RECUR is the EuRopEan association of urology renal cell carcinoma guidelines panel Collaborative multicenter consortium for the studies of follow-Up and recurrence patterns in Radically treated renal cell carcinoma patients.
The best way to follow-up patients after they have had surgery to remove a kidney cancer lacks a strong evidence base. Urological Malignancies programme lead Professor Grant Stewart, together with colleagues from 15 European countries form the RECUR consortium, a group focused on using data on kidney cancer recurrence to establish best practice in patient follow-up. The group aims to improve patient outcomes after initial renal cell carcinoma (RCC) treatment through personalised follow-up, tailored to the particulars of each patients’ cancer. So far, the group has published four high-impact papers using patient data to evaluate the efficacy of various follow-up strategies.
Two RECUR papers assess the importance of frequency of follow-up imaging on overall survival of patients, by enabling earlier identification of recurrence cancer (most usually in the lymph nodes, lungs, liver, brain or bone). Using the RECUR database of kidney cancer patients who underwent surgery with curative intent with up to four years of follow-up, a 2018 study demonstrated that a more intensive imaging frequency than that already recommended in the 2017 European Association of Urology guidelines is unlikely to improve overall survival. A second analysis of data came to similar conclusions, demonstrating that the frequency of cross-section imaging and mode of imaging at detection ‘had no bearing on the oncological outcome.’ The paper authors go on to conclude that further research is needed to confirm these findings and to help design follow-up strategies that may be less intense and more personalised for individual patients.
A study of the long-term outcomes of follow-up for initially localised clear cell RCC found that among low-risk patients, although recurrences were rare, they were predominantly symptomatic, an indicator of poorer survival outcomes. Treatment of recurrences with curative intent (i.e., by surgical removal or ablation), especially in higher-risk patients, is disappointing. The paper concludes that kidney cancer recurrence and patient survival correlated with clinical factors known to predict kidney cancer. Therefore, the design of follow-up strategies should consider these factors.
Most recently, the group found that histological subtypes of renal cell carcinoma have a distinct pattern and dynamics of recurrence. Patients should be followed-up differently according to subtype and risk score. Results of this study suggest that intermediate- to high-risk papillary RCC patients ‘may benefit from cross-sectional abdominal imaging’ every six months until two years after surgery. For patients with chromophobe RCC, where the bold conclusion was made that routine imaging might be abandoned ‘except for abdominal computed tomography in patients with advanced tumour stage or positive margins.’
Professor Grant Stewart said of RECUR: ‘The importance of these findings is that they will lead to new thinking about the optimal follow-up of patients with kidney cancer. A clinical trial of follow-up is needed to prove the best way to follow patients up so that those at risk of recurrence are closely observed and those not at risk avoid exposure to excess radiation via CT scans and the ‘scanxiety’ of waiting for results.’
RECUR bibliography
Abu-Ghanem Y, et al. The Impact of Histological Subtype on the Incidence, Timing, and Patterns of Recurrence in Patients with Renal Cell Carcinoma After Surgery—Results from RECUR Consortium. Eur Urol Oncol (2020), https://doi.org/10.1016/j.euo.2020.09.005
Debestani S, et al. Increased use of cross-sectional imaging for follow-up does not improve post-recurrence survival of surgically treated initially localized R.C.C.: results from a European multicenter database (R.E.C.U.R.). Scand J Urol (2019), https://doi.org/10.1080/21681805.2019.1588919
Dabestani S, et al. Long-term Outcomes of Follow-up for Initially Localised Clear Cell Renal Cell Carcinoma: RECUR Database Analysis. Eur Urol Oncol (2019), https://doi.org/10.1016/j.euf.2018.02.010
Debestani S, et al. Intensive Imaging-based Follow-up of Surgically Treated Localised Renal Cell Carcinoma Does Not Improve Post-recurrence Survival: Results from a European Multicentre Database (RECUR). Eur Urol Oncol (2018), https://doi.org/10.1016/j.eururo.2018.10.007