No Value in Surveillance of Pulmonary Recurrence After RCC Resection

A study suggests there is little to no clinical value in surveillance of pulmonary recurrence following resection of T1a renal cell carcinoma (RCC) in patients without preoperative lung pathology at baseline. Findings from this study were presented by David Charles, MD, of the Medical College of Wisconsin in Milwaukee, at the 2021 American Urological Association Annual Meeting.

According to the researchers, between 20% and 30% of localized RCC will recur after surgical excision, with approximately 50% to 60% being lung metastases. Clinical guidelines from the National Comprehensive Cancer Network and American Urological Association recommend clinicians employ chest surveillance using chest x-ray at least once per year for up to 5 years.

Previous studies, however, have reported substantially low rates of pulmonary recurrence in T1 to T3 RCC following surgical resection, said Dr. Charles and colleagues. Despite these findings, both national and international clinical guidelines still recommend chest surveillance with chest x-ray following localized RCC surgical resection. To further investigate these recommendations, Dr. Charles and researchers examined a cohort of 463 pT1a patients in an effort to gain additional understanding of the value of follow-up chest imaging in a population at particularly low risk.

The retrospective study included patients with a mean age of 58.3 years (range, 23-87 years) who underwent surgical excision of T1a RCC between the years 2000 and 2020. In the analysis, the researchers reviewed and evaluated several different baseline demographic variables in addition to baseline pulmonary pathology, RCC pathology, and contemporary chest imaging.

In the retrospective cohort, the mean follow-up was 47.6 months and ranged between one month and 201 months. On patients’ most recent pulmonary surveillance imaging, the majority of the population (72.4%) underwent chest x-ray, and more than one-quarter of patients (27.6%) underwent chest computed tomography. Irrespective of modality, the researchers identified no pulmonary recurrence on any surveillance imaging in patients who did not have pulmonary nodules on imaging prior to operation.

“With the prior studies in mind, in patients without baseline preoperative lung pathology, we further corroborate that there is minimal to no clinical value in surveillance for pulmonary recurrence after resection of T1a RCC,” wrote Dr. Charles and colleagues in their abstract.