Login to Access Video or Poster Abstract: MP72-12
Sources of Funding: None

Introduction

The risk of recurrence following surgical excision of clear cell renal cell carcinoma (ccRCC) varies based on clinical and pathologic features, while risk of non-cancer death evolves as a function of age and comorbidities. Despite these differences in how these competing risks mature over time, current guidelines recommend surveillance based on stage alone. We therefore sought to develop risk adapted postoperative surveillance recommendations.

Methods

Patients with ccRCC managed surgically between 1990 and 2008 (n=2,511) were identified from the Mayo Clinic Nephrectomy registry and risks of abdominal and chest recurrence estimated using accelerated failure-time (AFT) models by pathology stage (pT1a, pT1b, pT2, pT3/4, or pTanyN+). Similarly, risk of non-cancer death was estimated by age (<50, 51-59, 60-69, 70-79, and ≥80) and comorbidity index (CCI: ≤1 versus >1). Recommended surveillance schedules balance estimated risk of non-cancer death with recurrence risk where allowable recurrence is up to the risk of non-cancer death. Surveillance intervals were calculated based on each 1%, 3%, and 5% recurrence risk increase to a maximum 10 years. Intervals shorter than 3 months were not allowed, with the next risk increase calculated from the date of the adjusted interval.

Results

AFT models for recurrence and death for stage, age, and comorbidity risk groups were generated (tables). Recommended interval schedules (e.g. 1%, 3%, or 5%) are based on the predicted risk of non-cancer death for a given age and CCI group. For example, patients <70 years with a CCI score ≤1 would be followed on a 1% risk of recurrence schedule for the duration of 10 years of follow-up regardless of stage. Conversely, patients 60-69 years old with a CCI >1, would follow a 1% interval for the first year only, then switch to 3% interval until year 6, at which point they would follow a 5% schedule.

Conclusions

Using an AFT model for estimating risk of recurrence and risk of death we were able to generate risk-adapted screening intervals for surgical managed patients with RCC.

Funding

None