PD16-04 CURATIVE SURGERY IN RCC WITH THROMBUS; A COMPREHENSIVE RISK MODEL FROM A MODERN MULTICENTER ANALYSIS

Abstract

You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 2014PD16-04 CURATIVE SURGERY IN RCC WITH THROMBUS; A COMPREHENSIVE RISK MODEL FROM A MODERN MULTICENTER ANALYSIS Tyler M. Bauman, Vitaly Margulis, Christopher G. Wood, William P. Christensen, Vishnukamal Golla, Ramy F. Youssef, Laura-Maria Krabbe, David F. Jarrard, Tracy M. Downs, and E. Jason Abel Tyler M. BaumanTyler M. Bauman More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , Christopher G. WoodChristopher G. Wood More articles by this author , William P. ChristensenWilliam P. Christensen More articles by this author , Vishnukamal GollaVishnukamal Golla More articles by this author , Ramy F. YoussefRamy F. Youssef More articles by this author , Laura-Maria KrabbeLaura-Maria Krabbe More articles by this author , David F. JarrardDavid F. Jarrard More articles by this author , Tracy M. DownsTracy M. Downs More articles by this author , and E. Jason AbelE. Jason Abel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1149AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives Recurrence is common in N0M0 patients with renal cell carcinoma (RCC) with venous thrombus after surgery. High risk patients may benefit from increased surveillance or enrollment in adjuvant clinical trials, but quality predictive models for recurrence are lacking for this patient population. The purpose of this study is to identify prognostic factors for disease recurrence in N0M0 RCC with venous thrombus using a multicenter contemporary dataset Methods Comprehensive patient data was collected for N0M0 RCC patients undergoing attempted curative surgery from 2000-2012 at the University of Wisconsin, UT Southwestern, and MD Anderson Cancer Center. Univariate and multivariate (MV) analysis was used to identify variables associated with risk of recurrence. Factors considered in analysis included: age, BMI, gender, smoking status, presence of local or systemic symptoms, year of surgery, laterality, preoperative labs (hemoglobin, creatinine, albumin, neutrophil count, lymphocyte count, ABO blood type), OR blood loss, receipt of blood transfusion, thrombus level, pT stage, tumor diameter, perinephric fat invasion, histologic subtype, and sarcomatoid de-differentiation. Results Of 470 patients identified, 191 (40.7%) progressed to metastatic disease during the study period. Thrombus extended into renal vein in 259 (55.1%), IVC below diaphragm 167 (35.5%) and IVC above diaphragm 44 (9.4%). Median CSS was 136.6 months (IQR 43.8-NR) and median follow-up was 28.4 months (IQR 12.2-54.9). After MV analysis, independent predictors of disease recurrence included: BMI ≤(HR 2.64, p=0.009), hemoglobin <LLN (HR 1.60, p=0.01), perinephric fat invasion (1.58, p=0.006), non-clear cell histology (2.02, p=0.008), and grade 4 (1.80; p=0.04). Independent predictors were used to create a risk factor model (figure). 5 year recurrence free survival (RFS) was 77% in patients with 0 risk factors compared to 19% in patients with more than 2 risk factors. Conclusions Independent predictors of disease recurrence in RCC with thrombus include: BMI ≤20, hemoglobin <LLN, perinephric fat invasion, non-clear cell histology, and grade 4. Patients with multiple risk factors should be considered for increased surveillance or adjuvant therapy clinical trials. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e487-e488 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Tyler M. Bauman More articles by this author Vitaly Margulis More articles by this author Christopher G. Wood More articles by this author William P. Christensen More articles by this author Vishnukamal Golla More articles by this author Ramy F. Youssef More articles by this author Laura-Maria Krabbe More articles by this author David F. Jarrard More articles by this author Tracy M. Downs More articles by this author E. Jason Abel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...