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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Clin+Oncol
2014 ; 32
(36
): 4059-65
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Evaluation of the National Comprehensive Cancer Network and American Urological
Association renal cell carcinoma surveillance guidelines
#MMPMID25403213
Stewart SB
; Thompson RH
; Psutka SP
; Cheville JC
; Lohse CM
; Boorjian SA
; Leibovich BC
J Clin Oncol
2014[Dec]; 32
(36
): 4059-65
PMID25403213
show ga
PURPOSE: The National Comprehensive Cancer Network (NCCN) and American Urological
Association (AUA) provide guidelines for surveillance after surgery for renal
cell carcinoma (RCC). Herein, we assess the ability of the guidelines to capture
RCC recurrences and determine the duration of surveillance required to capture
90%, 95%, and 100% of recurrences. PATIENTS AND METHODS: We evaluated 3,651
patients who underwent surgery for M0 RCC between 1970 and 2008. Patients were
stratified as AUA low risk (pT1Nx-0) after partial (LR-partial) or radical
nephrectomy (LR-radical) or as moderate/high risk (M/HR; pT2-4Nx-0/pTanyN1).
Guidelines were assessed by calculating the percentage of recurrences detected
when following the 2013 and 2014 NCCN and AUA recommendations, and associated
Medicare costs were compared. RESULTS: At a median follow-up of 9.0 years
(interquartile range, 5.7 to 14.4 years), a total of 1,088 patients (29.8%)
experienced a recurrence. Of these, 390 recurrences (35.9%) were detected using
2013 NCCN recommendations, 742 recurrences (68.2%) were detected using 2014 NCCN
recommendations, and 728 recurrences (66.9%) were detected using AUA
recommendations. All protocols missed the greatest amount of recurrences in the
abdomen and among pT1Nx-0 patients. To capture 95% of recurrences, surveillance
was required for 15 years for LR-partial, 21 years for LR-radical, and 14 years
for M/HR patients. Medicare surveillance costs for one LR-partial patient were
$1,228.79 using 2013 NCCN, $2,131.52 using 2014 NCCN, and $1,738.31 using AUA
guidelines. However, if 95% of LR-partial recurrences were captured, costs would
total $9,856.82. CONCLUSION: If strictly followed, the 2014 NCCN and AUA
guidelines will miss approximately one third of RCC recurrences. Improved
surveillance algorithms, which balance patient benefits and health care costs,
are needed.