BACKGROUND: It is unclear whether post-nephrectomy patients with renal cell carcinoma (RCC) are routinely assessed for recurrence risk post-operatively and whether patients at high recurrence risk are seen by providers who can evaluate candidacy for adjuvant systemic therapy (AST) and adjuvant clinical trials.
METHODS: We identified all patients with locoregional RCC who underwent nephrectomy within Duke University Health System between 4/1/2015 and 12/31/2019 via an institutional database. Medical records were reviewed to identify patient characteristics, post-nephrectomy referrals, treatment, and follow up. Patients with tumor stage 3 and tumor grade 2, regional lymph-node metastasis, or both, were classified as high recurrence risk.
RESULTS: Of 618 patients with locoregional RCC who underwent nephrectomy, 136 (22%) had high risk of recurrence. Of those, 25 patients with high risk disease (18%) were referred to a medical oncologist for discussion of AST. Twenty-three (92%) referrals took place ≥2018. Three patients received AST. The decision not to receive AST after referral was primarily made by the oncologist in 10 (46%), patient in 8 (36%), and unrecorded in 4 (18%) of 22 cases for multiple reasons (Figure 1). Individual surgeons referred high risk patients for discussion of AST with varying frequency, ranging from 0 to 100% in 2019.
CONCLUSIONS: Despite increasing patients with high-risk locoregional RCC referred to medical oncologists after nephrectomy, few patients received AST. These findings highlight the need for continued identification of effective AST and referral of patients most likely to benefit.
