MP45-19 EVALUATION OF THE UTILITY OF LYMPH-VASCULAR INVASION AS AN INDEPENDENT PROGNOSTIC PREDICTOR OF OVERALL SURVIVAL FOR PATIENTS WITH RENAL CELL CARCINOMA THAT UNDERGO NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I (MP45)1 Sep 2021MP45-19 EVALUATION OF THE UTILITY OF LYMPH-VASCULAR INVASION AS AN INDEPENDENT PROGNOSTIC PREDICTOR OF OVERALL SURVIVAL FOR PATIENTS WITH RENAL CELL CARCINOMA THAT UNDERGO NEPHRECTOMY Nikola Rakic, Ivan Rakic, Jacob Keeley, Nicholas Corsi, Chandler Bronkema, Marcus Jamil, Akshay Sood, Giacomo Novara, Mani Menon, Craig Rogers, and Firas Abdollah Nikola RakicNikola Rakic More articles by this author , Ivan RakicIvan Rakic More articles by this author , Jacob KeeleyJacob Keeley More articles by this author , Nicholas CorsiNicholas Corsi More articles by this author , Chandler BronkemaChandler Bronkema More articles by this author , Marcus JamilMarcus Jamil More articles by this author , Akshay SoodAkshay Sood More articles by this author , Giacomo NovaraGiacomo Novara More articles by this author , Mani MenonMani Menon More articles by this author , Craig RogersCraig Rogers More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002066.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Lymph-vascular invasion (LVI) is recognized as an adverse pathological feature in patients with renal cell carcinoma (RCC). However, its impact on overall survival (OS) is not clear, and scarcely addressed in literature. Our aim was to assess the prognostic ability of LVI as a predictor of OS in RCC patients using a large, North American cohort. METHODS: We included 45,036 cM0 RCC patients, diagnosed between 2010 and 2015, that underwent partial or radial nephrectomy within the National Cancer Database. Kaplan-Meier curves and long-rank test were used to depict and compare survival curves. Cox regression analysis tested the relationship between LVI and OS, after accounting for the following covariates: age, Charlson Comorbidity Index status, pathological tumor stage, number of nodes removed, number of positive nodes, pathological nodal status (LNI), and pathological LVI status. RESULTS: Median age (IQR) was 60 (52-68), and most patients had pT1 stage (70.0%). Nodal status was pN0, pN1, and pNx in 14.0%, 3.7%, and 82.3%, respectively. Overall, 7.7% of patients had LVI. Median (IQR) follow-up of the cohort was 38 months (20-59). At 5-years, OS was 59.8% in patients with LVI vs. 85.1% in patients without LVI (p-value<.0001). When patients were stratified based on nodal stage, these rates were 55.8% vs. 77.2% in pN0 patients, (p<0.0001) and 34.1% vs. 39.7% in pN1 patients (p<0.0001). LVI was an independent predictor of higher overall risk of mortality (hazard ratio [HR]: 1.53, 95% CI: 1.36–1.71, p<.001). Other covariates that had a detrimental prognostic impact included pN1 disease (HR: 2.08), Fuhrman grade 3 disease (HR: 1.30), Fuhrman grade 4 disease (HR: 2.54), a pT2 disease (HR: 1.40) and pT3/4 disease (HR: 1.92). (all p-value<0.0001) CONCLUSIONS: Our findings highlight the detrimental impact of LVI on OS in a large nationwide cohort. To the best of our knowledge, this is the first validation of the prognostic ability of LVI in RCC patients on a nationwide level, as virtually all previous studies were institutional. Besides, we observed a synergistic impact for LVI in the presence of pN1, as these patients fare worse than those who have pN1 disease without LVI. Our findings highlight an important utility that LVI can provide in deciding a patient’s prognosis after nephrectomy, and further exploration should examine exactly what its role may become. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e811-e811 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikola Rakic More articles by this author Ivan Rakic More articles by this author Jacob Keeley More articles by this author Nicholas Corsi More articles by this author Chandler Bronkema More articles by this author Marcus Jamil More articles by this author Akshay Sood More articles by this author Giacomo Novara More articles by this author Mani Menon More articles by this author Craig Rogers More articles by this author Firas Abdollah More articles by this author Expand All Advertisement Loading ...