Saeed Dabestani1, Christian Beisland2,3, Grant D Stewart4, Karim Bensalah5, Eirikur Gudmundsson6, Thomas B Lam7,8, William Gietzmann7, Paimaun Zakikhani8, Lorenzo Marconi9, Sergio Fernandéz-Pello10, Serenella Monagas11, Samuel P Williams12, Thomas Powles13, Erik Van Werkhoven14, Richard Meijer15, Alessandro Volpe16, Michael Staehler17, Börje Ljungberg18, Axel Bex19. 1. a Department of Clinical Sciences Lund , Lund University, Skane University Hospital , Lund , Sweden. 2. b Department of Urology , Haukeland University Hospital , Bergen , Norway. 3. c Department of Clinical Medicine , University of Bergen , Bergen , Norway. 4. d Department of Surgery , Academic Urology Group, University of Cambridge , Cambridge , United Kingdom. 5. e Department of Urology , University of Rennes , Rennes , France. 6. f Department of Urology , Landspitali University Hospital , Reykjavik , Iceland. 7. g Academic Urology Unit , University of Aberdeen , Aberdeen , United Kingdom. 8. h Department of Urology , Aberdeen Royal Infirmary , Aberdeen , United Kingdom. 9. i Department of Urology , Coimbra University Hospital , Coimbra , Portugal. 10. j Department of Urology , Cabueñes University Hospital , Gijón , Spain. 11. k Department of Urology , San Agustin University Hospital , Aviles , Spain. 12. l Medical School , University of Edinburgh , Edinburgh , United Kingdom. 13. m Barts Cancer Institute , Queen Mary University of London , London , United Kingdom. 14. n Department of Bioinformatics and Statistics , The Netherlands Cancer Institute , Amsterdam , The Netherlands. 15. o Department of Urology , University Medical Center Utrecht , Utrecht , The Netherlands. 16. p Department of Urology , University of Eastern Piedmont , Novara , Italy. 17. q Department of Urology , Klinikum Grosshadern, Ludwig Maximilians University of Munich , Munich , Germany. 18. r Department of Surgical and Perioperative Sciences , Umeå University , Umeå , Sweden. 19. s Division of Surgical Oncology, Department of Urology , The Netherlands Cancer Institute , Amsterdam , The Netherlands.
Abstract
Objective: Modality and frequency of image-based renal cell carcinoma (R.C.C.) follow-up strategies are based on risk of recurrence. Using the R.E.C.U.R.-database, frequency of imaging was studied in regard to prognostic risk groups. Furthermore, it was investigated whether imaging modality utilized in contemporary follow-up were associated with outcome after detection of recurrence. Moreover, outcome was compared based on whether the assessment of potential curability was a pre-defined set of criteria's (per-protocol) or stated by the investigator. Materials and methods: Consecutive non-metastatic R.C.C. patients (n = 1,612) treated with curative intent at 12 institutes across eight European countries between 2006 and 2011 were included. Leibovich or U.I.S.S. risk group, recurrence characteristics, imaging modality, frequency and survival were recorded. Primary endpoints were overall survival (O.S.) after detection of recurrence and frequency of features associated with favourable outcome (non-symptomatic recurrences and detection within the follow-up-programme). Results: Recurrence occurred in 336 patients. Within low, intermediate and high risk for recurrence groups, the frequency of follow-up imaging was highest in the early phase of follow-up and decreased significantly over time (p < 0.001). However, neither the image modality for detection nor ≥ 50% cross-sectional imaging during follow-up were associated with improved O.S. after recurrence. Differences between per protocol and investigator based assessment of curability did not translate into differences in O.S. Conclusions: As expected, the frequency of imaging was highest during early follow-up. Cross-sectional imaging use for detection of recurrences following surgery for localized R.C.C. did not improve O.S. post-recurrence. Prospective studies are needed to determine the value of imaging in follow-up.
Objective: Modality and frequency of image-based renal cell carcinoma (R.C.C.) follow-up strategies are based on risk of recurrence. Using the R.E.C.U.R.-database, frequency of imaging was studied in regard to prognostic risk groups. Furthermore, it was investigated whether imaging modality utilized in contemporary follow-up were associated with outcome after detection of recurrence. Moreover, outcome was compared based on whether the assessment of potential curability was a pre-defined set of criteria's (per-protocol) or stated by the investigator. Materials and methods: Consecutive non-metastatic R.C.C. patients (n = 1,612) treated with curative intent at 12 institutes across eight European countries between 2006 and 2011 were included. Leibovich or U.I.S.S. risk group, recurrence characteristics, imaging modality, frequency and survival were recorded. Primary endpoints were overall survival (O.S.) after detection of recurrence and frequency of features associated with favourable outcome (non-symptomatic recurrences and detection within the follow-up-programme). Results: Recurrence occurred in 336 patients. Within low, intermediate and high risk for recurrence groups, the frequency of follow-up imaging was highest in the early phase of follow-up and decreased significantly over time (p < 0.001). However, neither the image modality for detection nor ≥ 50% cross-sectional imaging during follow-up were associated with improved O.S. after recurrence. Differences between per protocol and investigator based assessment of curability did not translate into differences in O.S. Conclusions: As expected, the frequency of imaging was highest during early follow-up. Cross-sectional imaging use for detection of recurrences following surgery for localized R.C.C. did not improve O.S. post-recurrence. Prospective studies are needed to determine the value of imaging in follow-up.