Low yield of surveillance imaging after surgery for T1 kidney cancer.
OBJECTIVE
To examine the mode of relapse detection and subsequent treatment after partial or radical nephrectomy in patients with low-risk (pT1, N0, Nx) kidney cancer.


METHODS
Retrospective study on 1404 patients treated with partial or radical nephrectomy for low-risk kidney cancer from the years 2000-2012. Scans for chest imaging (X-ray or CT) and abdominal imaging (CT, MRI, or ultrasound) are tabulated. For those patients with relapse, the site, mode of detection, and symptoms were recorded.


RESULTS
Twenty-one patients relapsed with a median follow-up of 4.1 years for patients who did not relapse. In 17 (81 %) patients, relapse was detected by imaging alone, while 4 (19 %) patients presented with symptoms. Of the patients who relapsed by imaging, 13 (76 %) were treated immediately, while 4 (24 %) continued observation. During the first 3 years of follow-up, 5762 imaging studies were performed to detect 8 relapses, with 6 patients receiving immediate treatment. The median number of imaging studies per patient per year for the first 3 years was 1.7 (interquartile range 1.0, 2.3) including 30 % CT, 3 % MRI, 36 % X-ray, and 31 % ultrasounds.


CONCLUSIONS
We found a low yield of surveillance imaging in the first 3 years for pT1 kidney cancer. Nearly 1000 imaging studies were performed to detect one relapse that required treatment. Further studies are needed to evaluate the clinical impact of imaging surveillance according to recent guidelines.
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Mfeuerste1@nshs.edu.|Department of Urology, Lenox Hill Hospital, 170 E. 77th St, New York, NY, 10075, USA. Mfeuerste1@nshs.edu.
Michael A
http://orcid.org/0000-0002-7956-6087
MA
Feuerstein
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
John E
JE
Musser
Department of Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Matthew
M
Kent
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Michael
M
Chevinsky
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Eugene K
EK
Cha
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Simon
S
Kimm
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
William M
WM
Hilton
Department of Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Daniel D
DD
Sjoberg
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Timothy F
TF
Donahue
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Hebert A
HA
Vargas
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Jonathan A
JA
Coleman
Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Paul
P
Russo
D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000453:epidemiology; D009367:Neoplasm Staging; D009392:Nephrectomy; D011159:Population Surveillance; D012189:Retrospective Studies
Follow-up studies; Nephrectomy; Renal neoplasm