Fellow Memorial Sloan Kettering Cancer Center, United States
Background: AUA guidelines for follow-up of clinically localized renal neoplasms in 2013 introduced risk-adjusted follow-up recommendations after partial nephrectomy (PN), with less frequent surveillance imaging in low-risk patients. We sought to evaluate the impact of guideline adherence at our institution on outcomes in affected patient cohorts.
Methods: 3255 patients underwent PN between January 2000 and March 2017. We used Kaplan-Meier methods to estimate metastasis-free (MFS), cancer-specific (CSS), and overall survival (OS), and multivariable Cox proportional hazard regression for each outcome, with follow-up before or after guideline implementation as the predictor, adjusted for guideline risk [low (pT1, N0/X) vs moderate/high (pT2+)].
Results: The “before” (N=2289) and “after” (N=966) groups showed similar overall tumor characteristics: median tumor size 2.9 cm in both groups; tumor stage pT1 in 79% and 80%; positive surgical margin rates of 5.8% and 5.1%, respectively. 296 patients died from any cause, 24 of whom died from kidney cancer. 47 patients had biopsy-proven metastases (Table 1), with a median follow-up time among survivors of 4.4 years (IQR 2.0, 7.6). The “after” group had significantly better MFS (HR: 0.34; 95% CI 0.13, 0.87; p =0.024) and non-significantly better CSS (HR: 0.28; 95% CI 0.06, 1.20; p = 0.086) and OS (HR: 0.75; 95% CI 0.51, 1.12; p = 0.2).
Conclusions: Detection of metastases following PN is a rare event, regardless of follow-up regimen. Adoption of the AUA guidelines may increase MFS but does not impact CSS or OS, which supports guideline adherence for risk-adapted follow-up of clinically localized renal neoplasms after PN.
