Editorial Comment: Stage and Histopathology, Stratification for Recurrence, Time to Recurrence, and Oncological Outcomes for T1 Renal Cell Carcinoma After Partial Nephrectomy: A 20-Year Retrospective Experience From a Single Institution

Although most patients with low-grade renal cell carcinoma treated with partial nephrectomy experience favorable outcomes, a subset develops recurrence, which negatively affects overall survival. This underscores the importance of long-term surveillance. Current National Comprehensive Cancer Network (NCCN) and American Urological Association (AUA) guidelines recommend imaging follow-up for 5 years in patients with pT1 renal cell carcinoma after partial nephrectomy,1 but there is no consensus on surveillance beyond that period. Decisions regarding extended imaging are typically left to informed/shared decision-making between clinicians and patients. Sandoval et al2 propose a structured long-term surveillance protocol, recommending imaging every 2 to 3 years for up to 10 years postoperatively. In their retrospective study of 310 patients with complete data, 28 (9%) experienced recurrence at a mean of 45.6 months. Importantly, 25% of these recurrences occurred after 5 years, with a mean time to recurrence of 93.4 months (7.78 years). Although cancer-specific mortality was low at 2%, recurrence was significantly associated with death (Hazard Ratio 4.42, P < .05). This study highlights a potential gap in current guidelines and suggests that a low-frequency, extended surveillance strategy may help detect late recurrences and reduce cancer-specific mortality. However, it does not address critical factors that influence existing protocols, such as the cost of prolonged imaging, radiation exposure, and the importance of shared decision-making.3 Although prospective validation would be ideal, the low event rate and long latency make such trials financially and logistically challenging. Extending surveillance for all patients to detect a small percentage of late recurrences may not be sustainable, emphasizing the need for improved tumor genomics and biomarker-based risk stratification. These tools could help tailor follow-up protocols to those at highest risk, optimizing resource use while maintaining oncological vigilance.