Patient symptoms, tumor size, tumor necrosis, and microvascular invasion are some of the other factors that have been evaluated and integrated into risk stratification models that separate patients into low-, intermediate-, or high-risk groups according to the probability of local recurrence or distant metastases [11,14,18,19]. Most recurrences occur within 3 years after treatment, with a median time to relapse of 1 to 2 years; thus, most surveillance guidelines address follow-up for up to 5 years after treatment [2,9,11,22]. In patients with high-risk tumors (ie, pT2 and pT3 tumors), especially those patients without a significant competing risk for non-RCC death, follow-up beyond 5 years may also be considered because of a nonnegligible incidence of late recurrence [14,18]. Patients who have undergone PN have a similar or slightly higher incidence of local recurrence compared with those who have undergone RN [11,23]. In some guidelines, a more rigorous follow-up protocol is recommended to assess for local recurrence in those who have undergone PN [2,9]. However, more commonly, recurrence manifests as distant metastases [10,20,24,25]. The lungs are the most common site affected by metastases, followed by the lymph nodes, bones, liver, adrenal glands, and brain. Other less common sites include the spleen, pancreas, diaphragm, heart, skin, and connective tissues. Apart from bone and brain metastases, most metastases and local recurrences are identified in asymptomatic patients [10,15,18,26]. Post-treatment Follow-up of Renal Cell Carcinoma Radiography Chest A chest radiograph is a low-yield diagnostic tool for detecting pulmonary metastasis in patients after surgical excision of RCC, particularly in those with low-risk tumors, irrespective of the treatment modality (RN, PN, or ablation) [27,28].
Post Treatment Follow up and Active Surveillance of Renal Cell Carcinoma. Patient symptoms, tumor size, tumor necrosis, and microvascular invasion are some of the other factors that have been evaluated and integrated into risk stratification models that separate patients into low-, intermediate-, or high-risk groups according to the probability of local recurrence or distant metastases [11,14,18,19]. Most recurrences occur within 3 years after treatment, with a median time to relapse of 1 to 2 years; thus, most surveillance guidelines address follow-up for up to 5 years after treatment [2,9,11,22]. In patients with high-risk tumors (ie, pT2 and pT3 tumors), especially those patients without a significant competing risk for non-RCC death, follow-up beyond 5 years may also be considered because of a nonnegligible incidence of late recurrence [14,18]. Patients who have undergone PN have a similar or slightly higher incidence of local recurrence compared with those who have undergone RN [11,23]. In some guidelines, a more rigorous follow-up protocol is recommended to assess for local recurrence in those who have undergone PN [2,9]. However, more commonly, recurrence manifests as distant metastases [10,20,24,25]. The lungs are the most common site affected by metastases, followed by the lymph nodes, bones, liver, adrenal glands, and brain. Other less common sites include the spleen, pancreas, diaphragm, heart, skin, and connective tissues. Apart from bone and brain metastases, most metastases and local recurrences are identified in asymptomatic patients [10,15,18,26]. Post-treatment Follow-up of Renal Cell Carcinoma Radiography Chest A chest radiograph is a low-yield diagnostic tool for detecting pulmonary metastasis in patients after surgical excision of RCC, particularly in those with low-risk tumors, irrespective of the treatment modality (RN, PN, or ablation) [27,28].