Clinical T1a Research Articles

Comparing the oncologic outcomes of local tumor destruction vs. local tumor excision vs. partial nephrectomy in T1a solid renal masses: a population-based cohort study from the SEER database.

There are few large-scale analyses comparing local tumor destruction (LTD) or local tumor enucleation/excision (LTE) relative to partial nephrectomy (PN) for patients with T1a renal masses in terms of cancer-specific survival (CSS) and overall survival (OS). The authors aimed to compare CSS and OS after LTD versus LTE versus PN. Within the Surveillance, Epidemiology, and End Results (SEER) database (2000-2019), the authors identified patients with clinical T1a renal masses and histologically confirmed kidney cancer treated with LTD, LTE, or PN. After 1:1 ratio propensity score matching (PSM), comparisons between the groups were conducted. Kaplan-Meier analysis and log-rank tests were used to compare survival in the matched population. In the overall cohort of 3717 LTD patients versus 1993 LTE patients versus 26935 PN patients, 77.3% of LTD-treated patients and 74.4% of LTE-treated patients were over 60 years old, while only 50.3% of PN-treated patients were over 60 years old. PN was more strongly associated with CSS [hazard ratio ((HR)=1.276, P <0.001) and OS (HR=1.112, P <0.001)] than was LTD, while PN was less strongly associated with CSS (HR=1.040, P =0.230) and OS (HR=0.888, P =0.002) than was LTE, not only in the PSM cohort but also in the subgroups of patients with a tumor size ≤3cm and patients with a tumor size of 3.1-4cm. In clinical T1a solid renal mass patients, LTD was associated with lower CSS and OS than LTE and PN, while LTE demonstrated noninferior CSS and superior OS to PN regardless of tumor size.

Other-cause mortality in incidental prostate cancer.

In incidental prostate cancer (IPCa), elevated other-cause mortality (OCM) may obviate the need for active treatment. We tested OCM rates in IPCa according to treatment type and cancer grade and we hypothesized that OCM is significantly higher in not-actively-treated patients. Within the Surveillance, Epidemiology, and End Results database (2004-2015), IPCa patients were identified. Smoothed cumulative incidence plots as well as multivariable competing risks regression models were fitted to address OCM after adjustment for cancer-specific mortality (CSM). Of 5121 IPCa patients, 3655 (71%) were not-actively-treated while 1466 (29%) were actively-treated. Incidental PCa not-actively-treated patients were older and exhibited higher proportion of Gleason sum (GS) 6 and clinical T1a stage. In smoothed cumulative incidence plots, 5-year OCM was 20% for not-actively-treated versus 8% for actively-treated patients. Conversely, 5-year CSM was 5% for not-actively-treated versus 4% for actively-treated patients. No active treatment was associated with 1.4-fold higher OCM, even after adjustment for age, cancer characteristics, and CSM. According to GS, OCM reached 16%, 27%, and 35% in GS 6, 7, and 8-10 not-actively-treated IPCa patients, respectively and exceeded CSM recorded for the same three groups (2%, 6%, and 28%, respectively). Our results quantified OCM rates, confirming that in not-actively-treated IPCa patients OCM is indeed significantly higher than in their actively-treated counterparts (HR: 1.4). These observations validate the use of no active treatment in IPCa patients, in whom OCM greatly surpasses CSM (20% vs. 5%).

CtDNA predicts clinical T1a to pathological T3a upstaging after partial nephrectomy.

Most patients diagnosed with clear cell renal cell carcinoma (ccRCC) are also detected with small and organ-confined tumors, and the majority of these are classified as clinical tumor stage 1a (cT1a). A considerable proportion of patients with cT1 RCC shows tumor upstaging to pathological stage 3a (pT3a), and these patients have worse oncological outcomes. The role of circulating tumor DNA (ctDNA) in RCC has been limited to monitoring treatment response and resistance. Therefore, the present study aimed to evaluate the potential of ctDNA in predicting pT3a upstaging in cT1a ccRCC. We sequenced plasma samples preoperatively collected from 48 patients who had undergone partial nephrectomy for cT1a ccRCC using data from a prospective cohort RCC. The ctDNA were profiled and compared with clinicopathological ccRCC features to predict pT3a upstaging. Associations between ctDNA, tumor complexity, and pT3a upstaging were evaluated. Tumor complexity was assessed using the anatomical classification system. Univariate analysis used chi-squared and Student's t-tests; multivariate analysis considered significant factors from univariate analyses. Of the 48 patients with cT1a ccRCC, 12 (25%) were upstaged to pT3a, with ctDNA detected in 10 (20.8%), predominantly in patients with renal sinus fat invasion (SFI; n = 8). Among the pT3a group, ctDNA was detected in 75%, contrasting with only 2.8% in patients with pT1a (1/36). Detection of ctDNA was the only significant preoperative predictor of pT3a upstaging, especially in SFI. This study is the first to suggest ctDNA as a preoperative predictor of pT3a RCC upstaging from cT1a based on preoperative radiological images.

The long-term outcomes of local tumor destruction versus partial nephrectomy for cT1a non-clear cell renal cell carcinoma and development of prognostic nomograms

PurposeThere is a lack of authoritative opinions on local tumor destruction (LTD) for clinical T1a (cT1a) non-clear cell renal cell carcinoma (nccRCC). We aim to compare the outcomes of cT1a nccRCC after partial nephrectomy (PN) or LTD and explore prognostic factors.MethodsPatients diagnosed with cT1a nccRCC receiving LTD or PN between 2000 and 2020 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. A 1:1 propensity score matching (PSM) was performed for patients receiving LTD and PN. Kaplan–Meier survival analysis, Cox regression analysis, competing risk regression models, and subgroup analysis were used to compare outcomes and identify prognostic factors. Prognostic nomograms were established and evaluated based on the multivariate models.ResultsA total of 3664 cT1a nccRCC patients were included. The LTD group had poorer overall survival (OS) and similar cancer-specific survival (CSS) compared with the PN group before and after PSM (p < 0.05), while the other-cause mortality rate of the LTD group was higher than that of the PN group. Age, marital status, household income, prior tumor history, interval between diagnosis and treatment, treatments, and tumor size were identified as independent predictive factors for OS. Age, tumor size, prior tumor history, and histological type were identified as independent predictive factors for CSS. Then the nomograms predicting OS and CSS were constructed based on these prognostic factors, which showed excellent performance in risk stratification and accuracy.ConclusionLTD could achieve comparable cancer-control effects as PN among cT1a nccRCC patients. The OS and CSS nomograms worked effectively for prognosis assessment.

Phase II study of pembrolizumab in combination with radiation with or without olaparib in localized high-risk prostate cancer.

TPS351 Background: Definitive radiation therapy (DRT) combined with androgen deprivation therapy (ADT) remains the standard of care in patients with high-risk prostate cancer (HRPC) who do not want surgery. However, up to 50% experience biochemical recurrence (BCR) within 5 years. A phase 3 NCIC group reported the 10-year biochemical recurrence free survival was 63% in ADT plus DRT vs. 27% in ADT alone. There is an urgent need for effective novel combination strategies. We hypothesize combined immune sensitizing effects of PARPi and radiation will result in significant activity of immunotherapy in men with HRPC. Methods: This is a multicenter phase II randomized study to assess biochemical response rates, safety and tolerability of combined therapy in pts with localized HRPC who elected for concurrent DRT. A total of 64 pts will be randomized 1:1 to receive either pembrolizumab (P) combined with olaparib or single agent P in addition to the standard of care ADT with DRT. Hypofractionated IMRT (2.4 to 4 Gy per fraction over 4-6 weeks) will be delivered and all pts will receive adjuvant P for one year and ADT for at least 18 months. All pts will undergo germline testing. Key eligible criteria include biopsy confirmed prostate adenocarcinoma who meets at least one of the four high-risk features: 1) clinical T3a, T3b or T4, 2) N1, 3) Gleason grade group 4 or 5, and 4) PSA &gt;20 ng/ml. Patients with less than 2 cm pelvic nodes and received ADT therapy within 3months prior to study enrollment are allowed. PSA &gt;150 ng/ml and patients with distant metastases will be excluded. The primary endpoint is to assess the proportion of patients who achieve a PSA nadir level of ≤ 0.06 ng/ml within six months after completion of radiation therapy in each arm. The secondary objectives include safety/tolerability, BCR and metastasis-free survival at 3 years. BCR is defined by the Phoenix definition. The study is designed to detect a 15% improvement in PSA nadir ≤ 0.06 ng/mL within 6 months after completion of the combined therapy versus historical control group data Geara FB et al., 2017. Enrollment began in August 2023. Clinical trial information: NCT05568550 .

PADRES: a phase 2 clinical trial of neoadjuvant axitinib for complex partial nephrectomy.

To report the results of PADRES (Prior Axitinib as a Determinant of Outcome of Renal Surgery, NCT03438708), a study investigating neoadjuvant axitinib for tumours of high complexity with imperative indication for partial nephrectomy (PN). We conducted a single-arm phase II clinical trial of localized (cT1b-cT3M0) clear-cell renal cell carcinoma (RCC) patients with imperative indications for nephron preservation, where PN is a high-risk procedure due to complexity (RENAL score 10-12). Axitinib 5 mg was administered twice daily for 8 weeks with repeat imaging at completion, followed by surgery. The primary outcome was successful completion of planned PN following axitinib treatment. Secondary objectives included changes in tumour diameter, RENAL nephrometry score, renal function and Response Evaluation Criteria in Solid Tumours (RECIST) v1.1, and surgical complications. Twenty-seven patients were enrolled (median age 69 years). Prior to therapy, twenty patients (74.0%) had ≥ clinical T3a staged tumours. Axitinib resulted in reductions in tumour diameter (7.5 vs 6.2 cm; P < 0.001) and RENAL score (11 vs 10; P < 0.001). Nine patients (33.3%) had partial response based on RECIST and nine (33.3%) were clinically downstaged. PN was performed in twenty patients (74.0%); twenty-five patients (96.2%) had negative margins. Six patients (22.2%) had Clavien III-IV complications. The median change in estimated glomerular filtration rate (preoperative to last follow-up) was 8.5 mL/min/1.73 m2 . Neoadjuvant axitnib resulted in reductions in tumour size and complexity, enabling safe and feasible PN and functional preservation in patients with complex renal masses and imperative indication.

Use of PIRADS 2.1 to predict capsular invasion in patients with radiologic T3a prostate cancer.

Using multi-parametric magnetic resonance imaging (mpMRI) to identify patients with clinical T3a (cT3a) who were overestimated on mpMRI with final pathological T2 (pT2). To suggest that the neurovascular bundle (NVB) can be preserved by evaluating the characteristics of patients according to their pathological grade among cT3a prostate cancer (PCa) patients using mpMRI. Patients who underwent robot-assisted laparoscopic radical prostatectomy (RALP) were retrospectively analyzed and those patients with clinical T3aN0M0 were enrolled. These enrolled patients were divided into a localized cancer group with pT2 PCa and a locally advanced group with pT3a or higher. Factors affecting the diagnosis of localized PCa after RALP in patients with cT3a PCa were evaluated. Among the preoperative parameters of patients with cT3a PCa, the prostate specific antigen density (PSAD) (OR: 3.76, 95% CI: 1.85-7.64, p<0.001), international society of urological pathology (ISUP) grade (p<0.05), and index lesion size (OR: 1.44, 95% CI: 1.85-7.64, p<0.001) were significantly associated with pathological locally advanced PCa. Optimal cut-off values for prediction of pT3a or higher were 0.36 ng/mL2 for PSAD (sensitivity: 55.7%, specificity: 70.8%), 1.77cm for index lesion size (sensitivity: 54.3%, specificity: 66.0%), and 2.5 for ISUP grading (sensitivity: 67.6%, specificity: 53.2%). For prediction of pT3a or higher among patients with cT3a PCa, a nomogram was developed using ISUP grade, index lesion size, and PSAD on prostate biopsy (area under the curve: 0.71, 95% CI: 0.670-0.754, p<0.001). PSAD less than 0.36 index lesion size less than 1.77cm, and biopsy ISUP grade 1-2 are highly likely to indicate that there is no actual extracapsular extension in cT3a PCa patients. PSAD, ISUP, and index lesion size showed significant associations with the classification of pathologic localized and locally advanced PCa in patients with cT3a PCa. A nomogram including these features can predict the diagnosis of locally advanced PCa in patients with cT3a PCa.

P155 - Factors affecting acute kidney injury and subsequent renal function recovery after robot-assisted partial nephrectomy for clinical T1a renal masses

P155 - Factors affecting acute kidney injury and subsequent renal function recovery after robot-assisted partial nephrectomy for clinical T1a renal masses

The prognostic nomogram for PSA-incongruent low-risk prostate cancer treated by radical prostatectomy.

To establish a prognostic nomogram for PSA-incongruent low-risk prostate cancer (PCa) patients (Gleason score 6 and clinical stage T2a) at diagnosis and treated with radical prostatectomy (RP), based on clinical and pathological metrics. In total, 217 patients diagnosed with PCa were included in this study. All patients had a Gleason score of 6 (GS6) in biopsy, had clinical T2a before surgery and were treated with RP. Biochemical progression-free survival (bPFS) was analyzed using the Kaplan-Meier method. Univariate and multivariate analyses were used to determine prognostic factors related to bPFS. A prognostic nomogram was established based on factors that were significant in the multivariate analyses. The median bPFS had a significant difference in the subgroup of PSA at diagnosis (' < 10ng/mL': 71.698 [67.549-75.847] vs '10-20ng/mL': 71.038 [66.220-75.857] vs ' ≥ 20ng/mL': 26.746 [12.384-41.108] months [Log Rank P < 0.001]), the subgroup of T stage upgrade (Negative: 70.016 [65.846-74.187] vs 'T2b/c': 69.183 [63.544-74.822] vs 'T3/4': 32.235 [11.877-52.593] months [Log Rank P < 0.001]) and the subgroup of Gleason score upgrade (Negative: 72.63 [69.096-76.163] vs '3 + 4': 68.393 [62.243-74.543] vs '4 + 3': 41.427 [27.517-55.336] vs ' ≥ 8': 28.291 [7.527-49.055] [Log Rank P < 0.001]). PSA at diagnoses (Hazard Ratio (HR) 1.027, 95% CI 1.015-1.039, P < 0.001), T stage upgrade (HR 2.116, 95% CI 1.083-4.133, P = 0.028), and Gleason score upgrade (HR 2.831, 95% CI 1.892-4.237, P < 0.001) were identified as independent predictors with significance in multivariable Cox regression analysis. A nomogram was established based on these three factors. Our study indicated that PSA-incongruent low-risk PCa patients (PSA with 10-20ng/mL) had a similar prognosis to those with real low-risk PCa (PSA < 10ng/mL) in the D' Amico criteria. We also established a nomogram based on three significant prognostic factors, including PSA at diagnosis, T stage upgrade, and Gleason score upgrade, which were associated with clinical outcomes in prostate cancer patients with GS6 and T2a after surgery.

Phase II study of axitinib prior to partial nephrectomy to preserve renal function: An interim analysis of the PADRES clinical trial.

683 Background: In renal cell carcinoma (RCC), partial nephrectomy (PN) is indicated for patients with solitary kidney, chronic kidney disease, or bilateral tumors. A subset of these patients, however, may have large and complex renal masses not initially suitable for PN. Neoadjuvant Tyrosine Kinase Inhibitor therapy has shown promising results in cytoreducing renal tumors and may permit PN in circumstances not otherwise feasible. Methods: This was a single arm phase II clinical trial of neoadjuvant axitinib in patients with complex (RENAL nephrometry score 10-12 and cT1b-cT3M0) biopsy-proven clear cell RCC with strong indications for partial nephrectomy (PN), and in whom radical nephrectomy may result in dialysis dependence. Axitinib 5 mg was administered orally twice daily for 8 weeks prior to surgery. Primary outcome was reduction in longest tumor diameter; secondary outcomes included tumor response (RECIST), change in RENAL score, feasibility of PN, change in estimated glomerular filtration rate (DeGFR), and post-surgical complications. Results: 26 patients were enrolled. 19 (73.1%) patients had ≥ clinical T3a staged tumors. Post therapy, 17 (65.4%) patients had ≥T3a staged tumors. Axitinib resulted in reductions in tumor size (7.7 vs. 6.3 cm, p&lt;0.001) and RENAL score (11 vs. 10, p &lt;0.001); 9 (34.6%) had partial response, and 17 (65.4%) stable disease by RECIST criteria. PN was successfully performed in 19 (73.1%); 24 (96.8%) achieved negative margins. Six (23.1%) had Clavien III-IV post-surgical complications. Median percentage DeGFR was 14.7%; one (3.8%) patient who had a radical nephrectomy had long-term dialysis dependence. Conclusions: Neoadjuvant axitnib resulted in significant reductions in tumor size and complexity, enabling PN in a cohort of complex renal masses, and with acceptable safety and functional preservation. Clinical trial information: NCT03438708 . [Table: see text]

Histopathologic features and parameters predicting recurrence potential of small renal masses

Abstract Background Small renal masses (SRMs) are defined as contrast-enhanced masses with a diameter of ≤4 cm, usually consistent with clinical stage T1a renal cell carcinoma (RCC). This study aimed to explore the histopathological features of a contemporary series of SRMs and investigate parameters that could predict their pathological nature, metastatic potential, and recurrence potential. Materials and methods Small renal masses were identified in 166 of 427 patients who underwent surgery for suspected RCC. The radical nephrectomy/partial nephrectomy ratio was 1:44, and autotransplantation was performed in a single case. Variables associated with metastatic recurrence of SRM were analyzed using χ2 and logistic regression models. Results Renal cell carcinoma was confirmed in 86% (n = 143) of cases, whereas benign tumors were present in 14% (n = 23) of cases. Seventeen percent of the RCC cases were high-grade (Fuhrman G3–4). Among SRMs with a diameter of &gt;2 cm, 71% were malignant. The mean ± standard deviation diameter of the removed SRMs was 28 ± 12 mm, significantly higher in the malignant SRMs group (31 ± 8 vs. 24 ± 9 mm) (p = 0.005). During follow-up, local recurrence was identified in 4 patients versus new distant metastasis in 11 patients. Metastatic lesions were detected in the lungs (1.8%), bone (1.2%), distant (1.9%) and regional lymph nodes (1.2%), liver (0.6%), and multiple organs (2.4%). Patients with malignant SRMs were significantly older than those with benign tumors (p = 0.036). The multivariate analysis identified tumor size, Fuhrman grade, stage, nodal and distant metastasis status, tumor localization, and treatment modality as characteristics significant for tumor recurrence. Conclusions The majority of treated neoplasms were malignant, but their incidence was low among SRMs with a diameter of &lt;2 cm. Our results emphasized the importance of histopathological features and treatment modalities in predicting malignant recurrence.

Cancer-specific Mortality After Cryoablation vs Heat-based Thermal Ablation in T1a Renal Cell Carcinoma.

Guidelines suggest less favorable cancer control outcomes for local tumor destruction in T1a renal cell carcinoma patients with tumor size 3.1-4 cm. We compared cancer-specific mortality between cryoablation vs heat-based thermal ablation in patients with tumor size 3.1-4 cm, as well as in patients with tumor size ≤3 cm. Within the Surveillance, Epidemiology, and End Results database (2004-2018), we identified patients with clinical T1a stage renal cell carcinoma treated with cryoablation or heat-based thermal ablation. After up to 2:1 ratio propensity score matching between patients treated with cryoablation vs heat-based thermal ablation, we addressed cancer-specific mortality relying on competing risks regression models, adjusted for other-cause mortality and other covariates (age, tumor size, tumor grade, and histological subtype). Of 1,468 assessable patients with tumor size 3.1-4 cm, 1,080 vs 388 were treated with cryoablation vs heat-based thermal ablation, respectively. After up to 2:1 propensity score matching that resulted in 757 cryoablations vs 388 heat-based thermal ablations, in multivariable competing risks regression models, heat-based thermal ablation was associated with higher cancer-specific mortality (HR:2.02, P < .001), relative to cryoablation. Of 4,468 assessable patients with tumor size ≤3 cm, 3,354 vs 1,114 were treated with cryoablation vs heat-based thermal ablation, respectively. After up to 2:1 propensity score matching that resulted in 2,217 cryoablations vs 1,114 heat-based thermal ablations, in multivariable competing risks regression models, heat-based thermal ablation was not associated with higher cancer-specific mortality (HR:1.13, P = .5) relative to cryoablation. Our findings corroborated that in cT1a patients with tumor size 3.1-4 cm, cancer-specific mortality is twofold higher after heat-based thermal ablation vs cryoablation. Conversely, in patients with tumor size ≤3 cm either ablation technique is equally valid. These findings should be considered at clinical decision making and informed consent.

A novel nomogram can predict pathological T3a upstaged from clinical T1a in localized renal cell carcinoma.

ABSTRACTHypothesis:Nomogram can be built to predict the pathological T3a upstaging from clinical T1a in patients with localized renal cell carcinoma before surgery.Purpose:Renal cell carcinoma (RCC) patients with clinical T1a (cT1a) disease who are upstaged to pathological T3a (pT3a) have reduced survivals after partial nephrectomy. We aimed to develop a nomogram-based model predicting pT3a upstaging in RCC patients with preoperative cT1a based on multiple preoperative blood indexes and oncological characteristics.Materials and Methods:Between 2010 and 2019, 510 patients with cT1a RCC were individually matched according to pT3a upstaging and pathological T1a (pT1a) at a 1:4 ratio using clinicopathologic features. Least absolute shrinkage and selection operator regression analysis was used to identify the most important risk factor from 40 peripheral blood indicators, and a predictive model was established. Multivariate logistic regression analysis was performed with the screened blood parameters and clinical data to identify significant variables. Harrell’s concordance index (C-index) was applied to evaluate the accuracy of the model for predicting pT3a upstaging in patients with cT1a RCC.Results:Out of 40 blood indexes, the top ranked predictor was fibrinogen (FIB). Age, the ratio of the tumor maximum and minimum diameter (ROD), FIB, and tumor size were all independent risk factors for pT3a upstaging in multivariate analysis. A predictive ARFS model (Age, ROD, FIB, tumor Size) was established, and the C-index was 0.756 (95% CI, 0.681-0.831) and 0.712 (95% CI, 0.638-0.785) in the training and validation cohorts, respectively.Conclusions:Older age, higher ROD, increased FIB level, and larger tumor size were independent risk factors for upstaging. The ARFS model has a high prediction efficiency for pT3a upstaging in patients with cT1a RCC.

Tumor-derived exosomal HOTAIRM1 regulates SPON2 in CAFs to promote progression of lung adenocarcinoma

ObjectiveSPON2 is one of the extracellular matrix proteins, which is closely related to the progression of a variety of tumors including non-small cell lung cancer (NSCLC), but its upstream regulation mechanism remains unclear. Our research aims to find the specific regulatory pathway of SPON2 by exploring the potential crosstalk between tumor cells and cancer-associated fibroblasts (CAFs) in tumor microenvironment (TME) of NSCLC.MethodsWe analyzed T1 lung adenocarcinoma samples from TCGA and screened extracellular matrix proteins that indicate poor prognosis. Expression level of SPON2 was verified by qPCR in clinical samples. The exosomes of NSCLC cell supernatant were extracted and identified by nanoparticle tracking analysis (NTA) and transmission electron microscope, western blots. The exosomes and CAFs were co-cultured, and cell migration and Matrigel invasion assay were used to evaluate the effect of CAFs on the migration and invasion of NSCLC cells. The interaction between LncRNA and miRNA was verified by Targetscan prediction, luciferase reporter assay, and RNA binding protein immunoprecipitation (RIP).ResultsWe found that the expression of SPON2 was up-regulated in clinical T1a stage NSCLC patients. The expression of lnc HOTAIRM1 (HOTAIRM1) in exosomes secreted by NSCLC tissues increased. After exosomal HOTAIRM1 entered CAFs, HOTAIRM1 can adsorb miR-328-5p to up-regulate the expression of SPON2 in CAFs. Up-regulation of SPON2 in CAFs could promote the migration and invasion of NSCLC cells.ConclusionTumor-derived exosomal HOTAIRM1 can transfer into CAFs and competitively adsorb miR-328-5p, and regulate the SPON2 expression of CAFs cells, ultimately promote the progression of NSCLC. The discovery of this regulatory pathway can provide a new potential therapeutic target for the diagnosis and treatment of NSCLC.

Detection Ability of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for Clinical T Classification of Synchronous Esophageal Cancer in Pharyngeal Cancer.

The utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) for clinical T classification of synchronous esophageal cancer (SEC) in pharyngeal cancer has not been fully elucidated. We investigated the association between 18F-FDG-PET/CT and clinical T classification for SEC. We retrospectively enrolled 90 patients with pharyngeal cancer having both Lugol chromoendoscopy and 18F-FDG-PET/CT at pretreatment. The association between 18F-FDG-PET/CT and pathological examination was compared by the Fisher's exact test. Pathologically, 12 patients with SEC were diagnosed. The number of locations for SEC with cT1a, cT1b, and cT3 was 20, 1, and 1, respectively. Sensitivity for cT1a-cT3, cT1b-cT3, and cT3 was 9.1%, 100%, and 100%, respectively. Locations of SEC with cT1b-cT3 were significantly detected. The locations of SEC with cT1b-cT3 were more frequently detected than those without cT1b-cT3 by 18F-FDG-PET/CT (p<0.01). Detection of SEC with clinical T1b-T3 in comparison to clinical T1a on pretreatment 18F-FDG-PET/CT for patients with pharyngeal cancer, was achieved with high sensitivity.

Cancer-specific Mortality in T1a Renal Cell Carcinoma Treated with Local Tumor Destruction Versus Partial Nephrectomy

BackgroundLarge-scale analyses addressing cancer-specific mortality (CSM) in T1a renal cell carcinoma (RCC) patients treated with local tumor destruction (LTD), relative to partial nephrectomy (PN), are scarce. ObjectiveTo compare CSM after LTD versus PN. Design, setting, and participantsWithin the Surveillance, Epidemiology, and End Results (SEER) database (2004–2018), we identified patients with clinical T1a stage RCC treated with LTD or PN. Outcome measurements and statistical analysesAfter 1:1 ratio propensity score matching (PSM) between patients treated with LTD versus PN, competing risks regression (CRR) models addressed CSM, after adjustment for other-cause mortality (OCM) and other covariates (age, tumor size, tumor grade, and histological subtype). Results and limitationsRelative to the 35 984 PN patients, 5936 LTD patients were older and more frequently harbored unknown RCC histological subtype or unknown grade. After 1:1 PSM that resulted in 5352 LTD versus 5352 PN patients, the 10-yr CSM rate was 8.7% versus 5.5%. In multivariable CRR models, LTD was associated with higher CSM, relative to PN (hazard ratio [HR]: 1.58, p < 0.001). Subgroup analyses revealed invariably higher CSM after LTD versus PN in patients with tumor size ≤3 cm (10-yr CSM 7.2% vs 5.3%, multivariable HR: 1.47, p < 0.001) and in patients with tumor size 3.1–4 cm (10-yr CSM 11.4% vs 6.1%, multivariable HR: 1.72, p < 0.001). Lack of information regarding earlier cancer controls, retreatment, tumor location within the kidney, and type of surgery represented limitations. ConclusionsIn T1a RCC patients, LTD is invariably associated with higher CSM relative to PN, even after adjustment for OCM and all available patient and tumor characteristics, and regardless of tumor size considerations. However, the magnitude of CSM disadvantage was more pronounced in LTD patients with tumor size 3.1–4 cm than in those with tumor size ≤3 cm. Patient summaryIn patients with small renal masses, we observed higher cancer-specific death rates for local tumor destruction (LTD) than for partial nephrectomy. The LTD disadvantage was more pronounced for patients with tumor size 3.1–4 cm, but was also present in those with tumor size ≤3 cm.

Differential efficacy of ablation therapy versus partial nephrectomy between clinical T1a and T1b renal tumors: A systematic review and meta-analysis.

To assess the differential clinical outcomes of patients treated with partial nephrectomy (PN) vs. those treated with ablation therapy (AT) such as radiofrequency ablation, cryoablation and microwave ablation for cT1b compared to cT1a renal tumors. Multiple databases were searched for articles published before August 2021. Studies were deemed eligible if they compared clinical outcomes in patients who underwent PN with those who underwent AT for cT1a and/or cT1b renal tumors. Overall, 27 studies comprising 13,996 patients were eligible for this meta-analysis. In both cT1a and cT1b renal tumors, there was no significant difference in the percent decline of estimated glomerular filtration rates or in the overall/severe complication rates between PN and AT. Compared to AT, PN was associated with a lower risk of local recurrence in both patients with cT1a and cT1b tumors (cT1a: pooled risk ratio [RR]; 0.43, 95% confidence intervals [CI]; 0.28-0.66, cT1b: pooled RR; 0.41, 95%CI; 0.23-0.75). Subgroup analyses regarding the technical approach revealed no statistical difference in local recurrence rates between percutaneous AT and PN in patients with cT1a tumors (pooled RR; 0.61, 95%CI; 0.32-1.15). In cT1b, however, PN was associated with a lower risk of local recurrence (pooled RR; 0.45, 95%CI; 0.23-0.88). There was no difference in distant metastasis or cancer mortality rates between PN and AT in patients with cT1a, or cT1b tumors. AT has a substantially relevant disadvantage with regards to local recurrence compared to PN, particularly in cT1b renal tumors. Despite the limitations inherent to the nature of retrospective and unmatched primary cohorts, percutaneous AT could be used as a reasonable alternative treatment for well-selected patients with cT1a renal tumors.

Percutaneous cryoablation for clinical T3a renal cell carcinoma (< 7 cm) with segmental vein involvement or perinephric fat invasion based on preoperative evaluation of high-resolution multidetector computed tomography scan

PurposeTo retrospectively assess the feasibility, safety, renal function, technique efficacy rate, and survival of patients with clinical T3a renal cell carcinoma (RCC).Materials and methodsSixteen cryoablation sessions were performed in 14 patients (10 men; mean age, 69.8 ± 10.5 years; range, 49–90 years) with 14 clear cell T3a RCCs (mean, 3.3 ± 0.9 cm; range, 1.9–5.2 cm). One patient was on dialysis. Transcatheter arterial embolization was performed before cryoablation in 15 sessions. The primary endpoint was the technique efficacy rate. The secondary endpoints included feasibility, safety, renal function, and survival.ResultsCryoablation was technically successful in all RCC cases. In two RCCs, cryoablation was performed twice because of local tumor progression. No major adverse events were observed. All patients were alive without metastases, with a median follow-up of 45 months (6−93 months). Complete response was achieved by cryoablation in 11 RCCs (78.6%). The primary and secondary technique efficacy rates were 77.1% and 84.4% at 1 year, 57.9% and 73.9% at 3 years, and 57.9% and 73.9% at 5 years, respectively. One patient underwent dialysis given a total contralateral nephrectomy due to another RCC 1 month after initial cryoablation and a total ipsilateral nephrectomy 46 months after initial cryoablation due to local progression. Except for two dialysis patients, of the 12 patients with a median follow-up of 41 months (6–93 months), none were on dialysis.ConclusionCryoablation was safe and effective in T3a RCC, which mainly involved the renal venous branches and may represent an alternative treatment for inoperable patients.

MP51-05 IMPACT OF CLINICAL STAGING BASED ON DRE VS IMAGING (TRUS/MRI) IN A LOCALIZED PROSTATE CANCER RISK ASSESSMENT NOMOGRAM

You have accessJournal of UrologyCME1 May 2022MP51-05 IMPACT OF CLINICAL STAGING BASED ON DRE VS IMAGING (TRUS/MRI) IN A LOCALIZED PROSTATE CANCER RISK ASSESSMENT NOMOGRAM Kevin Chang, Scott Greenberg, Janet Cowan, Katsuto Shinohara, Hao Nguyen, Matthew Cooperberg, and Peter Carroll Kevin ChangKevin Chang More articles by this author , Scott GreenbergScott Greenberg More articles by this author , Janet CowanJanet Cowan More articles by this author , Katsuto ShinoharaKatsuto Shinohara More articles by this author , Hao NguyenHao Nguyen More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , and Peter CarrollPeter Carroll More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002626.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Cancer of the Prostate Risk Assessment (CAPRA) score is a validated risk assessment tool for biochemical recurrence (BCR) risk after radical prostatectomy (RP) for localized prostate cancer (PCa). The score is calculated from age, PSA at diagnosis, Gleason score pattern, % positive biopsy cores, and clinical stage by digital rectal exam (DRE). Since its publication, transrectal ultrasonography (TRUS) and magnetic resonance imaging (MRI) have increasingly been used in clinical evaluation but have yet to be integrated into PCa risk-stratification models. We used both clinical- and imaging-derived stage as CAPRA score imputations to assess the association between the base and imaging-adjusted CAPRA model and the outcome of BCR. METHODS: We retrospectively analyzed patients who underwent RP for PCa diagnosed between 2000-2017 and staged ≤T3a on both DRE and imaging (TRUS/MRI). DRE was treated as a binary variable (T1 vs ≥T2) as was imaging (≤T2 vs T3a). BCR was defined as 2 consecutive PSA ≥0.2 ng/ml starting 8 weeks post-surgery or receipt of salvage treatment. Two CAPRA scores were computed: one with DRE-derived and one with image-based T-stage. Life table estimates were used to evaluate likelihood of BCR-free survival after RP stratified by CAPRA scores. We performed Cox regression to examine the association between clinical CAPRA components and BCR risk and to determine whether stratifying clinical T1, T2, and T3a disease in CAPRA was independently associated with BCR risk on multivariate analysis. RESULTS: Of 1972 patients studied, 5% had upstaging in CAPRA risk group with imaging-based clinical stage. Life table estimates were comparable between DRE- and imaging-based CAPRA score with regard to likelihood of BCR-free survival. In separate unadjusted Cox regression models, DRE-based (HR 1.57; 95% CI 1.50-1.64) and imaging-based CAPRA (HR 1.56; 95% CI 1.50-1.63) were both independently associated with risk of recurrence after RP and model fit did not differ significantly. On multivariable Cox regression adjusted for CAPRA component variables, clinical stage ≥T2 on DRE (HR 1.28; 95% CI 1.06-1.54) and T3a on imaging (HR 1.79; 95% CI 1.47-2.19) were independently associated with BCR risk. CONCLUSIONS: Both DRE- and imaging-based CAPRA nomograms are associated with BCR risk after RP for PCa. Each staging modality offers independent information on the risk assessment nomogram, which supports the continued use of DRE-based clinical staging in PCa risk stratification and demonstrates the potential benefit imaging may add to models and staging standards. Source of Funding: UCSF Goldberg-Benioff Program in Translational Cancer Biology © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e876 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Chang More articles by this author Scott Greenberg More articles by this author Janet Cowan More articles by this author Katsuto Shinohara More articles by this author Hao Nguyen More articles by this author Matthew Cooperberg More articles by this author Peter Carroll More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP47-08 SURGICAL DELAY AFTER BIOPSY AND RISK OF UPSTAGING FOR CLINICAL T1A RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 May 2022MP47-08 SURGICAL DELAY AFTER BIOPSY AND RISK OF UPSTAGING FOR CLINICAL T1A RENAL CELL CARCINOMA Leilei Xia, Ruchika Talwar, Raju Chelluri, Daniel Lee, and Thomas Guzzo Leilei XiaLeilei Xia More articles by this author , Ruchika TalwarRuchika Talwar More articles by this author , Raju ChelluriRaju Chelluri More articles by this author , Daniel LeeDaniel Lee More articles by this author , and Thomas GuzzoThomas Guzzo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002618.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal mass biopsy (RMB) has been increasingly used as the initial management of small renal masses. However, little is known about whether surgical delay after the positive biopsy results increases the risk of upstaging for small renal cell carcinomas (RCCs). METHODS: Patients with clinical T1aN0M0 RCCs (≤4cm) diagnosed between 2010 and 2016 who underwent RMB and then partial nephrectomy (PN) or radical nephrectomy (RN) were identified from the National Cancer Database (NCDB). Surgical delay time (SDT) was defined as days between RMB and definitive surgical resection (PN or RN). SDT was categorized into five groups: 1-30 days, 31-60 days, 61-90 days, 91-120 days, and 121-180 days. Upstaging to pT3a was used as the primary outcome of interest. Positive surgical margin (PSM) was used as a secondary outcome and analyses were restricted to PN cohort only. RESULTS: A total of 4,340 patients were included and 237 (5.5%) patients had pT3a upstaging. Of the 2,874 patients who had PN, PSM rate was 8.2%. pT3a upstaging and PSM rates stratified by SDT is shown in the Figure. Multivariable logistic regression showed that compared with SDT of 1-30 days, SDT of 31-60 days (odds ratio [OR]=1.04, P= 0.833), 61-90 days (OR=1.17, P= 0.481), and 91-120 days (OR=1.14, P= 0.631) were not associated with increased odds of pT3a upstaging. Patients with SDT of 121-180 days had a higher risk of pT3a upstaging (OR= 1.93, P=0.016). When STD was ≤ 120 days, multivariable logistic regression with SDT considered as a continuous variable showed increased SDT was also not associated with higher odds of pT3a upstaging (OR=1.002, P=0.461). In the PN cohort, multivariable logistic regressions showed no significant associations between SDT and PSM with SDT either considered as a categorical or continuous variable. CONCLUSIONS: In this NCDB study, increased SDT from RMB to definitive surgical resection of cT1aN0M0 RCCs was not associated with worse oncologic outcomes within 120 days after the RMB but patients with SDT > 120 days might have increased risk of upstaging. These findings have significant implications for patient counseling regarding active surveillance, RMB, and definitive surgical resection for small renal masses. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e812 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leilei Xia More articles by this author Ruchika Talwar More articles by this author Raju Chelluri More articles by this author Daniel Lee More articles by this author Thomas Guzzo More articles by this author Expand All Advertisement PDF DownloadLoading ...