Paolo Capogrosso1, Umberto Capitanio2, Giovanni La Croce2, Alessandro Nini2, Andrea Salonia2, Francesco Montorsi2, Roberto Bertini2. 1. Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: paolo.capogrosso@gmail.com. 2. Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
Abstract
CONTEXT: Postoperative follow-up is considered the standard of care for nonmetastatic renal cell carcinoma (RCC). However, level 1 evidence regarding a proper follow-up protocol for RCC is still lacking, making clinical practice extremely heterogeneous. OBJECTIVE: To evaluate systematically and summarise the evidence supporting the current clinical guidelines on follow-up after RCC treatment. EVIDENCE ACQUISITION: A search of Medline, PubMed and Scopus was performed to identify articles published in the last 5 yr addressing the role of follow-up in the RCC setting. Relevant studies were then screened, and the data were extracted, analysed, and summarised. The Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria were applied. EVIDENCE SYNTHESIS: Although several series regarding oncologic outcomes and protocols of surveillance after nephrectomy for localised RCC have been published in the literature, the individual preferences of the treating urologist make the daily clinical scenario extremely heterogeneous regarding follow-up indications and modality. Clinical guidelines support a stage-specific stratification of patient prognosis based on pathologic staging or prognostic models. In the context of a prospectively durable follow-up protocol exposing patients to several imaging tests, concerns about radiation exposure must be taken into account. A better understanding of tumour biology, which would lead to a correct individualisation of patient prognosis through the use of validated prognostic tools, would allow for a more tailored follow-up treatment. CONCLUSIONS: A consensus regarding the pattern and modalities of surveillance after treatment for RCC is still lacking. A standardised evidence-based surveillance protocol that would allow for the early detection of recurrences and limit unnecessary radiation exposure and unwarranted costs is mandatory. PATIENT SUMMARY: A surveillance protocol after treatment for a renal tumour is essential for the early detection and treatment of eventual metastases. A general consensus regarding timing and modalities for follow-up protocol still does not exist, but published evidence commonly sustains some general principles.
CONTEXT: Postoperative follow-up is considered the standard of care for nonmetastatic renal cell carcinoma (RCC). However, level 1 evidence regarding a proper follow-up protocol for RCC is still lacking, making clinical practice extremely heterogeneous. OBJECTIVE: To evaluate systematically and summarise the evidence supporting the current clinical guidelines on follow-up after RCC treatment. EVIDENCE ACQUISITION: A search of Medline, PubMed and Scopus was performed to identify articles published in the last 5 yr addressing the role of follow-up in the RCC setting. Relevant studies were then screened, and the data were extracted, analysed, and summarised. The Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria were applied. EVIDENCE SYNTHESIS: Although several series regarding oncologic outcomes and protocols of surveillance after nephrectomy for localised RCC have been published in the literature, the individual preferences of the treating urologist make the daily clinical scenario extremely heterogeneous regarding follow-up indications and modality. Clinical guidelines support a stage-specific stratification of patient prognosis based on pathologic staging or prognostic models. In the context of a prospectively durable follow-up protocol exposing patients to several imaging tests, concerns about radiation exposure must be taken into account. A better understanding of tumour biology, which would lead to a correct individualisation of patient prognosis through the use of validated prognostic tools, would allow for a more tailored follow-up treatment. CONCLUSIONS: A consensus regarding the pattern and modalities of surveillance after treatment for RCC is still lacking. A standardised evidence-based surveillance protocol that would allow for the early detection of recurrences and limit unnecessary radiation exposure and unwarranted costs is mandatory. PATIENT SUMMARY: A surveillance protocol after treatment for a renal tumour is essential for the early detection and treatment of eventual metastases. A general consensus regarding timing and modalities for follow-up protocol still does not exist, but published evidence commonly sustains some general principles.
Authors: Paolo Capogrosso; Alessandro Larcher; Daniel D Sjoberg; Emily A Vertosick; Francesco Cianflone; Paolo Dell'Oglio; Cristina Carenzi; Andrea Salonia; Andrew J Vickers; Francesco Montorsi; Roberto Bertini; Umberto Capitanio Journal: J Urol Date: 2018-01-31 Impact factor: 7.450
Authors: Manuela Costantini; Maria Luana Poeta; Ruth M Pfeiffer; Dana Hashim; Catherine L Callahan; Steno Sentinelli; Laura Mendoza; Marco Vicari; Vincenzo Pompeo; Angela Cecilia Pesatori; Curt T DellaValle; Giuseppe Simone; Vito Michele Fazio; Michele Gallucci; Maria Teresa Landi Journal: Clin Genitourin Cancer Date: 2021-07-10 Impact factor: 3.121