Surveillance strategies following curative therapy for localized renal cell carcinoma

Advances in the diagnosis, staging, and treatment of patients with renal cell carcinoma (RCC) have resulted in improved survival pf patients with locally recurrent and metastatic disease. Assuming that success of clinical intervention at the time of relapse is inversely proportional to the disease burden at the time of salvage treatment, ideal surveillance protocol should allow the earliest identification of potentially treatable recurrences while minimizing unnecessary examinations and patients anxiety. In addition, optimal surveillance regimen would take into account primary tumor characteristics; initial treatment modality; incidence, timing, and pattern of recurrence; and effectiveness of available salvage treatments. Anatomic tumor stage remains the most important prognosticator of outcome in RCC and a cornerstone of several currently. proposed surveillance strategies. Nonetheless, recent identification of novel clinical and pathologic prognostic factors in RCC have resulted in gradual transition from the use of solitary clinical factors, such as tumor, node, metastasis staging system, to the introduction of systems that integrate multiple validated prognostic factors. Finally, development of new and meaningful biomarkers and their incorporation into integrated staging algorithms will likely revolutionize the staging and surveillance of RCC patients.