Of the cohort of 1630 patients, 854 patients (52%) were treated with RN and 776 (48%) were treated with PN. As expected, the most common histology was clear cell [1273(78%)]; in contrast, papillary type 1, papillary type 2, and chromophobe tumors were found in 137 (8.4%), 113 (6.9%), and 107 (6.6%) patients, respectively. Most were ECOG 0-1 (85%), Fuhrman grade 1-2 (72%), node-negative (96%), and pT1-2 (78%). In terms of recurrence, 221 (15.4%) patients recurred within the first year after surgery.
Both investigated models (UISS and modified UISS+age+histology) showed high accuracy in predicting early recurrence after surgery, with an AUC of 0.84 (95% CI: 0.81, 0.88) for the new model and 0.83 (95% CI: 0.80, 0.87) for the UISS model. Both models showed a good net benefit in predicting early recurrence at decision curve analysis.
Of note, patients diagnosed with low-risk tumor types (e.g., papillary type 1 and chromophobe), the average risk of early recurrence significantly dropped within each UISS risk category when tumor histology was added to the predictive model (1.6% vs. 0.6% in the low-risk category; 5.5% vs. 1.9% for intermediate-risk; 45% vs. 22% for high-risk).
In contrast, Kaplan-Meier analyses showed no difference in the risk of late recurrence among UISS risk categories.
As such, the authors note that the UISS model should be applied, as recommended by the EAU Guidelines, to tailor the follow-up protocol in the early period after surgical treatment of RCC (within the first 12 months). Patients with low-risk histology, specifically papillary type 1 and chromophobe, deserve a less stringent follow-up, regardless of their UISS risk category.
As for late recurrence, their results do not support the use of a risk-stratification model to design a surveillance protocol after five years post-surgery, as the recurrence risk is the same across risk categories.
Speaker: P. Capogrosso
Co-Author(s): Muttin F., Larcher A, Sjoberg D., Vertosick E., Cianflone F., Dell'Oglio P., Carenzi C., Salonia A., Vickers A., Montorsi F., Bertini R., Capitanio U.
Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, Twitter: @tchandra_uromd at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark