MP24-11 IS PATHOLOGICAL UPSTAGING TO T3 RENAL CELL CARCINOMA ASSOCIATED WITH A SIMILAR PROGNOSIS TO NON-UPSTAGED PATHOLOGIC T3 DISEASE? A MULTICENTER ANALYSIS

Abstract

You have accessJournal of UrologyCME1 May 2022MP24-11 IS PATHOLOGICAL UPSTAGING TO T3 RENAL CELL CARCINOMA ASSOCIATED WITH A SIMILAR PROGNOSIS TO NON-UPSTAGED PATHOLOGIC T3 DISEASE? A MULTICENTER ANALYSIS Ryan Nasseri, Kevin Hakimi, Ava Saidian, Riccardo Autorino, Brian Lane, Yasuha Fujii, Michele Marchioni, Hajime Tanaka, Dattatraya Patil, Francesco Porpiglia, Sabrina Noyes, Chandru Sundaram, James Porter, Andrea Minervini, Umberto Capitianio, Francesco Montorsi, Viraj Master, and Ithaar Derweesh Ryan NasseriRyan Nasseri More articles by this author , Kevin HakimiKevin Hakimi More articles by this author , Ava SaidianAva Saidian More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Brian LaneBrian Lane More articles by this author , Yasuha FujiiYasuha Fujii More articles by this author , Michele MarchioniMichele Marchioni More articles by this author , Hajime TanakaHajime Tanaka More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Sabrina NoyesSabrina Noyes More articles by this author , Chandru SundaramChandru Sundaram More articles by this author , James PorterJames Porter More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Umberto CapitianioUmberto Capitianio More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Viraj MasterViraj Master More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002563.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pathological upstaging to T3a disease may occur following radical (RN) or partial nephrectomy (PN) for patients with T1/T2 renal cell carcinoma (RCC). Follow up and perceived prognosis for these patients is similar to those who initially presented with clinical T3 RCC. We sought to compare survival outcomes in patients who underwent surgical therapy for upstaged versus non-upstaged pT3 RCC. METHODS: We conducted a retrospective analysis of a multi-institutional dataset of patients who underwent radical (RN) or partial nephrectomy (PN) with final pathologic stage of pT3. Patients were classified as being upstaged (US) from cT1 or cT2 or non-upstaged (NUS) with cT3 disease. Primary outcome was cancer specific survival (CSS)/cancer specific mortality (CSM), with secondary outcomes being Overall Survival (OS)/all-cause mortality (ACM) and Progression/progression-free survival (PFS). Multivariable Cox regression analysis (MVA) was conducted for predictors of mortality outcomes and Kaplan Meier Analyses (KMA) were conducted for survival outcomes comparing US and NUS groups. RESULTS: 1232 patients were analyzed (853 US/379 NUS; median follow up 46.2 months). MVA for CSM found that clear cell RCC (HR 2.1, p <0.001), positive surgical margin (HR 1.7, p=0.047), and NUS (HR 1.5, p=0.003) were independently associated with worsened CSM. MVA for ACM revealed age (HR 1.01, p=0.002), RN (HR 2.5, p <0.001), preoperative GFR <60 (HR 1.4, p=0.007), clear-cell RCC (HR 1.4, p=0.007), positive surgical margin (HR 2.2, p <0.001), and NUS (1.27, p=0.023) were independently associated with worsened ACM. MVA for Progression revealed Age (HR 1.01, p=0.022), positive margin (HR 1.9, p=0.016), and NUS (HR 1.67, p <0.001) to be predictive. Comparing NUS and US groups, KMA revealed worsened 5 year CSS (56% vs. 75%, p <0.001; Figure), 5 year OS (42% vs. 58%, p <0.001) and 5 year PFS (33% vs. 58%, p <0.001). CONCLUSIONS: Pathologic upstaging of clinical T1/T2 to T3 RCC was associated with improved survival outcomes when compared to non-upstaged pathologic T3 RCC. Such differences need to be taken into account when designing follow up protocols and for refinement of risk stratification in the T3 RCC stage group. Further investigation is requisite. Source of Funding: Stephen Weissman Kidney Cancer Research Fund © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e396 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Nasseri More articles by this author Kevin Hakimi More articles by this author Ava Saidian More articles by this author Riccardo Autorino More articles by this author Brian Lane More articles by this author Yasuha Fujii More articles by this author Michele Marchioni More articles by this author Hajime Tanaka More articles by this author Dattatraya Patil More articles by this author Francesco Porpiglia More articles by this author Sabrina Noyes More articles by this author Chandru Sundaram More articles by this author James Porter More articles by this author Andrea Minervini More articles by this author Umberto Capitianio More articles by this author Francesco Montorsi More articles by this author Viraj Master More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF DownloadLoading ...