The overall recurrence rate of T1 renal cell carcinoma is low. We evaluated abdominal imaging after partial nephrectomy based on current guidelines for T1 renal cell carcinoma surveillance.
We retrospectively reviewed T1 renal cell carcinoma patients who underwent partial nephrectomy between 2006-2012 followed by abdominal imaging at our institution. Primary and secondary outcomes were incidence and timing of imaging diagnosed abdominal recurrences, respectively. A literature review was conducted to summarize prior reports of incidence and timing of recurrences after PN for T1 disease.
In total, 160 T1a and 37 T1b patients underwent partial nephrectomy. Seven patients had an abdominal recurrence: 3 patients with both local and distant recurrences, and 4 patients with a metachronous contralateral kidney recurrence. The incidence of an abdominal recurrence detected by imaging was higher in T1b compared to T1a groups (10.8% vs. 1.9%, p=0.024). Although not significant, the median time to recurrence occurred earlier in T1b vs. T1a (13 vs. 37 months, p=0.480), and both groups had recurrences after 3 years of suggested guideline surveillance. In the literature combined with the present study, the time to median recurrence for T1b vs. T1a was 24 vs. 29 months, respectively (p=0.226).
Recurrences detected by abdominal imaging occurred earlier and more frequently in T1b compared to T1a patients. Future recommendations for surveillance strategies after PN should distinguish T1a from T1b with less intense frequency of imaging for T1a. A longer period of surveillance should be considered since recurrences can occur beyond 3 years.
The Journal of urology. 2017 Apr 22 [Epub ahead of print]
Igor Sorokin, Noah E Canvasser, Vitaly Margulis, Yair Lotan, Ganesh Raj, Arthur Sagalowsky, Jeffrey C Gahan, Jeffrey A Cadeddu
Department of Urology, UT Southwestern Medical Center, Dallas, TX., Department of Urology, UT Southwestern Medical Center, Dallas, TX. Electronic address: .