PD39-08 PREOPERATIVE CHECKPOINT INHIBITORS ARE NOT ASSOCIATED WITH INCREASED SURGICAL COMPLICATIONS COMPARED TO PREOPERATIVE TYROSINE KINASE INHIBITORS OR UPFRONT CYTOREDUCTIVE NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) II (PD39)1 Apr 2020PD39-08 PREOPERATIVE CHECKPOINT INHIBITORS ARE NOT ASSOCIATED WITH INCREASED SURGICAL COMPLICATIONS COMPARED TO PREOPERATIVE TYROSINE KINASE INHIBITORS OR UPFRONT CYTOREDUCTIVE NEPHRECTOMY Daniel Shapiro*, Mary Westerman, Nizar Tannir, Jianjun Gao, Hyunsoo Hwang, Xuemei Wang, Surena Matin, Jose Karam, and Christopher Wood Daniel Shapiro*Daniel Shapiro* More articles by this author , Mary WestermanMary Westerman More articles by this author , Nizar TannirNizar Tannir More articles by this author , Jianjun GaoJianjun Gao More articles by this author , Hyunsoo HwangHyunsoo Hwang More articles by this author , Xuemei WangXuemei Wang More articles by this author , Surena MatinSurena Matin More articles by this author , Jose KaramJose Karam More articles by this author , and Christopher WoodChristopher Wood More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000918.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Checkpoint inhibitors (CI) are increasingly utilized for metastatic renal cell carcinoma (mRCC), including in the preoperative (preop) setting. This study investigated perioperative outcomes and postoperative complications in patients who received preop CI compared to patients who received preop tyrosine kinase inhibitors (TKI) or upfront CN. METHODS: Data were analyzed from consecutive RCC patients who underwent nephrectomy for locally advanced or mRCC at a single institution from 2010-2019. Patient cohorts included those receiving either preop CI, preop TKI or upfront CN. 90-day postoperative complications according to the Clavien system were tabulated with Clavien ≥IIIa considered high grade. Clinicopathologic variables were compared with Fisher’s exact or Kruskal-Wallis test. Univariable and multivariable logistic regression evaluated associations between clinical variables and probability of complication. RESULTS: A total of 636 patients underwent nephrectomy and had complete data. 53 received preop CI therapy, 191 received preop TKI and 392 had an upfront CN. Among preop CI patients, 37 received anti-PD1, 8 received anti-CTLA4, and 8 received anti-PD1+anti-CTLA4 therapy. The median time on therapy was 1.8 and 2.8 months for CI and TKI, respectively (p=0.0001). Groups were compared by age, gender, race, Charlson comorbidity, ECOG, smoking, BMI, IMDC risk, stage, histology, grade, tumor size, and surgical approach. No differences were found except for median pathologic tumor size: 9cm for CI, 9cm for TKI, and 10cm for upfront CN (p=0.002). Surgical outcomes showed differences in duration (median 145min CI, 166min TKI, and 180min upfront CN; p=0.04), blood loss (median 250cc CI, 425cc TKI, and 510cc upfront CN; p=0.01), and number receiving a thrombectomy (28.3% CI, 25.1% TKI, and 36.2% upfront CN; p=0.02). No difference was found in the total (24.5% CI, 36.7% TKI, and 39.8% upfront CN; p=0.09) or high-grade complication rate (7.6% CI, 8.9% TKI, and 10.4% upfront CN; p=0.80). Univariable analysis identified thrombectomy and surgical approach associated with high grade complication. After MV analysis, only thrombectomy was independently associated with high grade complication (OR 3.84, 95% CI 2.21-6.61, p<0.001). Preoperative therapy was not associated with high grade complication. CONCLUSIONS: Preoperative CI therapy appears safe without increased risk of overall or high-grade complications when compared to preoperative TKI therapy or upfront CN. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e811-e812 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Shapiro* More articles by this author Mary Westerman More articles by this author Nizar Tannir More articles by this author Jianjun Gao More articles by this author Hyunsoo Hwang More articles by this author Xuemei Wang More articles by this author Surena Matin More articles by this author Jose Karam More articles by this author Christopher Wood More articles by this author Expand All Advertisement PDF downloadLoading ...