Surveillance for metastatic disease after definitive treatment for renal cell carcinoma
- Brian Shuch, MD
Brian Shuch, MD
- Assistant Professor
- Department of Urology
- Yale School of Medicine
- Allan J Pantuck, MD, MS, FACS
Allan J Pantuck, MD, MS, FACS
- Associate Professor
- UCLA David Geffen School of Medicine
- Tobias Klatte, MD
Tobias Klatte, MD
- UCLA David Geffen School of Medicine
For patients with renal cell carcinoma (RCC), surgery may be curative when patients present with localized disease. However, many patients who are initially resected eventually relapse, and the prognosis in these cases is often poor. Thus, optimal management requires careful surveillance for recurrent disease in those who have undergone a potentially curative resection.
The timing and patterns of recurrent and/or metastatic disease and specific recommendations for surveillance following the initial treatment of localized RCC will be reviewed here. An overview of the treatment of RCC is presented separately. (See "Prognostic factors in patients with renal cell carcinoma".)
The advantages of an aggressive surveillance program must be balanced against the financial costs and the psychologic distress that repeated testing can cause the patient. The rationale for surveillance is based upon several observations:
●Diagnosis of recurrence while the metastatic burden is limited may increase the likelihood of a favorable response to systemic treatment. (See "Immunotherapy of renal cell carcinoma", section on 'Interleukin-2'.)
●Surgical resection of a single or limited number of metastases or an isolated local-regional recurrence can result in long-term survival. (See "Role of surgery in patients with metastatic renal cell carcinoma" and 'Locoregional recurrence' below.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Antonelli A, Cozzoli A, Zani D, et al. The follow-up management of non-metastatic renal cell carcinoma: definition of a surveillance protocol. BJU Int 2007; 99:296.
- Klatte T, Patard JJ, Wunderlich H, et al. Metachronous bilateral renal cell carcinoma: risk assessment, prognosis and relevance of the primary-free interval. J Urol 2007; 177:2081.
- Miyao N, Naito S, Ozono S, et al. Late recurrence of renal cell carcinoma: retrospective and collaborative study of the Japanese Society of Renal Cancer. Urology 2011; 77:379.
- Stewart SB, Thompson RH, Psutka SP, et al. Evaluation of the National Comprehensive Cancer Network and American Urological Association renal cell carcinoma surveillance guidelines. J Clin Oncol 2014; 32:4059.
- Kim SP, Weight CJ, Leibovich BC, et al. Outcomes and clinicopathologic variables associated with late recurrence after nephrectomy for localized renal cell carcinoma. Urology 2011; 78:1101.
- Ljungberg B, Alamdari FI, Rasmuson T, Roos G. Follow-up guidelines for nonmetastatic renal cell carcinoma based on the occurrence of metastases after radical nephrectomy. BJU Int 1999; 84:405.
- Levy DA, Slaton JW, Swanson DA, Dinney CP. Stage specific guidelines for surveillance after radical nephrectomy for local renal cell carcinoma. J Urol 1998; 159:1163.
- Hafez KS, Novick AC, Campbell SC. Patterns of tumor recurrence and guidelines for followup after nephron sparing surgery for sporadic renal cell carcinoma. J Urol 1997; 157:2067.
- Sandock DS, Seftel AD, Resnick MI. A new protocol for the followup of renal cell carcinoma based on pathological stage. J Urol 1995; 154:28.
- Hofmann HS, Neef H, Krohe K, et al. Prognostic factors and survival after pulmonary resection of metastatic renal cell carcinoma. Eur Urol 2005; 48:77.
- Donat SM, Diaz M, Bishoff JT, et al. Follow-up for Clinically Localized Renal Neoplasms: AUA Guideline. J Urol 2013; 190:407.
- http://www.nccn.org/professionals/physician_gls/pdf/kidney.pdf (Accessed on October 07, 2015).
- Seaman E, Goluboff ET, Ross S, Sawczuk IS. Association of radionuclide bone scan and serum alkaline phosphatase in patients with metastatic renal cell carcinoma. Urology 1996; 48:692.
- Frank I, Blute ML, Cheville JC, et al. An outcome prediction model for patients with clear cell renal cell carcinoma treated with radical nephrectomy based on tumor stage, size, grade and necrosis: the SSIGN score. J Urol 2002; 168:2395.
- Baloch KG, Grimer RJ, Carter SR, Tillman RM. Radical surgery for the solitary bony metastasis from renal-cell carcinoma. J Bone Joint Surg Br 2000; 82:62.
- Kollender Y, Bickels J, Price WM, et al. Metastatic renal cell carcinoma of bone: indications and technique of surgical intervention. J Urol 2000; 164:1505.
- Shvarts O, Lam JS, Kim HL, et al. Eastern Cooperative Oncology Group performance status predicts bone metastasis in patients presenting with renal cell carcinoma: implication for preoperative bone scans. J Urol 2004; 172:867.
- Franklin JR, Figlin R, Rauch J, et al. Cytoreductive surgery in the management of metastatic renal cell carcinoma: the UCLA experience. Semin Urol Oncol 1996; 14:230.
- Fujisaki S, Takayama T, Shimada K, et al. Hepatectomy for metastatic renal cell carcinoma. Hepatogastroenterology 1997; 44:817.
- Itano NB, Blute ML, Spotts B, Zincke H. Outcome of isolated renal cell carcinoma fossa recurrence after nephrectomy. J Urol 2000; 164:322.
- Sandhu SS, Symes A, A'Hern R, et al. Surgical excision of isolated renal-bed recurrence after radical nephrectomy for renal cell carcinoma. BJU Int 2005; 95:522.
- Thomas AZ, Adibi M, Borregales LD, et al. Surgical Management of Local Retroperitoneal Recurrence of Renal Cell Carcinoma after Radical Nephrectomy. J Urol 2015; 194:316.
- Mori Y, Kondziolka D, Flickinger JC, et al. Stereotactic radiosurgery for brain metastasis from renal cell carcinoma. Cancer 1998; 83:344.
- Hoshi S, Jokura H, Nakamura H, et al. Gamma-knife radiosurgery for brain metastasis of renal cell carcinoma: results in 42 patients. Int J Urol 2002; 9:618.
- Shuch B, La Rochelle JC, Klatte T, et al. Brain metastasis from renal cell carcinoma: presentation, recurrence, and survival. Cancer 2008; 113:1641.
- Hoffmann NE, Gillett MD, Cheville JC, et al. Differences in organ system of distant metastasis by renal cell carcinoma subtype. J Urol 2008; 179:474.
- Siddiqui SA, Frank I, Cheville JC, et al. Postoperative surveillance for renal cell carcinoma: a multifactorial histological subtype specific protocol. BJU Int 2009; 104:778.
- Montie JE. Follow-up after partial or total nephrectomy for renal cell carcinoma. Urol Clin North Am 1994; 21:589.
- Klatte T, Seligson DB, LaRochelle J, et al. Molecular signatures of localized clear cell renal cell carcinoma to predict disease-free survival after nephrectomy. Cancer Epidemiol Biomarkers Prev 2009; 18:894.
- Parker AS, Leibovich BC, Lohse CM, et al. Development and evaluation of BioScore: a biomarker panel to enhance prognostic algorithms for clear cell renal cell carcinoma. Cancer 2009; 115:2092.
- Di Napoli A, Signoretti S. Tissue biomarkers in renal cell carcinoma: issues and solutions. Cancer 2009; 115:2290.
- Klatte T, Rao PN, de Martino M, et al. Cytogenetic profile predicts prognosis of patients with clear cell renal cell carcinoma. J Clin Oncol 2009; 27:746.
- Hakimi AA, Chen YB, Wren J, et al. Clinical and pathologic impact of select chromatin-modulating tumor suppressors in clear cell renal cell carcinoma. Eur Urol 2013; 63:848.
- Peña-Llopis S, Vega-Rubín-de-Celis S, Liao A, et al. BAP1 loss defines a new class of renal cell carcinoma. Nat Genet 2012; 44:751.
- Kunkle DA, Egleston BL, Uzzo RG. Excise, ablate or observe: the small renal mass dilemma--a meta-analysis and review. J Urol 2008; 179:1227.
- Klatte T, Grubmüller B, Waldert M, et al. Laparoscopic cryoablation versus partial nephrectomy for the treatment of small renal masses: systematic review and cumulative analysis of observational studies. Eur Urol 2011; 60:435.
- Weight CJ, Kaouk JH, Hegarty NJ, et al. Correlation of radiographic imaging and histopathology following cryoablation and radio frequency ablation for renal tumors. J Urol 2008; 179:1277.
- TIME TO RECURRENCE
- Duration of surveillance
- Late recurrences
- SITES OF METASTASIS
- Lung metastases
- Bone metastases
- Liver metastases
- Locoregional recurrence
- Brain metastases
- Impact of histology
- SURVEILLANCE PROTOCOLS
- AUA guidelines
- - Stage I or T1N0/X (partial or radical nephrectomy)
- - PT2-4N0/X or pTanyN1
- NCCN guidelines
- - Stage I
- - Stage II/III
- Biomarkers and the future of surveillance
- SURVEILLANCE AFTER THERMOABLATION
- ADJUVANT THERAPY
- SUMMARY AND RECOMMENDATIONS