STAGE-SPECIFIC GUIDELINES FOR SURVEILLANCE AFTER RADICAL NEPHRECTOMY FOR LOCAL RENAL-CELL CARCINOMA

Purpose: We report stage specific followup guidelines based on our eva luation of the pattern of recurrence in 286 patients treated for local NO or Nx renal cell carcinoma. Materials and Methods: We retrospectiv ely reviewed the clinical records of 286 patients with pT1 to pT3N0 or Nx renal cell carcinoma who underwent nephrectomy at our center betwe en February 1985 and December 1994. In cases of later metastases the m edian interval to first metastasis, site of metastasis and method of d iagnosis were correlated with the primary lesion stage. Results: Metas tases developed in 68 patients a median of 23 months after nephrectomy . Eight of the 113 patients with pT1 disease had metastases (median ti me to diagnosis 38 months), while 17 of 64 with pT2 disease and 43 of 109 with pT3 disease had metastases (medians 32 and 17 months, respect ively). Of the 92 metastases 59 (64%) were asymptomatic, including 44 detected on routine chest x-rays (32) and blood tests (12). Isolated a symptomatic intra-abdominal metastases were diagnosed by surveillance computerized tomography in only 6 patients (9%). The remaining patient s with metastases had associated clinical symptoms and/or abnormal res ults on interval tests that prompted further diagnostic studies. Concl usions: We confirmed that the risk of metastatic renal cell carcinoma is stage dependent. Therefore, surveillance protocols should be based on the pathological stage of the primary tumor. We recommend an annual chest x-ray, and serum liver function and alkaline phosphatase level tests for patients with pT1 disease. These studies are indicated begin ning at 6 and 3 months for pT2 and pT3 disease, respectively, continui ng every 6 months for 3 years and then annually. Surveillance computer ized tomography should be performed at 24 and 60 months in patients wi th pT2 and pT3 disease or earlier when the results of any routine stud y are abnormal or clinical symptoms are present. Bone and brain survei llance studies should be prompted by site specific symptoms, elevated alkaline phosphatase levels or the diagnosis of metastasis at another site.