MP14-15 THE SPINAL DISTRIBUTION OF METASTATIC RENAL CELL CARCINOMA: SUPPORT FOR LOCOREGIONAL RATHER THAN ARTERIAL HEMATOGENOUS MODE OF EARLY BONY DISSEMINATION

Abstract

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) I (MP14)1 Apr 2020MP14-15 THE SPINAL DISTRIBUTION OF METASTATIC RENAL CELL CARCINOMA: SUPPORT FOR LOCOREGIONAL RATHER THAN ARTERIAL HEMATOGENOUS MODE OF EARLY BONY DISSEMINATION Kyrollis Attalla*, Cihan Duzgol, Lily McLaughlin, Jessica Flynn, Irina Ostrovnaya, Renzo G. DiNatale, Andrew W. Silagy, Jonathan Coleman, Chung-Han Lee, Maria I. Carlo, Martin H. Voss, Paul Russo, Mark Bilsky, A. Ari Hakimi, and Nelson Moss Kyrollis Attalla*Kyrollis Attalla* More articles by this author , Cihan DuzgolCihan Duzgol More articles by this author , Lily McLaughlinLily McLaughlin More articles by this author , Jessica FlynnJessica Flynn More articles by this author , Irina OstrovnayaIrina Ostrovnaya More articles by this author , Renzo G. DiNataleRenzo G. DiNatale More articles by this author , Andrew W. SilagyAndrew W. Silagy More articles by this author , Jonathan ColemanJonathan Coleman More articles by this author , Chung-Han LeeChung-Han Lee More articles by this author , Maria I. CarloMaria I. Carlo More articles by this author , Martin H. VossMartin H. Voss More articles by this author , Paul RussoPaul Russo More articles by this author , Mark BilskyMark Bilsky More articles by this author , A. Ari HakimiA. Ari Hakimi More articles by this author , and Nelson MossNelson Moss More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000839.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To investigate the distribution of spinal metastasis in metastatic renal cell carcinoma (mRCC) and to explore relationships between biological and clinical factors and patterns of spinal spread. METHODS: An institutional database was queried to identify patients with mRCC and spinal metastatic involvement from June 2005 – November 2018. A radiologist examined all cross-sectional imaging involving the spine and scored each level for absence or presence of disease. Clinical and biologic features including primary tumor size and degree of spinal and non-bony metastatic involvement (including regional lymph node and distant deposits) were collected. Spinal distributions were evaluated by the Kolmogorov Smirnov test and compared across radiographic and clinical parameters. RESULTS: One-hundred patients with 685 spinal levels involved by mRCC were evaluated. A nonuniform spatial distribution was observed across the cohort; a preponderance of thoracolumbar involvement was noted with the mode at L3 (p<0.001). No difference in metastatic distribution was observed in right versus left-sided tumors. Tumors <4cm compared to >7cm, patients who had distant spread versus bone-only disease, and patients with increasing number of spine levels involved (1 versus >5 levels) had a significantly different distribution (p<0.001 for all comparisons). Smaller tumor size, distant spread, and greater number of involved levels appeared to have a more uniform distribution of spinal metastasis. CONCLUSIONS: These data support a dominant locoregional as opposed to arterial hematogenous mechanism for the early dissemination of mRCC to the spine. This is concordant with the theory of the valveless Batson plexus acting as a conduit for such spread, as the kidneys are compartmentally distinct from, but reside just anterior to the spine at L1-L3. Characterizations of the biologic molecular features contributing to osseous tropism and aggressive tumor biology (as seen in the subset of patients with uniform spread, such as outlier patients with small tumors), have implications for surveillance and are an area of active investigation. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e201-e201 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kyrollis Attalla* More articles by this author Cihan Duzgol More articles by this author Lily McLaughlin More articles by this author Jessica Flynn More articles by this author Irina Ostrovnaya More articles by this author Renzo G. DiNatale More articles by this author Andrew W. Silagy More articles by this author Jonathan Coleman More articles by this author Chung-Han Lee More articles by this author Maria I. Carlo More articles by this author Martin H. Voss More articles by this author Paul Russo More articles by this author Mark Bilsky More articles by this author A. Ari Hakimi More articles by this author Nelson Moss More articles by this author Expand All Advertisement PDF downloadLoading ...