In 2021, the EAU Guidelines implemented a novel, expert opinion-based follow-up scheme, with a three-risk-category system for clear cell (cc) and non-cc renal cell carcinoma (non-ccRCC) after surgery with curative intent. We aimed to validate the novel follow-up scheme and provide data-driven recurrence estimates according to risk groups, to confirm or implement the oncologic surveillance strategy.
We identified 5,320 patients from a prospectively maintained database involving 28 French referral centers. The risk of recurrence, as either loco-regional or distant, was evaluated with the Kaplan-Meier method for each group (low- intermediate- or high-risk) according to ccRCC or non-ccRCC histology. The noncumulative distribution of recurrences was graphically investigated through the LOWESS smoother.
Two thousand two hundred ninety-three (58%), 926 (23%), and 738 (19%) had low-, intermediate, and high-risk ccRCC, and 683 (50%), 297 (22%), and 383 (28%) had low-, intermediate, and high-risk non-ccRCC, respectively. Median follow-up for survivors was 46 months. Overall, 661 patients experienced recurrence. Over time, the noncumulative risk of recurrence was approximately 10% for low-risk cc-RCC, non-ccRCC, and intermediate-risk non-ccRCC, with non-significant difference among the three recurrence functions (P=0.9). At 5-year, time point after which imaging should be de-intensified to biennial, the noncumulative risks of recurrence were: for intermediate risk ccRCC and non-ccRCC: 15% and 11%, respectively; for high-risk ccRCC and non-ccRCC: 24% and 8%, respectively. Among high-risk non-ccRCC patients there were 9 recurrences at 3-month. There was no significant difference between the recurrence function of high-risk non-ccRCC patients with negative imaging at 3-month and the one of intermediate-risk ccRCC (P=0.3).
Given the relatively low recurrence risk of patients with intermediate-risk non-ccRCC, those individuals could be followed up with a similar strategy to the low-risk category. Similarly, patients with high-risk non-ccRCC with negative imaging at 3-month, could be followed up similarly to intermediate-risk ccRCC after the 3-month time point.
Minerva urology and nephrology. 2024 Oct [Epub]
Alberto Martini, Jean-Christophe Bernhard, Ugo G Falagario, Guillaume Herman, Arna Geshkovska, Zine-Eddine Khene, François Audenet, Cecile Champy, Franck Bruyere, Muriel Rolland, Thibaut Waeckel, Martin Lorette, Nicolas Doumerc, Louis Surlemont, Bastien Parier, Thibault Tricard, Nicolas Branger, Constance Michel, Gaëlle Fiard, Alexis Fontenil, Maxime Vallée, Julien Guillotreau, Jean-Jacques Patard, Charlotte Joncour, Romain Boissier, Idir Ouzaid, Frédéric Panthier, Olivier Belas, Richard Mallet, Pierre Gimel, Stéphane DE Vergie, Pierre Bigot, Jean B Beauval
Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France., Department of Urology, CHU Bordeaux, Bordeaux, France., Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy., French AFU Cancer Committee - Kidney Cancer Group, Paris, France., Department of Urology, HEGP, Paris, France., Department of Urology, Henri Mondor University Hospital Center, Créteil, France., Department of Urology, University Hospital Center of Tours, Tours, France., Department of Urology, University Hospital Center of Lyon, Lyon, France., Department of Urology, University Hospital Center of Caen, Caen, France., Department of Urology, University Hospital Center of Lille, Lille, France., Department of Urology, University Hospital Center of Rouen, Rouen, France., Department of Urology, University Hospital Center of Kremlin Bicêtre, Le Kremlin-Bicêtre, France., Department of Urology, University Hospital Center of Strasbourg, Strasbourg, France., Department of Urology, Paoli Calmettes Institute, Marseille, France., Department of Urology, St Joseph Hospital, Paris, France., Department of Urology, University Hospital Center of Grenoble, Grenoble, France., Department of Urology, University Hospital Center of Nîmes, Nîmes, France., Department of Urology, University Hospital Center of Poitiers, Poitiers, France., Department of Urology, Pasteur Hospital, Toulouse, France., Department of Urology, Hospital Center of Mont-de-Marsan, Mont-de-Marsan, France., Department of Urology, University Hospital Center of Reims, Reims, France., Department of Urology, Tenon Hospital, Paris, France., Department of Urology, Pôle Santé Sud Le Mans, Le Mans, France., Department of Urology, Polyclinic of Francheville, Francheville, France., Department of Urology, Hospital of Cabestany, Cabestany, France., Department of Urology, University Hospital Center of Nantes, Nantes, France., Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France - .