ASCO GU 2018: Imaging Modalities Used for Follow-Up of Localized Renal Cell Carcinoma and Subsequent Effect on Overall Survival after Recurrence: RECUR-Database Analysis
Background:
Cross-sectional imaging (CSI) has emerged as the preferred imaging modality for staging and follow-up (FU). Moreover, the 2017 EAU renal cell carcinoma (RCC) guidelines discourage the use of Chest X-Ray (CXR). In an international database (RECUR) data were collected to compare imaging modalities in contemporary FU, and to explore if more frequent use of CSI translates into improved overall survival (OS) after recurrence.
Methods:
Consecutive non-metastatic RCC patients treated with curative intent at 12 institutes across 8 European countries between 2006 and 2011, with at least 4 years of FU were included in this study. Leibovich or UICC risk group (RG) (low, intermediate, high), recurrence characteristics, type of FU imaging (CSI (CT or MRI) vs. Conventional (CXR or Ultrasound)) and survival data were recorded. Isolated local, solitary and oligometastatic recurrences were considered potentially curable while all others were considered probably incurable. Patients were analyzed according to type of imaging that resulted in detection of recurrence (CSI vs. conventional) and if > or < 50% of all FU imaging were CSI based.
Results:
Out of a total of 1612 patients, 336 (21%) had experienced a recurrence. Of these, 122 were potentially curable and and 213 potentially incurable. Of the 17,333 FU imaging procedures performed, 7,953 were CT (46%), 6,540 (38%) were CXR, 183 (1%) were MRI, and 2,651 (15%) were Ultrasound (US) investigations. The overall CT thorax/CXR- ratio decreased significantly across the risk groups, being 1.0, 0.46 and 0.35 in the high, intermediate and low risk groups, respectively (p < 0.001). Moreover, between the high risk groups and the other risk groups the overall CT Abd/US-ratio also decreased (3.2, 1.7 and 1.7, respectively)(p < 0.001). There was no significant difference in OS between patients with potentially curable and potentially incurable recurrences based on type of imaging with which the recurrence was detected, nor on the ratio of CSI ( > / < 50%) during FU.
Conclusions:
In summary, more than 50% of FU imaging was conventional, with CSI more often used in high risk groups. This study study suggests that the type of imaging (conventional vs. CSI) for detection of recurrence does not affect subsequent OS.
Presented by: Christian Beisland, Bergen, Norway
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan, at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA