Presentation Authors: Suzanne Merrill*, Eric Schaefer, Hershey, PA, Viraj Master, Dattatraya Patil, Atlanta, GA, Glenn Allen, E. Jason Abel, Madison, WI, Jay Raman, Hershey, PA
Introduction: The appropriate duration of postoperative renal cell carcinoma (RCC) surveillance remains unknown. Guidelines often leave discontinuation to provider discretion. Herein, we investigate when surveillance may be discontinued by estimating when risk of non-RCC death exceeds the risk of RCC recurrence.
Methods: We identified 1672 patients who underwent surgery for M0 RCC between 1999-2018. Patients were stratified by pathologic stage (pT1aN0-x, pT1bN0-x, pT2N0-x, pT3aN0-x, pT3b/c/4N0-x), histology (clear cell, papillary and chromophobe), age, and ECOG status (0,1,2-4). Using a competing risks analysis, cumulative incidence functions were estimated for RCC recurrence and non-RCC death using the Fine and Gray proportional subhazards model. Surveillance duration was estimated as the time point in which the cumulative incidence of non-RCC death exceeded that of RCC recurrence for a given stage, histology, age and ECOG score.
Results: At a median follow-up of 2.1 years (IQR 0.6-5.1 years), a total of 272 (16.3%) recurrences and 234 (14.0%) non-RCC deaths had occurred. The fitted model showed significant associations for stage with recurrence and for age and ECOG with non-RCC death, which resulted in different estimated durations. For example, for patients age 50 with pT1aN0-x clear cell and ECOG 0 the incidence of non-RCC death exceeded that of recurrence after 4.4 years (Fig). However, when ECOG status was 1 or 2-4 (Fig) or the patient age 70, regardless of ECOG status (data not shown), the incidence of non-RCC death exceeded that of recurrence at 30 days following surgery, suggesting that routine oncologic surveillance may not be necessary. Alternatively, for patients age 50 with >=pT3aN0-x clear cell, regardless of ECOG status, incidence of non-RCC death failed to exceed that of recurrence for >15 years (Fig), suggesting longer surveillance than currently recommended.
Conclusions: Modeling competing risks of RCC recurrence and non-RCC death, we estimated time points when routine RCC surveillance may be reasonably discontinued. These estimates may allow providers and patients to make informed decisions regarding when the focus of care can transition to more significant health conditions.