PD11-05 MULTICENTER COMPARISON OF OUTCOMES FOR CLINICAL AND PATHOLOGIC T3A RENAL CELL CARCINOMA

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD11)1 Apr 2020PD11-05 MULTICENTER COMPARISON OF OUTCOMES FOR CLINICAL AND PATHOLOGIC T3A RENAL CELL CARCINOMA Aaron Bradshaw*, Robert Uzzo, Umberto Capitanio, Brian Lane, Dattatraya Patil, Kazutaka Saito, Fady Ghali, Alexander Kutikov, Alessandro Larcher, Sabrina Noyes, Raksha Dutt, Cathrine Keiner, Nathan Miller, Fang Wan, Margaret Meagher, Devin Patel, Yasuhisa Fujii, Francesco Montorsi, Viraj Master, and Ithaar Derweesh Aaron Bradshaw*Aaron Bradshaw* More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Brian LaneBrian Lane More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Fady GhaliFady Ghali More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Sabrina NoyesSabrina Noyes More articles by this author , Raksha DuttRaksha Dutt More articles by this author , Cathrine KeinerCathrine Keiner More articles by this author , Nathan MillerNathan Miller More articles by this author , Fang WanFang Wan More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Devin PatelDevin Patel More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , Francesco MontorsiFrancesco Montorsi 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.0000000000000845.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The identification of imaging characteristics associated with T3a renal cell carcinoma (RCC) can may be challenging on pre-operative imaging. A substantial number of patients are upstaged to T3a following intervention. The impact of upstaging to pT3a disease on ultimate outcomes in comparison with clinical T3a RCC is unclear. We compared survival outcomes between patients with clinical T3a versus those upstaged to pT3a RCC. METHODS: This is a retrospective, multicenter analysis of patients with RCC of cT3a or pT3a staging who underwent operative management. Primary outcome was recurrence-free survival (RFS). Secondary outcomes were overall survival (OS) and cancer-specific survival (CSS). Cox regression multivariable analysis (MVA) was utilized for primary outcome. Kaplan-Meier analyses (KMA) were conducted to describe RFS, OS, and CSS with log-rank test comparing survival between clinical and upstaged T3a groups. RESULTS: 1314 patients were included in analysis (cT3a 309, pT3a 1005). Upstaged pT3a patients were more likely to be female (p=0.02) and have a higher BMI (p<0.01). Average tumor size was similar between groups (cT3a 7.7 vs. pT3a 7.2 cm, p=0.26), however a higher proportion of cT3a underwent radical nephrectomy (90.9% vs. 56.7% pT3a, p<0.01). Positive surgical margin rate was higher among pT3a (9.6% vs 2.3% cT3a, p<0.01) with a similar proportion having pathologically positive nodes (11.5% pT3a vs. 11.7% cT3a, p=0.96). MVA for RFS revealed increasing age (HR 1.01, p=0.03), clear cell RCC (HR 1.32, p=0.03), and positive node status (HR 3.83, p<0.01) to be independent risk factors of recurrence while sex (p=0.13), cT3a vs. pT3a staging (p=0.08), positive surgical margins (p=0.30), and type of surgery (p=0.95) were not significant. KMA demonstrated 5-year RFS of 52.2% and 55.6% for cT3a and pT3a respectively (p=0.04). KMA demonstrated 5-year OS rates of 69.0% and 59.0% (p=0.20) and 5-year CSS of 76.7% and 72.6% for cT3a and pT3a respectively (p=0.70) (Figure). CONCLUSIONS: Pathologic upstaging was not an independent risk factor for recurrence in T3a RCC. Despite an increased recurrence rate in clinical T3a RCC versus pathologically upstaged T3a, no difference in oncological outcomes were noted and pathologic upstaging does not compromise oncologic outcomes compared to clinical T3a disease. Source of Funding: Stephen Weissman Kidney Cancer Research Fund © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e254-e255 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Bradshaw* More articles by this author Robert Uzzo More articles by this author Umberto Capitanio More articles by this author Brian Lane More articles by this author Dattatraya Patil More articles by this author Kazutaka Saito More articles by this author Fady Ghali More articles by this author Alexander Kutikov More articles by this author Alessandro Larcher More articles by this author Sabrina Noyes More articles by this author Raksha Dutt More articles by this author Cathrine Keiner More articles by this author Nathan Miller More articles by this author Fang Wan More articles by this author Margaret Meagher More articles by this author Devin Patel More articles by this author Yasuhisa Fujii More articles by this author Francesco Montorsi More articles by this author Viraj Master More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...