MP47-18 SUSTAINABLE MULTIDISCIPLINARY TEAM REFERRAL FOR NON-METASTATIC RENAL CELL CARCINOMA: A SURVIVAL-BASED RECOMMENDATION

Abstract

You have accessJournal of UrologyCME1 May 2022MP47-18 SUSTAINABLE MULTIDISCIPLINARY TEAM REFERRAL FOR NON-METASTATIC RENAL CELL CARCINOMA: A SURVIVAL-BASED RECOMMENDATION Giuseppe Basile, Alberto Martini, Giuseppe Fallara, Antony Pellegrino, Alessandro Larcher, Daniele Raggi, Riccardo Campi, Sumanta Pal, Philippe Spiess, Francesco Montorsi, Toni K. Choueiri, Andrea Necchi, and Umberto Capitanio Giuseppe BasileGiuseppe Basile More articles by this author , Alberto MartiniAlberto Martini More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Antony PellegrinoAntony Pellegrino More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Daniele RaggiDaniele Raggi More articles by this author , Riccardo CampiRiccardo Campi More articles by this author , Sumanta PalSumanta Pal More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Toni K. ChoueiriToni K. Choueiri More articles by this author , Andrea NecchiAndrea Necchi More articles by this author , and Umberto CapitanioUmberto Capitanio More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002618.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To date, multidisciplinary team (MDT) evaluation, enrollment in pre-surgical trials and deferred active treatments are optional strategies for patients with Renal Cell Carcinoma (RCC), which are under investigation to maximize cancer control and implement health care policies. To provide recommendations regarding which patients with RCC may benefit the most from an early MDT evaluation. METHODS: We relied on a prospective dataset including patients diagnosed with RCC in 1998-2019 and treated by means of surgery alone at a tertiary referral center. The risk of other cause mortality (OCM) was evaluated against the risk of recurrence over time by means of the Weibull regression. Patients were stratified based on clinical stage (cT1a; cT1b; cT2; cT3-4), age (<60; 60-70; >70) and comorbidities [Charlson comorbidity index (CCI) 0 vs ≥1]. For each combination of cT stage, age and CCI, the potential need for a MDT referral was defined when the risk of recurrence exceeded the risk of OCM within the lower limit of the 95%CI of the mean time to recurrence. RESULTS: Overall, 1,162 (51%) patients had no comorbidities. Median follow-up was 7 years. Patients who would benefit most from a MDT evaluation are those diagnosed with A) cT3-4 disease (any age or comorbidity) or B) cT2 cancers if healthy and younger than 70 years or younger than 60 years with at least 1 comorbidity or C) cT1b if younger than 60 years and without comorbidities. Figure 1 depicts the risk of other cause mortality versus risk of recurrence following surgery for non-metastatic renal cell carcinoma according to age and cT stage in patients with no comorbidities or in presence of comorbidities. The continuous lines depict the risk of recurrence that decreases with time. Vertical lines depict the mean time to recurrence and associated 95% confidence interval calculated with mean restricted survival time. Dashed lines depict other cause mortality risk, which increases with time. CONCLUSIONS: Our findings can help selecting the optimal candidates for multidisciplinary evaluations and to consider RCC patients for clinical trials, deferred treatment, and treatment policy improvement, especially in the case of major healthcare disruptions, such as pandemics. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e817 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giuseppe Basile More articles by this author Alberto Martini More articles by this author Giuseppe Fallara More articles by this author Antony Pellegrino More articles by this author Alessandro Larcher More articles by this author Daniele Raggi More articles by this author Riccardo Campi More articles by this author Sumanta Pal More articles by this author Philippe Spiess More articles by this author Francesco Montorsi More articles by this author Toni K. Choueiri More articles by this author Andrea Necchi More articles by this author Umberto Capitanio More articles by this author Expand All Advertisement PDF DownloadLoading ...