Американское видение наблюдения за пациентов с раком почки после лечения - [Ссылки доступны только зарегистрированным пользователям ]
GUIDELINE STATEMENTS
Guideline Statement 1: Patients undergoing follow-up for treated or observed renal masses should undergo a history and physical examination directed at detecting signs and symptoms of metastatic spread or local recurrence. (Clinical Principle)
Guideline Statement 2: Patients undergoing follow-up for treated or observed renal masses should undergo basic laboratory testing to include blood urea nitrogen (BUN)/creatinine, urine analysis (UA) and estimated glomerular filtration rate (eGFR). Other laboratory evaluations, including complete blood count (CBC), lactate dehydrogenase (LDH), liver function tests (LFTs), alkaline phosphatase (ALP) and calcium level, may be used at the discretion of the clinician. (Expert Opinion) = вот они тоже рекомендуют посмотреть уровень щелочной фосфатазы и кальций в анализе крови
Guideline Statement 3. Patients with progressive renal insufficiency on follow-up laboratory evaluation should be referred to nephrology. (Expert Opinion)
Guideline Statement 4: The Panel recommends a bone scan in patients with an elevated alkaline phosphatase (ALP), clinical symptoms such as bone pain, and/or if radiographic findings are suggestive of a bony neoplasm. (Recommendation; Evidence Strength: Grade C) = т.е. иследование костей рекомендуют только у пациентов с повышенным уровнем щелочной фосфатазы
Guideline Statement 5: The Panel recommends against the performance of a bone scan in the absence of an elevated alkaline phosphatase (ALP) or clinical symptoms, such as bone pain, or radiographic findings suggestive of a bony neoplasm. (Recommendation; Evidence Strength: Grade C)
Guideline Statement 6: Patients with a history of a renal neoplasm presenting with acute neurological signs or symptoms must undergo prompt neurologic cross-sectional CT or MRI scanning of the head or spine based on localization of symptomatology. (Standard; Evidence Strength: Grade A)
Guideline Statement 7. The Panel recommends against the routine use of molecular markers, such Ki-67, p-53 and VEGF, as benefits remain unproven at this time. (Recommendation; Evidence Strength: Grade C)
Surgery: Low risk patients (pT1, N0, Nx):
Guideline Statement 8: Patients should undergo a baseline abdominal scan (CT or MRI) for nephron sparing surgery and abdominal imaging (US, CT or MRI) for radical nephrectomy within three to twelve months following renal surgery. (Expert Opinion)
Guideline Statement 9: Additional abdominal imaging (US, CT or MRI) may be performed in patients with low risk (pT1, N0, Nx) disease following a radical nephrectomy if the initial postoperative baseline image is negative. (Option; Evidence Strength: Grade C)
Guideline Statement 10: Abdominal imaging (US, CT, or MRI) may be performed yearly for three years in patients with low risk (pT1, N0, Nx) disease following a partial nephrectomy based on individual risk factors if the initial postoperative scan is negative. (Option; Evidence Strength: Grade C)
Guideline Statement 11: The Panel recommends that patients with a history of low risk (pT1, N0, Nx) renal cell carcinoma undergo yearly chest x-ray (CXR) to assess for pulmonary metastases for three years and only as clinically indicated beyond that time period. (Recommendation; Evidence Strength: Grade C)
Surgery: Moderate to High Risk Patients (pT2-4N0 Nx or any stage N+):
Guideline Statement 12: The Panel recommends that moderate to high risk patients undergo baseline chest and abdominal scan (CT or MRI) within three to six months following surgery with continued imaging (US, CXR, CT or MRI) every six months for at least three years and annually thereafter to year five. (Recommendation; Evidence Strength: Grade C)
Guideline Statement 13: The Panel recommends site-specific imaging as warranted by clinical symptoms suggestive of recurrence or metastatic spread. (Recommendation; Evidence Strength: Grade C)
Guideline Statement 14: Imaging (US, CXR, CT or MRI) beyond five years may be performed at the discretion of the clinician for moderate to high risk patients. (Option; Evidence Strength: Grade C)
Guideline Statement 15: Routine FDG-PET scan is not indicated in the follow-up for renal cancer. (Expert Opinion)
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