Comparison of Renal Cell Carcinoma Surveillance Guidelines: Competing Trade-Offs

Abstract

Renal cell carcinoma surveillance guidelines differ greatly in terms of intensity, cost and radiation exposure. It is important for clinicians to adopt standardized surveillance strategies that limit unnecessary cost and radiation exposure without compromising cancer control.

Risk‐adjusted proposal for >60 months follow up after surgical treatment of organ‐confined renal cell carcinoma according to life expectancy

“…To capture 95% of all recurrences, follow up would be required for 14–21 years depending on the American Urological Association risk criteria, resulting in significant costs for the healthcare system. A recent study showed expected costs between $600 and $3900 for a 5‐year surveillance strategy depending on the applied guideline and risk factors . Nevertheless, an early detection of metastases for treatment with curative intentions should benefit both patients and healthcare providers.…”

“…A recent study showed expected costs between $600 and $3900 for a 5-year surveillance strategy depending on the applied guideline and risk factors. 23 Nevertheless, an early detection of metastases for treatment with curative intentions should benefit both patients and healthcare providers. The cost of targeted therapy for palliative treatment of metastatic RCC may well exceed the costs for a surveillance algorithm based on RCC risk stratification and life expectancy.…”

Modification of American Joint Committee on cancer prognostic groups for renal cell carcinoma

“…16,17 As TNM stage grouping is the most widely used staging system, it also reflects the treatment changing paradigm. 18,19 The definition of stage Ia and Ib reflects better outcome of both T1N0M0 and T2N0M0, which means a good outcome for these patients in nowadays management. Similarly, the upgrading of T3N0M0 and T4N0M0 indicates that surgical consolidation in localized massive disease is more feasible in current surgical treatments.…”

“…The other important function of the AJCC stage grouping is to help clinical treatment decision‐making process, evaluate treatment efficacy, and determine the selection criteria for clinical trials . As TNM stage grouping is the most widely used staging system, it also reflects the treatment changing paradigm . The definition of stage Ia and Ib reflects better outcome of both T1N0M0 and T2N0M0, which means a good outcome for these patients in nowadays management.…”

European temporal trends in the use of lymph node dissection in patients with renal cancer

“…Follow-up strategies require precise risk estimation [14] and the lack of a correct nodal status assessment may underestimate the actual disease burden with critical consequences for any adjuvant [15] or salvage [6] strategy.…”