MP14-04 PREOPERATIVE TUMOR MEASUREMENTS ARE INDEPENDENTLY PREDICTIVE OF OVERALL SURVIVAL FOLLOWING CYTOREDUCTIVE NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) I (MP14)1 Apr 2020MP14-04 PREOPERATIVE TUMOR MEASUREMENTS ARE INDEPENDENTLY PREDICTIVE OF OVERALL SURVIVAL FOLLOWING CYTOREDUCTIVE NEPHRECTOMY Daniel Shapiro*, Jose Karam, Philippe Spiess, Jay Raman, Mary Westerman, Wade Sexton, Logan Zemp, Alyssa Bilotta, Glenn Allen, Surena Matin, Christopher Wood, and E. Jason Abel Daniel Shapiro*Daniel Shapiro* More articles by this author , Jose KaramJose Karam More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , Jay RamanJay Raman More articles by this author , Mary WestermanMary Westerman More articles by this author , Wade SextonWade Sexton More articles by this author , Logan ZempLogan Zemp More articles by this author , Alyssa BilottaAlyssa Bilotta More articles by this author , Glenn AllenGlenn Allen More articles by this author , Surena MatinSurena Matin More articles by this author , Christopher WoodChristopher Wood More articles by this author , and E. Jason AbelE. Jason Abel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000839.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Studies suggest that overall survival (OS) following cytoreductive nephrectomy (CN) is associated with preoperative tumor measurements including primary tumor diameter, number of metastatic sites, sum of metastatic tumor diameters and primary tumor percent of overall burden. Current risk models, however, do not account for tumor burden. This study evaluated associations between OS and preoperative tumor measurements for patients treated with CN during the targeted therapy era. METHODS: Data for consecutive mRCC patients treated with CN at 4 institutions from 2006-2017 were analyzed after determining IMDC risk category, primary tumor (PT) diameter, number of metastatic sites, sum of metastatic tumor diameters and PT percentage of overall burden. All patients had either CT or MRI within 1 month of surgery which was used for tumor measurements. Univariate and multivariable (MV) Cox models evaluated tumor measurement and IMDC risk associations with OS. RESULTS: A total of 617 patients were available for analysis. Median follow-up of patients alive at last follow-up was 42 months (IQR 23-68). Median PT diameter was 10.0 cm (IQR 7-13cm), number of metastatic sites was 2 (IQR 1-2), sum of metastatic tumor diameters was 4.5 cm (IQR 2-10cm) and PT percent of overall burden was 73.7% (IQR 60-85%). After univariate analysis, all 4 tumor burden measures were associated with OS (p≤0.001 for all). MV models evaluating IMDC risk category with individual tumor burden measurements demonstrated that all measures were predictive as continuous variables: PT diameter (HR 1.03, 95% CI 1.01-1.06, p=0.007), sum of metastatic tumor diameters (HR 1.04, 95% CI 1.02-1.05, p<0.001), PT percent of overall burden (HR 0.43, 95% CI 0.27-0.68, p<0.001), and number of metastatic sites (HR 1.52, 95% CI 1.25-1.85, p<0.001). Additional MV models were created using clinically significant tumor measurement cutoffs and IMDC risk groups. OS was independently associated with IMDC intermediate (HR 3.17, 95% CI 1.84-5.44, p<0.001) and poor risk (HR 3.85, 95% CI 2.21-6.70, p<0.001), PT percentage of overall burden <90% (HR 1.41, 95% CI 1.05-1.89, p=0.021), and >2 metastatic sites (HR 1.60, 95% CI 1.29-2.00, p<0.001). CONCLUSIONS: Primary tumor and metastatic disease burden are independently associated with OS following CN. Future risk models should include tumor burden measurements. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e196-e196 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Shapiro* More articles by this author Jose Karam More articles by this author Philippe Spiess More articles by this author Jay Raman More articles by this author Mary Westerman More articles by this author Wade Sexton More articles by this author Logan Zemp More articles by this author Alyssa Bilotta More articles by this author Glenn Allen More articles by this author Surena Matin More articles by this author Christopher Wood More articles by this author E. Jason Abel More articles by this author Expand All Advertisement PDF downloadLoading ...