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Radiologic follow-up of patients with T1-3a,b,c or T4N+M0 renal cell carcinoma after radical nephrectomy
J A Saidi1, J H Newhouse, I S Sawczuk
1Department of Urology, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Objectives:
To determine the pattern of disease recurrence after radical nephrectomy in patients with node-positive renal cell carcinoma (RCC) in order to design a schedule for subsequent radiologic evaluation.
Methods:
We reviewed the postoperative radiologic studies of 45 patients with T1-3a,b,c or T4N+M0 RCC enrolled in a prospective trial of adjuvant autolymphocyte therapy (ALT) after radical nephrectomy for node-positive disease. Chest radiograph and abdominal computed tomography (CT) were performed quarterly, and bone scan and head CT were performed every 6 months until disease recurrence, or earlier if clinically indicated. Time from surgery to recurrence and sites of recurrence were analyzed.
Results:
Twenty-nine patients (64%) had disease progression, with a mean time to progression of 14.9 months. Mean follow-up of patients without progression was 39 months. The sites of recurrence were retroperitoneal lymph nodes (n=14), lung (n=11), liver (n=5), bone (n=5), mediastinal lymph nodes (n=4), renal fossa (n=3), pelvis (n=2), brain (n=2), contralateral kidney (n=1), retrocecum (n=1), and skin (n=1). Fourteen patients had recurrence at more than one site. Of the patients whose disease progressed, 59% did so by 12 months, 83% by 24 months, and 93% by 36 months. Mean time to progression in the ALT group was delayed compared with the observation group, but the sites of disease recurrence were not different between the two groups. Abdominal CT alone detected recurrent lesions in 79% of patients with progression, and the combination of abdominal CT and chest radiograph detected lesions in 100% of patients with progression.
Conclusions:
Abdominal CT with chest radiograph detects recurrence in all patients with T1-3a,b,c or T4N+M0 RCC whose disease progresses, and more than 90% of recurrences occur within the first 3 years after surgery. We recommend abdominal CT and chest radiograph every 6 months for at least 3 years and yearly thereafter in this high-risk group of patients.