An Empiric Evaluation of the Effect of Variation in Intensity of Follow-Up for Surgically Treated Renal Neoplasms on Cancer Specific Survival

Follow-up protocols after surgical management of renal cell carcinoma (RCC) lack clear evidence linking the intensity of imaging surveillance to improved outcomes. In this context, we sought to characterize the relationship between intensity of surveillance imaging and cancer-specific survival.

Using Surveillance Epidemiology and End Results (SEER)-Medicare data, we identified 7,603 men with RCC treated surgically between 2004 and 2009. Multivariable negative binomial regression analysis was performed to assess the relationship between patient-level characteristics and the variation in the intensity of imaging. We modeled the association between kidney cancer-specific mortality and imaging intensity using Fine and Gray proportional sub-distribution hazards regression with other cause death treated as a competing risk for two separate follow-up periods (15 and 36 months).

More than 40% of patients in the short-interval cohort and more than 50% in the intermediate-interval group underwent no chest imaging during the duration of evaluated survivorship. More than 30% of patients in the both follow-up periods had no abdominal imaging tests performed. Overall, receiving follow-up imaging did not appear to confer an improvement in disease-specific survival when compared to those undergoing no imaging in the two survivorship periods.

There remains considerable variation in the post-treatment surveillance regimen for RCC patients in the US. Moreover, and more importantly, this study raises important questions regarding the link between post-treatment surveillance imaging and survival.

The Journal of urology. 2016 Aug 26 [Epub ahead of print]

William Sohn, Amy J Graves, Mark D Tyson, Brock O'Neil, Sam S Chang, Shenghua Ni, Daniel A Barocas, David F Penson, Matthew J Resnick

Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Geriatric Research, Education, and Clinical Center, Tennessee Valley VA Health Care System, Nashville, Tennessee, USA., Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Geriatric Research, Education, and Clinical Center, Tennessee Valley VA Health Care System, Nashville, Tennessee, USA. Electronic address: .