OBJECTIVE Modalities of surveillance to detect recurrence after nephrectomy for localized or locally advanced renal tumor are not standardized. The aim was to assess the impact of surveillance scheme on oncological outcomes. METHODS Patients treated for localized or locally advanced renal tumor with total or partial nephrectomy between 2006 and 2010 in an academic institution were included retrospectively. According to the University of California Los Angeles Integrated Staging System (UISS) protocol, follow-up was considered adequate or not. Symptoms, location and number of lesions at recurrence diagnosis were collected. Recurrence-free, cancer-specific and overall survivals were estimated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards regression models were calculated to identify prognostic factors. RESULTS A total of 267 patients were included. Median follow-up was 72 months. Recurrence rate was 23.2% (62/267 patients). Recurrences were local (16%), single metastatic (23%), oligo-metastatic (15%) or multi-metastatic (46%). 72.6% of the recurrences occurred within the 3 years after surgery. No recurrence was diagnosed by chest X-ray or abdominal ultrasound. One hundred and twenty-one patients had inadequate follow-up. They had similar recurrence-free survival, cancer-specific survival and overall survival as patients with adequate follow-up. In multivariable analysis, the presence of multi-metastatic lesions was an independent prognostic factor of worse cancer-specific mortality after recurrence diagnosis (HR = 10.15, 95% CI: 2.29-44.82, p = 0.002). CONCLUSION Role of chest X-ray and abdominal ultrasound for the detection of recurrences is limited. Rigorous follow-up according to the UISS protocol does not improve oncological outcomes. Follow-up schedules with less frequent imaging should be discussed.

中文翻译：

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常规成像对肾切除术治疗的局限性和局部晚期肾肿瘤患者复发诊断的影响。

目的对于局部或局部晚期肾脏肿瘤，在肾切除术后检测复发的监测方法尚不规范。目的是评估监测方案对肿瘤学结果的影响。方法回顾性分析2006年至2010年在某学术机构接受局部或局部晚期肾肿瘤全或部分肾切除术治疗的患者。根据加州大学洛杉矶分校综合分期系统（UISS）协议，随访被认为是否足够。收集复发诊断时的症状，病变部位和数量。使用Kaplan-Meier方法评估无复发，癌症特异性和整体生存率，并与对数秩检验进行比较。计算Cox比例风险回归模型以识别预后因素。结果共纳入267例患者。中位随访时间为72个月。复发率为23.2％（62/267例）。复发为局部（16％），单发（23％），少转移（15％）或多转移（46％）。72.6％的复发发生在手术后的三年内。胸部X线或腹部超声未诊断出复发。112例患者随访不足。与具有足够随访的患者相比，他们的无复发生存期，癌症特异性生存期和总生存期相似。在多变量分析中，多转移性病变的存在是复发诊断后癌症特异性死亡率恶化的独立预后因素（HR = 10.15，95％CI：2.29-44.82，p = 0.002）。结论胸部X线和腹部超声检查对复发的作用是有限的。根据UISS方案进行严格的随访不能改善肿瘤学结果。应当讨论影像学频率较低的随访计划。