An Empiric Evaluation of the Effect of Variation in Intensity of Followup for Surgically Treated Renal Neoplasms on Cancer Specific Survival

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• 作者：William Sohn^a ; Amy J. Graves^a ; Mark D. Tyson^a ; Brock O&rsquo ; Neil^a ; Sam S. Chang^a ; Shenghua Ni^a ; Daniel A. Barocas^a ; David F. Penson^a ; ^b ; ^c ; Matthew J. Resnick^a ; ^b ; ^c ; ^{Matthew.Resnick@vanderbilt.edu}
• 关键词：carcinoma ; renal cell ; multimodal imaging ; outcome assessment (health care) ; survival ; watchful waiting
• 刊名：The Journal of Urology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：197
• 期：1
• 页码：37-43
• 全文大小：295 K
• 卷排序：197

文摘

Followup protocols after the surgical management of renal cell carcinoma lack clear evidence linking the intensity of imaging surveillance to improved outcomes. In this context we characterized the relationship between surveillance imaging intensity and cancer specific survival.Materials and MethodsUsing SEER-Medicare data we identified 7,603 men with renal cell carcinoma treated surgically between 2004 and 2009. Multivariable negative binomial regression analysis was performed to assess the relationship between patient level characteristics and the variation in imaging intensity. We modeled the association between kidney cancer specific mortality and imaging intensity using Fine and Gray proportional subdistribution hazards regression with other cause death treated as a competing risk for 2 separate followup periods (15 and 36 months).ResultsMore than 40% of patients in the short interval cohort and more than 50% in the intermediate interval group underwent no chest imaging during the evaluated survivorship period. More than 30% of patients in both followup periods had no abdominal imaging tests performed. Overall, followup imaging did not appear to confer an improvement in disease specific survival compared to undergoing no imaging in the 2 survivorship periods.ConclusionsThere remains considerable variation in the posttreatment surveillance regimen for patients with renal cell carcinoma in the United States. More importantly, this study raises important questions regarding the link between posttreatment surveillance imaging and survival.