomatoid renal cell carcinoma: a comprehensive review of the biology and current treatment strategies. Oncologist. 2012;17:46–54.

    Article  CAS  Google Scholar 

  31. Costello BA, Zhang B, Lohse CM, Boorjian SA, Cheville JC, Leibovich BC, et al. Outcomes of patients with sarcomatoid renal cell carcinoma: the Mayo Clinic experience. J Clin Oncol. 2013;31(6_suppl):359. https://doi.org/10.1200/jco.2013.31.6_suppl.359.

    Article  Google Scholar 

  32. Belsante M, Darwish O, Youssef R, Bagrodia A, Kapur P, Sagalowsky AI, et al. Lymphovascular invasion in clear cell renal cell carcinoma – association with disease-free and cancer-specific survival. Urol Oncol. 2014;32(30):e23–8.

    Google Scholar 

  33. Lam JS, Shvarts O, Said JW, Pantuck AJ, Seligson DB, Aldridge ME, et al. Clinicopathologic and molecular correlations of necrosis in the primary tumor of patients with renal cell carcinoma. Cancer. 2005;103:2517–25.

    Article  CAS  Google Scholar 

  34. Leibovich BC, Cheville JC, Lohse CM, Zincke H, Frank I, Kwon ED, et al. A scoring algorithm to predict survival for patients with metastatic clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. J Urol. 2005;174:1759–63. discussion 1763

    Article  Google Scholar 

  35. Parker WP, Cheville JC, Frank I, Zaid HB, Lohse CM, Boorjian SA, et al. Application of the stage, size, grade, and necrosis (SSIGN) score for clear cell renal cell carcinoma in contemporary patients. Eur Urol. 2017;71:665–73.

    Article  Google Scholar 

  36. Peckova K, Martinek P, Pivovarcikova K, Vanecek T, Alaghehbandan R, Prochazkova K, et al. Cystic and necrotic papillary renal cell carcinoma: prognosis, morphology, immunohistochemical, and molecular-genetic profile of 10 cases. Ann Diagn Pathol. 2017;26:23–30.

    Article  Google Scholar 

  37. Cindolo L, de la Taille A, Messina G, Romis L, Abbou CC, Altieri V, et al. A preoperative clinical prognostic model for non-metastatic renal cell carcinoma. BJU Int. 2003;92:901–5.

    Article  CAS  Google Scholar 

  38. Kattan MW, Reuter V, Motzer RJ, Katz J, Russo P. A postoperative prognostic nomogram for renal cell carcinoma. J Urol. 2001;166:63–7.

    Article  CAS  Google Scholar 

  39. Veeratterapillay R, Rakhra S, El-Sherif A, Johnson M, Soomro N, Heer R. Can the Kattan nomogram still accurately predict prognosis in renal cell carcinoma using the revised 2010 tumor-nodes-metastasis reclassification? Int J Urol. 2012;19:773–6.

    Article  Google Scholar 

  40. Leibovich BC, Blute ML, Cheville JC, Lohse CM, Frank I, Kwon ED, et al. Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials. Cancer. 2003;97:1663–71.

    Article  Google Scholar 

  41. Zigeuner R, Hutterer G, Chromecki T, Imamovic A, Kampel-Kettner K, Rehak P, et al. External validation of the Mayo Clinic stage, size, grade, and necrosis (SSIGN) score for clear-cell renal cell carcinoma in a single European centre applying routine pathology. Eur Urol. 2010;57:102–9.

    Article  Google Scholar 

  42. Karakiewicz PI, Briganti A, Chun FK, Trinh QD, Perrotte P, Ficarra V, et al. Multi-institutional validation of a new renal cancer-specific survival nomogram. J Clin Oncol. 2007;25:1316–22.

    Article  Google Scholar 

  43. Zisman A, Pantuck AJ, Dorey F, Said JW, Shvarts O, Quintana D, et al. Improved prognostication of renal cell carcinoma using an integrated staging system. J Clin Oncol. 2001;19:1649–57.

    Article  CAS  Google Scholar 

  44. Ljungberg B, Albiges L, Bensalah K, Bex A, Giles RH, Hora M, et al. EAU guidelines: renal cell carcinoma. Eur Urol. 2017;

    Google Scholar 

  45. Donat SM, Diaz M, Bishoff JT, Coleman JA, Dahm P, Derweesh IH, et al. Follow-up for clinically localized renal neoplasms: AUA guideline. J Urol. 2013;190:407–16.

    Article  Google Scholar 

  46. Pierorazio PM, Johnson MH, Patel HD, Sozio SM, Sharma R, Iyoha E, et al. Management of renal masses and localized renal cancer: systematic review and meta-analysis. J Urol. 2016;196(4):989–99.

    Article  Google Scholar 

  47. Kang HW, Lee SK, Kim WT, Yun SJ, Lee SC, Kim WJ, et al. Surgical margin does not influence recurrence rate in pT1 clear cell renal cell carcinoma after partial nephrectomy: a multicenter study. J Surg Oncol. 2016;114:70–4.

    Article  Google Scholar 

  48. Shah PH, Moreira DM, Okhunov Z, Patel VR, Chopra S, Razmaria AA, et al. Positive surgical margins increase risk of recurrence after partial nephrectomy for high risk renal tumors. J Urol. 2016;196:327–34.

    Article  Google Scholar 

  49. Maurice MJ, Zhu H, Kim SP, Abouassaly R. Reexamining the association between positive surgical margins and survival after partial nephrectomy in a large American cohort. J Endourol. 2016;30:698–703.

    Article  Google Scholar 

  50. Pierorazio PM, Hyams ES, Lin BM, Mullins JK, Allaf ME. Laparoscopic radical nephrectomy for large renal masses: critical assessment of perioperative and oncologic outcomes of stage T2a and T2b tumors. Urology. 2012;79:570–5.

    Article  Google Scholar 

  51. Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H. Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc. 2000;75:1236–42.

    Article  CAS  Google Scholar 

  52. Alemozaffar M, Filson CP, Master VA. The importance of surgical margins in renal cell and urothelial carcinomas. J Surg Oncol. 2016;113:316–22.

    Article  Google Scholar 

  53. Yossepowitch O, Bjartell A, Eastham JA, Graefen M, Guillonneau BD, Karakiewicz PI, et al. Positive surgical margins in radical prostatectomy: outlining the problem and its long-term consequences. Eur Urol. 2008;55(1):87–99.

    Article  Google Scholar 

  54. Bensalah K, Pantuck AJ, Rioux-Leclercq N, Thuret R, Montorsi F, Karakiewicz PI, et al. Positive surgical margin appears to have negligible impact on survival of renal cell carcinomas treated by nephron-sparing surgery. Eur Urol. 2010;57:466–71.

    Article  Google Scholar 

  55. Abel EJ, Carrasco A, Karam J, Tamboli P, Delacroix S, Vaporciyan AA, et al. Positive vascular wall margins have minimal impact on cancer outcomes in non-metastatic RCC patients with tumor thrombus. BJU Int. 2014;114(5):667–73.

    Article  Google Scholar 

  56. Liu NW, Wren JD, Vertosick E, Lee JK, Power NE, Benfante NE, et al. The prognostic impact of a positive vascular margin on pT3 clear cell renal cell carcinoma. J Urol. 2016;195:264–9.

    Article  Google Scholar 

  57. Kassouf W, Siemens R, Morash C, Lacombe L, Jewett M, Goldenberg L, et al. Follow-up guidelines after radical or partial nephrectomy for localized and locally advanced renal cell carcinoma. Can Urol Assoc J. 2009;3:73–6.

    Article  Google Scholar 

  58. Motzer RJ, Jonasch E, Agarwal N, Bhayani S, Bro WP, Chang SS, et al. NCCN clinical practice guidelines in oncology: kidney cancer version 2.2017. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. 2016.

    Google Scholar 

  59. Doornweerd BH, de Jong IJ, Bergman LM, Ananias HJ. Chest X-ray in the follow-up of renal cell carcinoma. World J Urol. 2014;32:1015–9.

    CAS  PubMed  Google Scholar 

  60. Stewart SB, Thompson RH, Psutka SP, Cheville JC, Lohse CM, Boorjian SA, et al. Evaluation of the National Comprehensive Cancer Network and American Urological Association renal cell carcinoma surveillance guidelines. J Clin Oncol. 2014;32(36):4059–65.

    Article  Google Scholar 

  61. Thompson RH, Atwell T, Schmit G, Lohse CM, Kurup AN, Weisbrod A, et al. Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses. Eur Urol. 2015;67:252–9.

    Article  Google Scholar 

  62. Escudier B, Porta C, Schmidinger M, Rioux-Leclercq N, Bex A, Khoo V, et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27:v58–68.

    Article  CAS  Google Scholar 

  63. Brenner DJ, Elliston CD. Estimated radiation risks potentially associated with full-body CT screening. Radiology. 2004;232:735–8.

    Article  Google Scholar 

  64. Board on Radiation Effects Research Division on Earth and Life Sciences National Research Council of the National Academics. Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. Washington, D.C.: National Academies Press; 2006.

    Google Scholar 

  65. Mileto A, Nelson RC, Paulson EK, Marin D. Dual-energy MDCT for imaging the renal mass. Am J Roentgenol. 2015;204:W640–7.

    Article  Google Scholar 

  66. Capogrosso P, Capitanio U, La Croce G, Nini A, Salonia A, Montorsi F, et al. Follow-up after treatment for renal cell carcinoma: the evidence beyond the guidelines. Eur Urol. 2016;272:272–81.

    Article  Google Scholar 

  67. Sohn W, Graves AJ, Tyson MD, O’Neil B, Chang SS, Ni S, et al. An empiric evaluation of the effect of variation in intensity of followup for surgically treated renal neoplasms on cancer specific survival. J Urol. 2017;197:37–43.

    Article  Google Scholar 

  68. Park I, Lee JL, Ahn JH, Lee DH, Lee KH, Jeong IG, et al. Active surveillance for metastatic or recurrent renal cell carcinoma. J Cancer Res Clin Oncol. 2014;140:1421–8.

    Article  CAS  Google Scholar 

  69. Rini BI, Dorff TB, Elson P, Rodriguez CS, Shepard D, Wood L, et al. Active surveillance in metastatic renal-cell carcinoma: a prospective, phase 2 trial. Lancet Oncol. 2016;17:1317–224.

    Article  Google Scholar 

  70. Thomas AZ, Adibi M, Borregales LD, Hoang LN, Tamboli P, Jonasch E, et al. Surgical management of local retroperitoneal recurrence of renal cell carcinoma after radical nephrectomy. J Urol. 2015;194:316–22.

    Article  Google Scholar 

  71. Ljungberg B, Alamdari FI, Rasmuson T, Roos G. Follow-up guidelines for nonmetastatic renal cell carcinoma based on the occurrence of metastases after radical nephrectomy. BJU Int. 1999;84:405–11.

    Article  CAS  Google Scholar 

  72. Lam JS, Shvarts O, Leppert JT, Pantuck AJ, Figlin RA, Belldegrun AS. Postoperative surveillance protocol for patients with localized and locally advanced renal cell carcinoma based on a validated prognostic nomogram and risk group stratification system. J Urol. 2005;174:466–72. discussion 472; quiz 801

    Article  Google Scholar 

  73. Siddiqui SA, Frank I, Cheville JC, Lohse CM, Leibovich BC, Blute ML. Postoperative surveillance for renal cell carcinoma: a multifactorial histological subtype specific protocol. BJU Int. 2009;104:778–85.

    Article  Google Scholar 

  74. Williamson TJ, Pearson JR, Ischia J, Bolton DM, Lawrentschuk N. Guideline of guidelines: follow-up after nephrectomy for renal cell carcinoma. BJU Int. 2016;117:555–62.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Mayo Clinic Arizona, Phoenix, AZ, USA

    Karan Arora

  2. Department of Urology, University of Washington School of Medicine, Seattle, WA, USA

    Sarah P. Psutka

  3. Seattle Cancer Care Alliance, Seattle, WA, USA

    Sarah P. Psutka

  4. Harborview Medical Center, Seattle, WA, USA

    Sarah P. Psutka

Authors
  1. Karan Arora
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sarah P. Psutka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah P. Psutka .

Editor information

Editors and Affiliations

  1. The James Buchanan Brady Urological, Institute and Department of Urology, Johns Hopkins University School of Medic, Baltimore, MD, USA

    Michael A. Gorin

  2. The James Buchanan Brady Urological, Institute and Department of Urology, Johns Hopkins University School of Medic, Baltimore, MD, USA

    Mohamad E. Allaf

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Arora, K., Psutka, S.P. (2019). Posttreatment Surveillance for Renal Cell Carcinoma. In: Gorin, M., Allaf, M. (eds) Diagnosis and Surgical Management of Renal Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-92309-3_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-92309-3_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-92308-6

  • Online ISBN: 978-3-319-92309-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation