EARLY RECURRENCE PATTERNS SHOULD INFORM SURVEILLANCE PROTOCOLS FOLLOWING SURGERY FOR HIGH RISK NON-METASTATIC RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (PD46)1 Apr 2019PD46-08 EARLY RECURRENCE PATTERNS SHOULD INFORM SURVEILLANCE PROTOCOLS FOLLOWING SURGERY FOR HIGH RISK NON-METASTATIC RENAL CELL CARCINOMA Leo D. Dreyfuss*, Viraj A. Master, Jay D. Raman, Philippe E. Spiess, Charles C. Peyton, Suzanne B Merrill, Brian Sohl, Dattatraya Patil, Daniel D. Shapiro, Glenn O. Allen, and Edwin Jason Abel Leo D. Dreyfuss*Leo D. Dreyfuss* More articles by this author , Viraj A. MasterViraj A. Master More articles by this author , Jay D. RamanJay D. Raman More articles by this author , Philippe E. SpiessPhilippe E. Spiess More articles by this author , Charles C. PeytonCharles C. Peyton More articles by this author , Suzanne B MerrillSuzanne B Merrill More articles by this author , Brian SohlBrian Sohl More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Daniel D. ShapiroDaniel D. Shapiro More articles by this author , Glenn O. AllenGlenn O. Allen More articles by this author , and Edwin Jason AbelEdwin Jason Abel More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556752.99090.7cAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Adjuvant clinical therapy trials have demonstrated that recurrence is most common during the first two years following surgery for high risk renal cell carcinoma (RCC). The objective of this study is to evaluate the utility of surveillance imaging templates to identify recurrences and to describe site specific predictors of early (≤2 years) recurrence for non-metastatic ≥pT3a RCC patients following surgery at 4 independent centers. METHODS: Data for non-metastatic ≥pT3a RCC patients treated surgically from 2000-2016 at 4 centers was analyzed. Surveillance included cross sectional imaging of chest, abdomen and pelvis (CAP) q3-6 months following surgery. Imaging templates were defined by anatomic landmarks from radiology definitions. Prognostic factors for site specific recurrence were evaluated with uni/multivariate analysis. RESULTS: Of 1296 patients treated surgically for ≥pT3a RCC, recurrence was identified in 313 (24%) patients at median 9.8 (IQR=4.4-21) months postoperatively. Most recurrences were detected during the first (57%) and second year (20%) of postoperative surveillance. Complete follow-up information for 1 and 2 years was available for 844 and 709 patients. Initial recurrence was single site (52%) or multiple sites (48%), including: lung (51%), liver (24%), bone (24%), and brain (8%). Local recurrences were identified in 15 (5%) patients. Early recurrence sites were grouped by the imaging template necessary to diagnose metastases. Template- specific predictors of early recurrences are shown in table. Including only chest/abdominal imaging failed to identify 23% of metastases during the first two years following surgery. Pelvic imaging detected 9% of recurrences within in first 2 years. A total of 14% of recurrences were identified outside CAP template. Most common site of extra template metastasis was brain (58%). Nuclear grade 4 was only independent predictor of brain metastasis: OR=19, p=0.001. CONCLUSIONS: Postoperative surveillance imaging for high risk RCC patients should focus on chest and abdomen, but also include pelvic cross sectional imaging. Careful history and physical exam may help to identify recurrences outside imaging templates. Screening for brain metastases may be considered for patients with grade 4 primary tumors. Source of Funding: none Madison, WI; Atlanta, GA; Hershey, PA; Tampa, FL; Hershey, PA; Atlanta, GA; Madison, WI© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e834-e835 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leo D. Dreyfuss* More articles by this author Viraj A. Master More articles by this author Jay D. Raman More articles by this author Philippe E. Spiess More articles by this author Charles C. Peyton More articles by this author Suzanne B Merrill More articles by this author Brian Sohl More articles by this author Dattatraya Patil More articles by this author Daniel D. Shapiro More articles by this author Glenn O. Allen More articles by this author Edwin Jason Abel More articles by this author Expand All Advertisement PDF downloadLoading ...