Jamil Marcus L, Keeley Jacob, Sood Akshay, Dalela Deepansh, Arora Sohrab, Peabody James O, Trinh Quoc-Dien, Menon Mani, Rogers Craig G, Abdollah Firas
Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation (VCORE), Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Eur Urol. 2020 Feb;77(2):277-281. doi: 10.1016/j.eururo.2019.10.028. Epub 2019 Nov 6.
Currently, surveillance guidelines following surgical resection of clinically localized renal cell carcinoma (RCC) are clear within the first 5 yr; however, these lack the same degree of objectivity following this cutoff. We sought to investigate the long-term risk of recurrence in surgically treated RCC in order to determine the utility of long-term surveillance. A post hoc analysis of patients within the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) E2805 trial cohort was performed. The 36-mo cumulative incidence of recurrence was assessed at set intervals following surgery, in order to dynamically assess recurrence through the use of a conditional survival model. Of the 1943 patients included in the original cohort, 730 developed recurrence. The 36-mo cumulative incidences of recurrence were found to be 31%, 26%, 19%, 16%, 19%, and 20% for patients at 0, 12, 24, 36, 48, and 60 mo from surgery, respectively. At 0 mo from surgery, age, pathological T3/4 stage (hazard ratio [HR] = 1.56), pathological N1/2 stage (HR = 2.38), and Fuhrman grades 3 and 4 (HR = 1.36 and HR = 2.41, respectively) were independent predictors of recurrence; however, this was not seen at 60 mo following surgery. These findings support that surveillance imaging should be performed beyond 5 yr following surgical resection of intermediate- to high-risk RCC. PATIENT SUMMARY: : Follow-up for surgically resected localized renal cell carcinoma should be performed beyond 5 yr, for the rates of recurrence remain significant beyond this 5 yr endpoint.
目前，临床局限性肾细胞癌（RCC）手术切除后的监测指南在术后前5年是明确的；然而，超过这个时间节点后，这些指南缺乏同等程度的客观性。我们试图研究手术治疗的RCC的长期复发风险，以确定长期监测的效用。对东部肿瘤协作组-美国放射学会影像网络（ECOG-ACRIN）E2805试验队列中的患者进行了事后分析。在手术后的设定时间间隔评估36个月的累积复发率，以便通过使用条件生存模型动态评估复发情况。在最初队列中的1943例患者中，730例出现复发。发现手术后0、12、24、36、48和60个月的患者36个月累积复发率分别为31%、26%、19%、16%、19%和20%。在手术后0个月时，年龄、病理T3/4期（风险比[HR]=1.56）、病理N1/2期（HR=2.38）以及Fuhrman 3级和4级（HR分别为1.36和2.41）是复发的独立预测因素；然而，在手术后60个月时未观察到这种情况。这些发现支持，对于中高危RCC手术切除后，应在5年以上进行监测成像。患者总结：对于手术切除的局限性肾细胞癌，应在5年以上进行随访，因为在这个5年时间节点之后复发率仍然很高。
