van den Brink Luna, Reijerink Marlin A A, Henderickx Michael M E L, Bex Axel, Jamaludin Faridi S, Beerlage Harrie P, van Delden Otto M, van Moorselaar Reindert J A, Stoker Jaap, Bipat Shandra, Zondervan Patricia J
Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Eur Urol Oncol. 2025 Jun;8(3):829-840. doi: 10.1016/j.euo.2024.11.014. Epub 2024 Dec 10.
Current guidelines on radiological follow-up (FU) for patients after treatment for nonmetastatic renal cell carcinoma (RCC) are not based on robust evidence. This review aims to evaluate whether the 2022 European Association of Urology (EAU) guidelines are noninferior, in terms of recurrence and (overall) survival, to a higher imaging frequency of computed tomography (CT) of the chest and abdomen.
A literature search of relevant search machines (PubMed/Medline and EMBASE) was performed up to May 29, 2024. Studies describing patients with nonmetastatic RCC who underwent curative treatment by means of partial or radical nephrectomy were included. Studies with a higher number of CT scans than recommended by the EAU were compared with those that followed guidelines by examining recurrences and survival data. Outcomes were classified into risk groups according to the 2022 EAU guidelines.
Twenty studies met our inclusion criteria. Sixteen (80%) studies employed a higher imaging frequency during FU compared with 2022 EAU guideline recommendations, two studies (10%) followed the guidelines, and two studies (10%) performed less imaging. Recurrences were rare in low-risk studies (0-7.6%) and varied among high-risk studies, ranging between 33% and 40% in randomized controlled trials and 11% and 28% in retrospective studies. A meta-analysis was not suited due to clinical diversity, and the risk of bias was high among cohort studies.
Most studies employ a higher imaging frequency during FU after treatment for nonmetastatic RCC than recommended by the 2022 EAU guidelines. Survival and recurrence rates suggest that more frequent imaging than recommended by the EAU may not be advantageous, although high-quality evidence is needed to further improve guidelines.
In this review, we assessed radiological follow-up schedules for patients after surgery for kidney cancer and compared these with the follow-up schedules recommended by the European Association of Urology guidelines. We found that most studies apply more frequent imaging during follow-up than recommended by guidelines, although survival and recurrence rates are similar among studies with different imaging frequencies. We conclude that more frequent imaging than recommended by guidelines may not be necessary and that prospective studies are needed to determine whether imaging can be reduced further during follow-up.
目前关于非转移性肾细胞癌（RCC）患者治疗后放射学随访（FU）的指南并非基于有力证据。本综述旨在评估2022年欧洲泌尿外科学会（EAU）指南在复发和（总）生存方面是否不劣于更高频率的胸部和腹部计算机断层扫描（CT）成像。
截至2024年5月29日，对相关检索工具（PubMed/Medline和EMBASE）进行文献检索。纳入描述通过部分或根治性肾切除术接受根治性治疗的非转移性RCC患者的研究。将CT扫描次数高于EAU推荐次数的研究与遵循指南的研究进行比较，分析复发和生存数据。根据2022年EAU指南将结果分为风险组。
20项研究符合纳入标准。16项（80%）研究在随访期间采用了高于2022年EAU指南推荐的成像频率，2项研究（10%）遵循了指南，2项研究（10%）的成像次数较少。低风险研究中的复发很少见（0 - 7.6%），高风险研究中的复发情况各不相同，随机对照试验中的复发率在33%至40%之间，回顾性研究中的复发率在11%至28%之间。由于临床多样性，不适合进行荟萃分析，队列研究中的偏倚风险较高。
大多数研究在非转移性RCC治疗后的随访期间采用了高于2022年EAU指南推荐的成像频率。生存和复发率表明，高于EAU推荐频率的成像可能并无益处，尽管需要高质量证据来进一步完善指南。
在本综述中，我们评估了肾癌患者术后的放射学随访方案，并将其与欧洲泌尿外科学会指南推荐的随访方案进行了比较。我们发现，大多数研究在随访期间采用的成像频率高于指南推荐，尽管不同成像频率的研究之间生存和复发率相似。我们得出结论，高于指南推荐频率的成像可能没有必要，需要进行前瞻性研究以确定随访期间是否可以进一步减少成像。
