PD18-03 PROPOSAL FOR RECLASSIFICATION OF T1 AND T2A RENAL CELL CARCINOMA: RESULTS OF A MULTI-INSTITUTIONAL ANALYSIS

Abstract

You have accessJournal of UrologyCME1 May 2022PD18-03 PROPOSAL FOR RECLASSIFICATION OF T1 AND T2A RENAL CELL CARCINOMA: RESULTS OF A MULTI-INSTITUTIONAL ANALYSIS Margaret Meagher, Ava Saidian, Riccardo Autorino, Brian Lane, Yasuhisa Fujii, Michele Marchioni, Hajime Tanaka, Dattatraya Patil, Francesco Porpiglia, Sabrina Noyes, Ryan Nasseri, Chandru Sundaram, James Porter, Andrea Minervini, Umberto Capitanio, Francesco Montorsi, Viraj Master, and Ithaar Derweesh Margaret MeagherMargaret Meagher More articles by this author , Ava SaidianAva Saidian More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Brian LaneBrian Lane More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , Michele MarchioniMichele Marchioni More articles by this author , Hajime TanakaHajime Tanaka More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Sabrina NoyesSabrina Noyes More articles by this author , Ryan NasseriRyan Nasseri More articles by this author , Chandru SundaramChandru Sundaram More articles by this author , James PorterJames Porter More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Umberto CapitanioUmberto Capitanio 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.0000000000002556.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Outcomes of stage 1 renal cell carcinoma (RCC) are heterogeneous and vary widely. We sought to investigate whether re-alignment of T1 and T2 RCC would lead to a more rational consolidation of similar outcomes that may improve predictive ability of the T staging system. METHODS: We performed a retrospective multicenter analysis of patients undergoing radical (RN) or partial nephrectomy (PN) for pathologic T1-T2aN0M0 RCC. The cohort was divided into tumor size ≤2cm, >2 cm or <5cm, >5cm or <7 cm, and >7 or <10cm. Primary outcome was all-cause mortality (ACM)/overall survival (OS). Secondary outcomes were cancer-specific mortality (CSM)/cancer-specific survival (CSS) and recurrence/recurrence-free survival (RFS). Cox proportional hazards multivariable analysis (MVA) was used to elucidate predictive factors for ACM, CSM, and RFS. Kaplan Meier Analysis (KMA) was performed to analyze 5-year OS, CSS, and RFS. AUC/ROC analysis was utilized to compare the predictive capability of pT1 disease defined as <5cm and pT2a >5 and <10cm vs. the current pT1 <7cm and pT2a >7 and <10cm. RESULTS: 5126 patients were analyzed (median age 60.2 years, median follow-up 40.9 months). MVA demonstrated increasing pathologic tumor size [vs. <2 cm (referent)] to be independently associated with ACM [>5 to <7cm (HR 1.6, p=0.02), >7 to <10 cm (HR 1.9, p=0.004)], CSM [>7 to <10 cm (HR 4.1, p=0.002)] and recurrence pathologic tumor size [>5 to <7 cm (HR 4.9, p<0.001), >7 to <10 cm (HR 6.5, p<0.001)]. Comparing ≤2cm, >2 cm or <5cm, >5cm or <7 cm, and >7 or <10cm groups, KMA (Figure) revealed significantly worsened: 5-year OS with larger tumor size: (96% vs. 89% vs. 84%vs. 82%, respectively, p<0.001); 5-year CSS with larger tumor size (99% vs. 97% vs. 92% vs. 88%, respectively, p<0.001); and 5-year RFS with larger tumor size (97% vs. 95% vs. 86%, vs. 75%), p<0.001). AUC analysis revealed greater predictive power for proposed pT1 as <5cm and pT2 >5 and <10cm vs. the current pT1 <7cm and pT2 >7 and <10cm for OS (0.549 vs. 0.528), CSS (0.675 vs. 0.617), and RFS (0.681 vs. 0632). CONCLUSIONS: Revision of T1 RCC into <5 cm and T2a into >5cm and <10cm groups corresponds to distinctive tumor groups whose biological potential aligns more closely and may enhance risk stratification, refine pretreatment counseling, and augment postoperative follow-up protocols. Source of Funding: Stephen Weissman Kidney Cancer Research Fund © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e343 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Margaret Meagher More articles by this author Ava Saidian More articles by this author Riccardo Autorino More articles by this author Brian Lane More articles by this author Yasuhisa Fujii More articles by this author Michele Marchioni More articles by this author Hajime Tanaka More articles by this author Dattatraya Patil More articles by this author Francesco Porpiglia More articles by this author Sabrina Noyes More articles by this author Ryan Nasseri More articles by this author Chandru Sundaram More articles by this author James Porter More articles by this author Andrea Minervini More articles by this author Umberto Capitanio 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 ...