Presentation Authors: Leo D. Dreyfuss*, Madison, WI, Viraj A. Master, Atlanta, GA, Jay D. Raman, Hershey, PA, Philippe E. Spiess, Charles C. Peyton, Tampa, FL, Suzanne B Merrill, Brian Sohl, Hershey, PA, Dattatraya Patil, Atlanta, GA, Daniel D. Shapiro, Glenn O. Allen, Edwin Jason Abel, Madison, WI
Introduction: Adjuvant clinical therapy trials have demonstrated that recurrence is most common during the first two years following surgery for high risk renal cell carcinoma (RCC). The objective of this study is to evaluate the utility of surveillance imaging templates to identify recurrences and to describe site specific predictors of early (â‰¤2 years) recurrence for non-metastatic â‰¥pT3a RCC patients following surgery at 4 independent centers.
Methods: Data for non-metastatic â‰¥pT3a RCC patients treated surgically from 2000-2016 at 4 centers was analyzed. Surveillance included cross sectional imaging of chest, abdomen and pelvis (CAP) q3-6 months following surgery. Imaging templates were defined by anatomic landmarks from radiology definitions. Prognostic factors for site specific recurrence were evaluated with uni/multivariate analysis.
Results: Of 1296 patients treated surgically for â‰¥pT3a RCC, recurrence was identified in 313 (24%) patients at median 9.8 (IQR=4.4-21) months postoperatively. Most recurrences were detected during the first (57%) and second year (20%) of postoperative surveillance. Complete follow-up information for 1 and 2 years was available for 844 and 709 patients. _x000D_
Initial recurrence was single site (52%) or multiple sites (48%), including: lung (51%), liver (24%), bone (24%), and brain (8%). Local recurrences were identified in 15 (5%) patients._x000D_
Early recurrence sites were grouped by the imaging template necessary to diagnose metastases. Template- specific predictors of early recurrences are shown in table. Including only chest/abdominal imaging failed to identify 23% of metastases during the first two years following surgery. Pelvic imaging detected 9% of recurrences within in first 2 years._x000D_
A total of 14% of recurrences were identified outside CAP template. Most common site of extra template metastasis was brain (58%). Nuclear grade 4 was only independent predictor of brain metastasis: OR=19, p=0.001.
Conclusions: Postoperative surveillance imaging for high risk RCC patients should focus on chest and abdomen, but also include pelvic cross sectional imaging. Careful history and physical exam may help to identify recurrences outside imaging templates. Screening for brain metastases may be considered for patients with grade 4 primary tumors.