In this study, researchers attempted to characterize recurrence patterns in patients with localized high-risk (≥T3a) RCC following surgery, and to evaluate the utility of standard surveillance imaging protocols. Data of patients with ≥T3a RCC treated with surgery at 4 high-volume centers was analyzed. Of the 1057 patients treated with surgery, 270 (26%) had recurrence at 2 years of follow up. Single-site metastasis was encountered in 59% of these cases. Time to recurrence and overall survival did not differ between patients presenting with single-site or multiple-site metastasis. Lung was the most common site of recurrence (53%), followed by liver (20%), bone (17%), adrenal (9%), and brain (6%). Local recurrence was detected in only 10% of cases.
When classifying recurrence sites based on imaging template necessary to diagnose metastasis (chest and abdomen), standard imaging templates failed to identify 24% of metastases; 7% in pelvis, 6% in the brain, and 11% in other sites (neck, extremities). Predictors of brain metastasis included nuclear grade 4 (HR 8.1) and diameter >7.8 cm (HR 4.3). For bony metastasis, predictors were sarcomatoid features (HR 3.9), diameter >10 cm (HR 2.4), tumor thrombus (HR 2.1), and low functional status (HR 2). Of note, bone metastasis seemed have a negative impact on overall survival.
To conclude, careful history and physical exam may help to identify recurrences outside imaging templates. Given that 24% of metastases were outside the chest/abdomen template, pelvic cross sectional imaging is recommended. In addition, urologists should consider screening for brain metastasis with imaging in patients with grade 4 primary tumors.
Presented by: Leo Dreyfuss, Medical Student at University of Wisconsin-Madison
Co-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.
Affiliation: The University of Wisconsin
Written by Shlomi Tapiero, MD (Department of Urology, University of California-Irvine) at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois