MP47-17 SINGLE CENTER COMPARISON OF RADIOGRAPHIC AND MORPHOMETRIC CHARACTERISTICS AND OUTCOMES IN T3A PATHOLOGICALLY UPSTAGED AND NON-UPSTAGED RENAL CELL CARCINOMA

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP47-17 SINGLE CENTER COMPARISON OF RADIOGRAPHIC AND MORPHOMETRIC CHARACTERISTICS AND OUTCOMES IN T3A PATHOLOGICALLY UPSTAGED AND NON-UPSTAGED RENAL CELL CARCINOMA Saeed Ghassemzadeh, Aastha Shah, Dhruv Puri, Luke Wang, Franklin Liu, Sohail Dhanji, Kevin Hakimi, Mimi Nguyen, Ryan Nasseri, Margaret Meagher, Clara Cerrato, Juan Javier-Desloges, and Ithaar Derweesh Saeed GhassemzadehSaeed Ghassemzadeh More articles by this author , Aastha ShahAastha Shah More articles by this author , Dhruv PuriDhruv Puri More articles by this author , Luke WangLuke Wang More articles by this author , Franklin LiuFranklin Liu More articles by this author , Sohail DhanjiSohail Dhanji More articles by this author , Kevin HakimiKevin Hakimi More articles by this author , Mimi NguyenMimi Nguyen More articles by this author , Ryan NasseriRyan Nasseri More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Clara CerratoClara Cerrato More articles by this author , Juan Javier-DeslogesJuan Javier-Desloges More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A significant portion of patients presenting with Stage 1-2 Renal Cell Carcinoma (RCC) are pathologically upstaged to Stage 3 following surgery. This is due to previously undetected extension into the renal venous system, perirenal or renal sinus fat, or collecting system. Improved detection of potential T3 upstaging may prompt changes in disease management and may impact patient survival. We sought to compare pathologically upstaged and non-upstaged T3a RCC cases to identify characteristics of upstaged masses, predictors of T3a disease, and impact on oncological outcomes. METHODS: We conducted a single center retrospective analysis of patients with pathologic T3a RCC who underwent surgical intervention. The cohort was divided into a group of patients with masses which were upstaged, (cT1-cT2/pT3a) and a group with masses preoperatively identified as cT3a (non-upstaged, cT3a/pT3a) for descriptive and outcomes analyses. We sought to delineate proportion of underdiagnosed pT3a RCC, location of upstaged disease, and predictors of upstaging. Outcomes were overall survival (OS) and recurrence-free survival (RFS). Multivariate analyses (MVA) were performed to identify predictors of T3a invasion site and outcomes. Kaplan Meier survival analyses (KMA) were performed to compare survival outcomes. RESULTS: We analyzed 185 patients, of which 120 (64.9%) were upstaged and 65 (35.1%) were non-upstaged. When compared to non-upstaged masses, upstaged masses were significant for smaller size (6.8 cm vs 8.2 cm, p=0.008), lower RENAL score (8.7 vs 9.9, p<0.001), less hilar involvement (29.2% vs 86.2%, p<0.001), and increased exophyticity (41.7% vs 23.1%, p=0.011). On pathology, upstaged masses had greater proportions of perirenal fat invasion (53.3% vs 33.8%, p=0.011), but less venous system (44.2% vs 78.5%, p<0.001) and sinus fat invasion (35.8% vs 63.1%, p<0.001) compared to non-upstaged masses. RENAL domains R, E, and L were independent predictors for T3a disease foci (OR=0.053-7.70, p=0.001-0.042). MVA demonstrated that non upstaged cT3a RCC had a higher risk of recurrence (HR=2.01, p=0.043). KMA noted better RFS in upstaged patients compared to non-upstaged patients (80.8% vs 75.4%, p=0.002). CONCLUSIONS: Pathologically upstaged T3a RCC is associated with distinct morphology and invasion patterns, and improved recurrence free survival when compared to non-upstaged T3a RCC. RENAL domains can aid in identifying masses with upstaging potential. Source of Funding: UC San Diego Summer Research Fellowship © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e651 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Saeed Ghassemzadeh More articles by this author Aastha Shah More articles by this author Dhruv Puri More articles by this author Luke Wang More articles by this author Franklin Liu More articles by this author Sohail Dhanji More articles by this author Kevin Hakimi More articles by this author Mimi Nguyen More articles by this author Ryan Nasseri More articles by this author Margaret Meagher More articles by this author Clara Cerrato More articles by this author Juan Javier-Desloges More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...