MP41-07 PROPOSAL FOR RECLASSIFICATION OF UPSTAGED T1 AND T2 AND PATHOLOGICAL T3 RCC BASED ON IMPROVED ALIGNMENT OF SURVIVAL ANALYSES

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP41-07 PROPOSAL FOR RECLASSIFICATION OF UPSTAGED T1 AND T2 AND PATHOLOGICAL T3 RCC BASED ON IMPROVED ALIGNMENT OF SURVIVAL ANALYSES Margaret Meagher, Clara Cerrato, Dhruv Puri, Franklin Liu, Aastha Shah, Saeed Ghassemzadeh, Sohail Dhanji, Luke Wang, Dattatraya Patil, Kazutaka Saito, Yosuke Yasuda, Ryan Nasseri, Yasuhisa Fujii, Viraj Master, and Ithaar Derweesh Margaret MeagherMargaret Meagher More articles by this author , Clara CerratoClara Cerrato More articles by this author , Dhruv PuriDhruv Puri More articles by this author , Franklin LiuFranklin Liu More articles by this author , Aastha ShahAastha Shah More articles by this author , Saeed GhassemzadehSaeed Ghassemzadeh More articles by this author , Sohail DhanjiSohail Dhanji More articles by this author , Luke WangLuke Wang More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Yosuke YasudaYosuke Yasuda More articles by this author , Ryan NasseriRyan Nasseri More articles by this author , Yasuhisa FujiiYasuhisa Fujii 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.0000000000003279.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with pathologically upstaged tumors have worse survival outcomes than their non-upstaged matched counterparts. We sought to examine if pathologic upstaging incrementally may more rationally stratify cancer specific survival outcomes. METHODS: Multi-institutional (Emory, TMDU, UCSD) retrospective analysis of patients with renal cell carcinoma who underwent partial or radical nephrectomy between 1998-2020. Patients were divided into cT1 upstaged to pT3 (cT1/pT3), cT2 non-upstaged (cT2/pT2), cT2 upstaged to pT3 (cT2/pT3), and cT3 non-upstaged (cT3/pT3). Primary outcome was cancer specific mortality (CSM). Secondary outcomes were overall survival (OS) and recurrence free survival (RFS). Cox regression was utilized to analyze factors associated with outcomes. Kaplan Meier analysis (KMA) was performed to analyze 5-year CSM. ROC analysis was utilized to compare predictive value of AJCC 8th edition TNM staging vs proposed staging. RESULTS: 1093 patients were analyzed (283 cT1/pT3, 237 cT2/pT2, 244 cT2/pT3, and 329 cT3/pT3). Median follow-up was 25.9 months. Cox regression demonstrated that cT2/pT3 (HR 2.7, p<0.001 vs. cT1/pT3 [referent]) and cT3/pT3 (HR 2.6, p<0.001 vs. cT1/pT3 [referent]) were significantly associated with worsened CSM, while cT1/pT3 (HR 0.4, p<0.001 vs. cT3/pT3 [referent]) and cT2/pT2 (HR 0.4, p<0.001 vs. cT3/pT3 [referent]) were associated with improved CSM. Based on this, we proposed to realign cT1/pT3 with cT2/pT2 and cT2/pT3 with cT3/pT3. KMA revealed significant differences in 5-year CSM (cT1/pT3 82%, cT2/pT2 81%, cT2/pT3 67%, and cT3/pT3 60%, p<0.001). There were significant differences in 5-year OS (cT1/pT3 63%, cT2/pT2 67%, cT2/pT3 49%, and cT3/pT3 49%, p<0.001), and 5-year RFS (cT1/pT3 80%, cT2/pT2 83%, cT2/pT3 70%, and cT3/pT3 59%, p<0.001) on KMA. ROC analysis revealed an AUC of 0.529 for CSM and AUC of 0.502 for ACM using the current AJCC 8th edition TNM staging. ROC analysis revealed an AUC of 0.597 for CSM and AUC of 0.545 for our new proposal. CONCLUSIONS: Our analysis suggests that cT1 tumors pathologically upstaged to pT3 behave more similarly to pT2 tumors. Further delineation of pathologically upstaged tumors may more rationally stratify cancer specific survival outcomes to guide patient counseling and clinical decision making. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e556 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Margaret Meagher More articles by this author Clara Cerrato More articles by this author Dhruv Puri More articles by this author Franklin Liu More articles by this author Aastha Shah More articles by this author Saeed Ghassemzadeh More articles by this author Sohail Dhanji More articles by this author Luke Wang More articles by this author Dattatraya Patil More articles by this author Kazutaka Saito More articles by this author Yosuke Yasuda More articles by this author Ryan Nasseri More articles by this author Yasuhisa Fujii More articles by this author Viraj Master More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...