PD35-05 MULTICENTER VALIDATION OF PREDICTIVE MODEL FOR POSTSURGICAL RECURRENCE IN NON-METASTATIC RCC WITH THROMBUS

Abstract

You have accessJournal of UrologyKidney Cancer: Advanced I1 Apr 2015PD35-05 MULTICENTER VALIDATION OF PREDICTIVE MODEL FOR POSTSURGICAL RECURRENCE IN NON-METASTATIC RCC WITH THROMBUS Michael L. Blute, Timothy A. Masterson, Viraj A. Master, Vitaly Margulis, C. Adam Lorentz, Tyler Bauman, Kristin Zorn, Jose A. Karam, Christopher G. Wood, and E. Jason Abel Michael L. BluteMichael L. Blute More articles by this author , Timothy A. MastersonTimothy A. Masterson More articles by this author , Viraj A. MasterViraj A. Master More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , C. Adam LorentzC. Adam Lorentz More articles by this author , Tyler BaumanTyler Bauman More articles by this author , Kristin ZornKristin Zorn More articles by this author , Jose A. KaramJose A. Karam More articles by this author , Christopher G. WoodChristopher G. Wood 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.2015.02.2228AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Risk factors for recurrence after surgery in non-metastatic RCC patients with tumor thrombus are poorly defined. The purpose of this study is to develop and validate a prognostic model to predict recurrence after surgery in non-metastatic RCC with venous thrombus using contemporary data from 5 centers. METHODS Data was collected for consecutive non-metastatic RCC patients with venous involvement treated surgically from 2000-2012 at the University of Wisconsin, UTSW, MD Anderson, Emory University and Indiana University. Multivariate analysis evaluated associations with recurrence and variables including: age, BMI, gender, smoking, local or systemic symptoms, surgery year, laterality, preoperative labs (Hb, Cr, albumin, neutrophils and lymphocyte count, ABO type), EBL, transfusion, thrombus level, pT stage, tumor diameter, perinephric fat invasion, histologic subtype, and sarcomatoid features. A prognostic model was developed, validated, and compared within 2010 AJCC T stages for ability to predict RCC recurrence. RESULTS Of 637 patients, 239 (37.5%) progressed to metastatic disease within median follow-up of 24.9 months (IQR 12.2-54.9). Thrombus extended into renal vein in 300 (47.1%), IVC below diaphragm 280 (44.0%) and IVC above diaphragm 57 (8.9%). Initial multivariate analysis identified 5 independent predictors for recurrence: BMI ¡Ü 20 (HR 2.64, p=0.009), hemoglobin<LLN (HR 1.54, p=0.02), perinephric fat invasion (HR 1.51, p=0.01), grade 4 (HR 1.79, p=0.05) and non-clear cell histology (HR 1.81, p=0.03). These risk factors were used to develop and validate an un-weighted prognostic model. Patients with 0,1,2, or >2 risk factors represented 21%,36%, 31% and 12% of the total population, with 5-year recurrence-free survival probability 74.9%, 52.9%, 35.7%, and 22.5%; p<0.0001. The risk model demonstrated independent predictive ability to identify recurrence risk among T stages for 300 patients with pT3a (p=0.0001) and 263 patients with pT3b (p=0.01) RCC. CONCLUSIONS Independent predictors of disease recurrence in non-metastatic RCC with thrombus include: BMI ¡Ü20, anemia, perinephric fat invasion, Fuhrman grade 4 and non-clear cell histology. Patients with multiple risk factors should be considered for increased surveillance or adjuvant systemic therapy trials. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e761 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael L. Blute More articles by this author Timothy A. Masterson More articles by this author Viraj A. Master More articles by this author Vitaly Margulis More articles by this author C. Adam Lorentz More articles by this author Tyler Bauman More articles by this author Kristin Zorn More articles by this author Jose A. Karam More articles by this author Christopher G. Wood More articles by this author E. Jason Abel More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...