PD07-09 MANAGEMENT AND OUTCOMES OF MEDICALLY IMMUNOSUPPRESSED PATIENTS WITH CT1 RENAL CELL CARCINOMA

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD07-09 MANAGEMENT AND OUTCOMES OF MEDICALLY IMMUNOSUPPRESSED PATIENTS WITH CT1 RENAL CELL CARCINOMA Ali Ghasemzadeh, Eric Wendt, Brendan Dolan, Juliana Craig, Kyle Richards, Tudor Borza, Glenn Allen, David Jarrard, E. Jason Abel, and Daniel Shapiro Ali GhasemzadehAli Ghasemzadeh More articles by this author , Eric WendtEric Wendt More articles by this author , Brendan DolanBrendan Dolan More articles by this author , Juliana CraigJuliana Craig More articles by this author , Kyle RichardsKyle Richards More articles by this author , Tudor BorzaTudor Borza More articles by this author , Glenn AllenGlenn Allen More articles by this author , David JarrardDavid Jarrard More articles by this author , E. Jason AbelE. Jason Abel More articles by this author , and Daniel ShapiroDaniel Shapiro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003231.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although there is a paucity of data, non-metastatic small renal cell carcinoma (RCC) patients who are medically immunosuppressed because of a prior organ transplant or treatment of an underlying disease have a theoretically higher risk of disease progression. This study describes the treatment and outcomes of medically immunosuppressed patients with clinical T1 RCC (cT1). METHODS: An institutional database of patients treated or biopsied for RCC was queried for patients with pathologic diagnosis of cT1 RCC and were on chronic medical immunosuppression, defined as use of a WHO designated immunosuppressant or prednisone ≥5mg for at least 3 months prior to treatment of RCC and continued use during follow up. Outcomes for patients undergoing 1) surgery 2) ablation or 3) active surveillance (AS) are described. Wilcoxon Rank Sum, Fisher’s exact test and Kaplan Meier analysis was performed. RESULTS: Between 2010-2022, 74 medically immunosuppressed patients with RCC were identified who were treated with surgery (n=29), ablation (n=33), or AS (n=12). Median age was 60 years (IQR 51-68), median Charlson comorbidity index was 3 [IQR 2-5] and median follow-up was 48 months (IQR 29-80). Most patients were immunosuppressed due to prior organ transplant (57/74, 77%). Seven (58%) AS patients underwent deferred treatment (6 ablations, 1 nephrectomy) due to progressive tumor growth. Surgical patients were significantly younger than ablation or AS patients and had fewer comorbidities. The surgery and ablation 30-day readmission rate (17% vs 9%, p=0.7) and 90-day complication rate (24% vs 21%, p=0.9) was similar, respectively. No 90-day deaths occurred. One (3%) surgical and 2 (6%) ablation patients recurred locally. One (3%) surgical, 1 (3%) ablation, and no AS patients progressed to metastatic disease. No significant differences were noted for the local recurrence free, metastasis free, and overall survival for the 3 cohorts (P>0.05 for all) (Figure 1). CONCLUSIONS: For medically immunosuppressed patients with cT1 RCC, treatment outcomes are similar to historical series of non-immunosuppressed patients. These data suggest that small RCC tumors are not more aggressive in patients with medical immunosuppression but require careful selection to avoid morbidity and maintain oncologic control. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e165 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ali Ghasemzadeh More articles by this author Eric Wendt More articles by this author Brendan Dolan More articles by this author Juliana Craig More articles by this author Kyle Richards More articles by this author Tudor Borza More articles by this author Glenn Allen More articles by this author David Jarrard More articles by this author E. Jason Abel More articles by this author Daniel Shapiro More articles by this author Expand All Advertisement PDF downloadLoading ...