title: A prospective risk-stratified follow-up programme for radically treated renal cell carcinoma patients: evaluation after eight years of clinical use.
abstract: OBJECTIVE
  In mid-2007, we introduced a new risk-stratified follow-up programme (FUP) for surgically treated localized renal cell carcinoma. After inclusion, the patients have been followed prospectively. In this study, we present the results in regard to stratification, completeness of the FUP and recurrences.
  
  
  METHODS
  The FUP consists of three risk groups: low risk (LR), intermediate risk (IR) and high risk (HR), based on the risk stratification model introduced by Leibovich et al. (Cancer 97(7):1663-1671, 2003). In all risk groups, the patients are scheduled for ten follow-up visits (FUV) over 5 years, but seven, five and three FUVs, respectively, are outsourced to the patient's general practitioner (GP). Chest X-ray and abdomen CT are the imaging modalities used in the FUP.
  
  
  RESULTS
  Of 312 included patients, 195 (62.5 %) had a complete FUP. However, in 86 patients the scheduled FUP had to be reduced, leaving 86.3 % of the remaining patients with a complete FUP. By including GPs, the number of FUVs at the hospital was reduced by ~60 %. The 5-year probability for freedom of recurrence is 0.98, 0.84 and 0.52 for the LR, IR and HR groups, respectively. Of 31 recurrences, 20 patients (65 %) were diagnosed within the FUP. Eleven patients (35 %) were diagnosed due to symptoms, and five of these had recurrences in locations not covered by standard imaging. Patients diagnosed within the FUP showed a better prognosis for survival and could in greater part receive tumour-directed treatment.
  
  
  CONCLUSIONS
  After 8 years of clinical use, the outcome measures of the FUP seem to be within acceptable ranges.
authors.affiliation: Department of Urology, Haukeland University Hospital, 5021, Bergen, Norway. christian.beisland@helse-bergen.no.|Department of Clinical Medicine, University of Bergen, Bergen, Norway. christian.beisland@helse-bergen.no.
authors.forename: Christian
authors.identifier: http://orcid.org/0000-0002-3216-4937
authors.initials: C
authors.lastname: Beisland
authors.affiliation: Department of Urology, Haukeland University Hospital, 5021, Bergen, Norway.
authors.forename: Gigja
authors.initials: G
authors.lastname: Guðbrandsdottir
authors.affiliation: Department of Radiology, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Lars A R
authors.initials: LA
authors.lastname: Reisæter
authors.affiliation: Department of Pathology, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Leif
authors.initials: L
authors.lastname: Bostad
authors.affiliation: Department of Urology, Haukeland University Hospital, 5021, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Karin M
authors.initials: KM
authors.lastname: Hjelle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D013997:Time Factors; D055815:Young Adult
keywords: External validation; Follow-up; Integrated staging systems; Prospective evaluation; Recurrence; Renal cell carcinoma; Risk stratification; Survival