WCE 2017: The Utility of Axial Abdominal Imaging after Partial Nephrectomy for T1 Renal Cell Carcinoma Surveillance

Vancouver, Canada (UroToday.com) Dr. Brett Johnson, endourology fellow from the University of Texas Southwestern Medical Center, presented data comparing the recurrence rates of T1a and T1b renal cell carcinoma (RCC) after partial nephrectomy. The average recurrence rates of T1a and T1b in patients is 1-3% and 5-10%, respectively. Despite these differences, the guidelines for follow-up and surveillance of these tumors are largely the same. Dr. Johnson and his research team sought to determine the best possible way to monitor these different tumors without causing overtreatment. 

The study consisted of a retrospective review of T1 RCC patients between 2006-2012 within their institution in Dallas. There were 160 patients with T1a and 37 patients with T1b that were identified for the study. The typical follow-up and surveillance protocol consisted of CT/MRI scans within 3-12 months of surgery, followed by biannual, annual, or biennial scans depending on physician preference. 

The mean R.E.N.A.L. score between the two was 5.8 for T1a and 7.5 for T1b. The mean tumor size for T1a and T1b was 2.6 cm and 5.0 cm, respectively. The percentage of recurrence for the two tumor types was 1.9% over a median of 44 months for T1a and 10.8% over a median of 22 months. After 5 years of follow-up, the recurrence free survival (RFS) of T1a and T1b was 96.8% and 80.3%, respectively. 

With these findings, Dr. Johnson was able to conclude that recurrences that were detected by abdominal imaging occurred much earlier and more frequently in T1b patients as compared to T1a patients. During the closing of his presentation, Dr. Johnson wanted to stress the importance of differentiating the treatment of patients with T1a and T1b in the future, since the latter is a much more aggressive disease with a higher risk of recurrence. He also pointed out that surveillance periods should be extended since recurrences were detected beyond 3 years. 

Presented by: Brett Johnson, MD 

Authors: Igor Sorokin, MD, Brett Johnson, MD, Noah E. Canvasser,  MD, Vitaly Margulis, Yair Lotan, Ganesh Raj, Arther Sagalowsky, Jeffrey Gahan, MD, Jeffrey Cadeddu, MD
Affiliation: University of Texas Southwestern Medical Center, Department of Urology, UC Davis Medical Center Sacramento, California

Written by: Zachary Valley, Department of Urology, University of California-Irvine at 35th World Congress of Endourology– September 12-16, 2017, Vancouver, Canada.