The following is a summary of “Is chest imaging needed as part of pT1a renal cell carcinoma surveillance after surgical resection?,” published in the January 2024 issue of Urology by Charles, et al.

After surgery to remove pT1a renal cell cancer (RCC), 2% to 5% will come back, and 50% to 60% of these will be metastases in the lungs. It’s not clear what the best monitoring approach is to find repeats. There are different sets of standards. The NCCN and AUA say that chest X-rays (CXRs) should be used for monitoring at least once a year for 5 years. The EAU, on the other hand, doesn’t say anything specific about using CXRs. For a study, researchers sought to find out more about how useful monitoring CXR is, they looked back at pT1a patients who had surgery at a single hospital. 

They looked at the records of patients who had surgery to remove pT1 RCC between January 2000 and January 2020. Along with personal information, They also got information about the RCC histology, any recurrences, and the most recent chest images. They didn’t include patients with non-RCC disease or lung tumors on the first scan. They found 463 patients (mean age 58.3 years, range 23–87) who had surgery to remove a pT1a RCC. They were followed up on for an average of 47.6 months (range 1–201 months). 

On the most recent lung surveillance imaging, a chest CT was done on 27.6% (328/463) of patients and a CXR was done on 72.4% (335/463) of patients. No matter the type of imaging used, none of the monitoring images showed lung return (0/463). They discovered that keeping an eye out for pulmonary return after removal of pT1a RCC may not be clinically useful in patients without lung problems before surgery.

Source: sciencedirect.com/science/article/abs/pii/S107814392300340X