PD18-02 EXTERNAL VALIDATION OF THE ASSURE MODEL TO PREDICT ONCOLOGICAL OUTCOMES AFTER RESECTION OF HIGH-RISK RENAL CELL CARCINOMAS

Abstract

You have accessJournal of UrologyCME1 May 2022PD18-02 EXTERNAL VALIDATION OF THE ASSURE MODEL TO PREDICT ONCOLOGICAL OUTCOMES AFTER RESECTION OF HIGH-RISK RENAL CELL CARCINOMAS Zine-Eddine Khene, Alessandro Larcher, Jean-Christophe Bernhard, Nicolas Doumerc, Romain Boissier, Idir Ouzaid, Philippe Barthelemy, Morgan Roupret, Francesco Montorsi, Pierre Bigot, and Karim Bensalah Zine-Eddine KheneZine-Eddine Khene More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Jean-Christophe BernhardJean-Christophe Bernhard More articles by this author , Nicolas DoumercNicolas Doumerc More articles by this author , Romain BoissierRomain Boissier More articles by this author , Idir OuzaidIdir Ouzaid More articles by this author , Philippe BarthelemyPhilippe Barthelemy More articles by this author , Morgan RoupretMorgan Roupret More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Pierre BigotPierre Bigot More articles by this author , and Karim BensalahKarim Bensalah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002556.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A prognostic model based on the population of the ASSURE phase III trial has recently been described. The ASSURE model stratifies patients into risk groups to predict survival after surgical resection of intermediate and high-risk localized kidney cancer. Our objective was to validate the ASSURE model in a large independent multi-institutional cohort of patients treated in a “real life” setting outside of a clinical trial. METHODS: Data of patients from ten institutions who underwent radical or partial nephrectomy for a non-metastatic RCC between 2013 and 2019 were analyzed. We exclusively focused on patients with pT1b and ISUP 3-4, pT2, pT3, pT4, and N1 (i.e., those classified as intermediate and high risk according to the ASSURE model). The performance of the ASSURE model was evaluated in terms of discrimination and calibration. In addition, decision curve analysis (DCA) was used to determine whether the clinical value of the new model increased the net benefit over a realistic range of threshold probabilities. Finally, DCA of the ASSURE model was compared with that of older UCLA Integrated Staging System (UISS) and Leibovich 2018 score. RESULTS: 1372 patients were included in the analysis. Median age was 64 years (IQR 55-72). Median tumor size was 6.5 cm (IQR 5-9). The majority of tumors were clear cell RCCs (77%), of high ISUP grade (72% of grade 3 and 4), with 45% exhibiting tumor necrosis and 5% harboring nodal involvement. Median follow up was 54 months (IQR 32-75). Regarding disease-free survival, the ASSURE model showed modest discrimination (65%), miscalibration and poor net benefit compared with UCLA Integrated Staging System (UISS) and Leibovich 2018 models. Similarly, the ability of the ASSURE model to predict overall survival was poor in terms of discrimination (63%), with an overestimation on calibration plots and a modest net benefit for probability threshold between 10-40%. CONCLUSIONS: The ASSURE model is the last reported prognostic model that evaluates survival after surgical resection of a non-metastatic renal cell carcinoma. An improvement of patient classification was not clearly established when compared with available models, and implementation of this model in this setting still needs to be clarified. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e342 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zine-Eddine Khene More articles by this author Alessandro Larcher More articles by this author Jean-Christophe Bernhard More articles by this author Nicolas Doumerc More articles by this author Romain Boissier More articles by this author Idir Ouzaid More articles by this author Philippe Barthelemy More articles by this author Morgan Roupret More articles by this author Francesco Montorsi More articles by this author Pierre Bigot More articles by this author Karim Bensalah More articles by this author Expand All Advertisement PDF DownloadLoading ...