title: An Empiric Evaluation of the Effect of Variation in Intensity of Followup for Surgically Treated Renal Neoplasms on Cancer Specific Survival.
abstract: Followup protocols after the surgical management of renal cell carcinoma lack clear evidence linking the intensity of imaging surveillance to improved outcomes. In this context we characterized the relationship between surveillance imaging intensity and cancer specific survival.
  
  
  
  Using SEER-Medicare data we identified 7,603 men with renal cell carcinoma treated surgically between 2004 and 2009. Multivariable negative binomial regression analysis was performed to assess the relationship between patient level characteristics and the variation in imaging intensity. We modeled the association between kidney cancer specific mortality and imaging intensity using Fine and Gray proportional subdistribution hazards regression with other cause death treated as a competing risk for 2 separate followup periods (15 and 36 months).
  
  
  
  More than 40% of patients in the short interval cohort and more than 50% in the intermediate interval group underwent no chest imaging during the evaluated survivorship period. More than 30% of patients in both followup periods had no abdominal imaging tests performed. Overall, followup imaging did not appear to confer an improvement in disease specific survival compared to undergoing no imaging in the 2 survivorship periods.
  
  
  
  There remains considerable variation in the posttreatment surveillance regimen for patients with renal cell carcinoma in the United States. More importantly, this study raises important questions regarding the link between posttreatment surveillance imaging and survival.
authors: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: William
authors: W
authors: Sohn
authors: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Amy J
authors: AJ
authors: Graves
authors: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Mark D
authors: MD
authors: Tyson
authors: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Brock
authors: B
authors: O'Neil
authors: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Sam S
authors: SS
authors: Chang
authors: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Shenghua
authors: S
authors: Ni
authors: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Daniel A
authors: DA
authors: Barocas
authors: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee; Geriatric Research, Education, and Clinical Center, Tennessee Valley VA Health Care System, Nashville, Tennessee.
authors: David F
authors: DF
authors: Penson
authors: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee; Geriatric Research, Education, and Clinical Center, Tennessee Valley VA Health Care System, Nashville, Tennessee. Electronic address: Matthew.Resnick@vanderbilt.edu.
authors: Matthew J
authors: MJ
authors: Resnick
mesh_terms: D000367:Age Factors; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D002423:Cause of Death; D015331:Cohort Studies; D003952:Diagnostic Imaging / Q000379:methods*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods* / Q000401:mortality; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D018426:SEER Program; D016019:Survival Analysis; D014481:United States
keywords: carcinoma; multimodal imaging; outcome assessment (health care); renal cell; survival; watchful waiting