Increased use of cross-sectional imaging for follow-up does not improve post-recurrence survival of surgically treated initially localized RCC: results from a European multicenter database (RECUR)

Saeed Dabestani, Christian Beisland, Grant D. Stewart, Karim Bensalah, Eirikur Gudmundsson, Thomas B. Lam, William Gietzmann, Paimaun Zakikhani, Lorenzo Marconi, Sergio Fernandez-Pello, Serenella Monagas, Samuel P. Williams, Thomas Powles, Erik Van Werkhovenn, Richard Meijer, Alessandro Volpe, Michael Staehler, Borje Ljungberg, Axel Bex

Research output: Contribution to journalArticleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)14-20
Number of pages7
JournalScandinavian Journal of Urology
Volume53
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019

Keywords

  • Aged
  • Carcinoma, Renal Cell/diagnostic imaging
  • Databases, Factual
  • Diagnostic Imaging/methods
  • Europe
  • Female
  • Follow-Up Studies
  • Humans
  • Kidney Neoplasms/diagnostic imaging
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local/diagnostic imaging
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • imaging
  • follow-up
  • Renal cell carcinoma
  • overall survival

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