Risk of kidney-cancer recurrence persists beyond 5 years after surgery

Last Updated: 2019-12-24

By Will Boggs MD

NEW YORK (Reuters Health) - The risk of recurrence in surgically treated renal-cell carcinoma (RCC) persists beyond five years after surgery, suggesting the need for continued surveillance, according to a new analysis.

"The optimal postoperative surveillance duration in patients who undergo surgical resection of clinically localized renal-cell carcinoma remains unclear," said Dr. Marcus L. Jamil from Vattikuti Urology Institute, Henry Ford Health System, in Detroit.

"However, we hope to have provided new and exciting data which may provide information to both the treating physician and patient in regards to longer-term follow-up and surveillance," he told Reuters Health by email.

Current guidelines from the American Urological Association recommend following patients with intermediate- and high-risk RCC with imaging up to five years after surgery and leave longer follow-up to the discretion of the treating physician.

Dr. Jamil and colleagues evaluated the 36-month cumulative incidence of RCC recurrence at set intervals following surgery in their post hoc analysis of 1,943 patients from the ASSURE trial.

Overall, 730 patients developed recurrence during a median follow-up of 67.9 months.

At 0 months from surgery, the 36-month cumulative incidence of recurrence was 31.1%. It was 26.0% for patients who did not have recurrence at 12 months from surgery, 18.8% at 24 months, 16.1% at 36 months, 18.9% at 48 months, and 20.3% at 60 months, the researchers report in European Urology.

On multivariable analysis, age, pathological T3/4 stage, pathological N1/2 stage, Fuhrman grade 3, and Fuhrman grade 4 independently predicted disease recurrence at 0 months from surgery, but none of these variables predicted recurrence at 60 months from surgery.

"While our study is unable to establish the optimal follow-up length in RCC patients, it clearly shows that the risk of recurrence at year 5 appears similar, if not higher, to that at years 2, 3, and 4 from surgery, and as such, the recommendation to stop following patients at 5 years is not necessarily appropriate," Dr. Jamil said.

"Furthermore," he said, "our findings demonstrate that the immediate postoperative recurrence estimates do not reflect the risk of recurrence after a certain period of postoperative survivorship and that this immediate postoperative risk of recurrence is not adequate in providing both the physician and the patient with the necessary information for counseling on the change in risk over time and during long-term follow-up."

"We hope that the findings of a fairly stable risk of disease recurrence encourage health professionals to follow these patients beyond 5 years," Dr. Jamil said. "We would like to emphasize that the patients included in this study are those with intermediate- and high-risk disease with negative surgical margins and, therefore, further investigations are warranted before applying these findings to all patients in similar circumstances."

SOURCE: https://bit.ly/33bTACk European Urology, online November 6, 2019.