Abstract: PD52-06
Sources of Funding: None

Introduction

Oncologic surveillance is an integral part of renal cell carcinoma (RCC) care. Whether this practice affords a survival benefit remains unclear. Our objective was to determine whether detection of RCC recurrences in an asymptomatic vs. symptomatic manner influenced all cause mortality following kidney cancer surgery.

Methods

We identified 737 patients who underwent partial or radical nephrectomy for non-metastatic RCC at our institution between 1998 and 2016. Overall survival in patients with recurrence stratified by the type of detection (asymptomatic vs symptomatic) was estimated using Kaplan-Meier probabilities and compared with the log rank test. Cox proportional hazard regression models were used to evaluate the impact of the type of recurrence detection on survival.

Results

A total of 78 patients (10.6%) experienced recurrence after surgery at a median interval of 17 months (range, 0 - 172). Median postoperative follow-up for all recurrences was 47 months (range, 3 - 230). Recurrences were detected in 63 (80.8%) patients using routine surveillance (asymptomatic) and in 15 (19.2%) patients due to symptoms. There were no significant differences in clinicopathological features of the primary tumors between the two types of detection. Five and 10-year overall survival among patients with asymptomatic vs. symptomatic recurrences was 56% and 37% vs. 24% and 8%, respectively (p = 0.0003) (Figure). On multivariable analysis, patients in whom recurrences were detected from symptoms showed a 3-fold increased risk of death as compared to those in whom recurrences were detected asymptomatically via routine surveillance (HR 3.15, 95% CI 1.33, 7.46; p = 0.009).

Conclusions

Capturing RCC recurrences in an asymptomatic manner during routine surveillance is associated with improved patient survival. Further investigation to optimize a surveillance protocol which balances the benefit of early detection with the cost of follow-up is needed.

Funding

None