Clinical T1a Research Articles

Adhering to Quality Measures in Esophagectomy Is Associated With Improved Survival in All Stages of Esophageal Cancer

Quality measures for patients with early and locally advanced esophageal cancer undergoing esophagectomy have been made by national organizations. The rate of adherence to these measures as well as their association with overall survival are unknown. Esophagectomy patients were abstracted from the National Cancer Database. Because neoadjuvant status was available since 2006, the analysis of locally advanced patients began at this time point. Selected measures included: R0 resection, evaluation of 15 or more lymph nodes, and induction therapy for locally advanced tumors. Multivariate models identified variables associated with achieving quality measures. A Cox proportional hazards model evaluated factors associated with mortality. From 1998 to 2012, 4,908 of 16,040 (30.6%) early-stage esophageal cancer patients (clinical T1A to T2N0 <2cm, well-differentiated) underwent esophagectomy. Of 4,672 patients 4,518 (96.7%) achieved R0resection and 1,395 of 4,686 (29.8%) had 15 or more lymph nodes sampled. High-volume center type (>20 esophagectomies/year) was independently associated with meeting both measures (odds ratio [OR] 2.2, 95% confidence interval [CI]: 1.9 to 2.5). From 2006 to 2012, 7,747 of 20,437 (37.9%) locally advanced patients (clinical Stage IIB to IIIB) received esophagectomy. Of 6,966 patients 5,977 (85.8%) received induction therapy, 6,394 (91.8%) had R0 resection, and 2,852 (40.9%) had 15 or more lymph nodes sampled. High-volume center type was, again, associated with increased likelihood of meeting all quality measures (OR 2.17, 95% CI: 1.92 to 2.46). Meeting all quality measures was associated with the largest decrease in mortality for both early-stage (hazard ratio [HR] 0.27, 95% CI: 0.18 to 0.39) and locally advanced (HR 0.54, 95% CI: 0.40 to 0.73) esophageal cancer patients. Adherence to recommended quality measures is independently associated with improved overall survival in both early and locally advanced stages of esophageal cancer. Currently, few patients are receiving care in accordance with these recommendations.

ED05.02 Update on the Mesothelioma Staging System

ED05.02 Update on the Mesothelioma Staging System

The IASLC Mesothelioma Staging Project: Proposals for Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Pleural Mesothelioma

IntroductionThe current T component for malignant pleural mesothelioma (MPM) has been predominantly informed by surgical data sets and consensus. The International Association for the Study of Lung Cancer undertook revision of the seventh edition of the staging system for MPM with the goal of developing recommendations for the eighth edition. MethodsData elements including detailed T descriptors were developed by consensus. Tumor thickness at three pleural levels was also recorded. An electronic data capture system was established to facilitate data submission. ResultsA total of 3519 cases were submitted to the database. Of those eligible for T-component analysis, 509 cases had only clinical staging, 836 cases had only surgical staging, and 642 cases had both available. Survival was examined for T categories according to the current seventh edition staging system. There was clear separation between all clinically staged categories except T1a versus T1b (hazard ratio = 0.99, p = 0.95) and T3 versus T4 (hazard ratio = 1.22, p = 0.09), although the numbers of T4 cases were small. Pathological staging failed to demonstrate a survival difference between adjacent categories with the exception of T3 versus T4. Performance improved with collapse of T1a and T1b into a single T1 category; no current descriptors were shifted or eliminated. Tumor thickness and nodular or rindlike morphology were significantly associated with survival. ConclusionsA recommendation to collapse both clinical and pathological T1a and T1b into a T1 classification will be made for the eighth edition staging system. Simple measurement of pleural thickness has prognostic significance and should be examined further with a view to incorporation into future staging.

Re-Assessment of Intentional Extended Segmentectomy for Clinical T1aN0 Non-Small Cell Lung Cancer

This study compares long-term prognosis of intentional extended segmentectomy and lobectomy ofclinical T1aN0M0 non-small cell lung cancer (NSCLC). Risk factors of local-regional recurrence are identified and segmentectomy outcomes are examined per segment. 164 intentional extended segmentectomies were compared with 73 lobectomies subcategorized by consolidation to maximum tumor diameter ratio (C/T) measured by computed tomographies. Preoperative characteristics were propensity score matched to evaluate local-regional recurrence-free survival using the log-rank test. Preoperative factors and surgical procedure were analyzed with the Cox proportional hazards regression model to identify independent predictor of local-regional recurrence. Local-regional recurrence per segment were assessed by Kaplan-Meier estimates between both groups. No recurrences were observed for 46 C/T ≤0.5 segmentectomies. In 59 C/T >0.5 propensity score-matched pairs, 5-year local-regional recurrence-free survival rates of segmentectomies were 76.3%, versus 91.5% for lobectomies (p= 0.082). Multivariate analysis confirmed segmentectomies to be the only independent risk factor for local-regional recurrence-free probability (p= 0.020). Subset analysis reveals superior segmentectomies have significantly less local-regional recurrence (p= 0.029) than other segments and comparable prognosis to lower lobectomies. Left upper lobe segmentectomies also showed comparable prognosis to lobectomies. Segmentectomies in the right upper lobe and of basal segments showed significantly higher local recurrence (p= 0.001) than other segments. Basal segmentectomies showed significantly poor prognosis versus lower lobectomies (p= 0.005). For radiographically invasive right upper lobe or basal segment clinical T1a NSCLC, strict inclusion criteria is necessary for intentional segmentectomy. For superior and left upper lobe segments, however, segmentectomies may be preferred with prognosis comparable to lobectomies.

Predictors of Delayed Intervention for Patients on Active Surveillance for Small Renal Masses: Does Renal Mass Biopsy Influence Our Decision?

To review our clinical T1a renal mass active surveillance (AS) cohort to determine whether renal mass biopsy was associated with maintenance of AS. From our prospectively maintained database we identified patients starting AS from June 2009 to December 2011 who had at least 5 months of radiologic follow-up, unless limited by unexpected death or delayed intervention. The primary outcome was delayed intervention. Clinical, radiologic, and pathologic variables were compared. We constructed Kaplan-Meier survival curves for maintenance of AS. Cox multivariable regression analysis was performed to assess predictors of delayed intervention. We identified 118 patients who met criteria for inclusion with a median radiologic follow-up of 29.5 months. The delayed intervention group had greater initial mass size and faster growth rate compared to those who continued AS. Rate of renal mass biopsy was similar between the 2 groups. In the multivariable analysis, size >2 cm (hazard ratio [HR] 3.65, 95% confidence interval [CI] 1.28-10.38, P = .015), growth rate (continuous by mm/year: HR 1.26, 95% CI 1.12-1.41, P < .001), but not renal biopsy (HR 1.52, 95% CI 0.70-3.30, P = .29), were associated with increased risk of delayed intervention. Time-to-event curves also showed that size was closely associated with delayed intervention whereas renal mass biopsy was not. At our institution, growth rate and initial tumor size appear to be more influential than renal mass biopsy results in determining delayed intervention after a period of AS. Further analysis is required to determine the role of renal biopsy in the management of patients being considered for AS.

Economic Analysis of Prostate-Specific Antigen Screening and Selective Treatment Strategies.

Prostate-specific antigen (PSA) screening for prostate cancer is controversial. Experts have suggested more personalized or more conservative strategies to improve benefit-risk tradeoffs, but the value of these strategies-particularly when combined with increased conservative management for low-risk cases-is uncertain. To evaluate the potential cost-effectiveness of plausible PSA screening strategies and to assess the value added by increased use of conservative management among low-risk, screen-detected cases. A microsimulation model of prostate cancer incidence and mortality was created. A simulated contemporary cohort of US men beginning at 40 years of age underwent 18 strategies for PSA screening. Treatment strategies included (1) contemporary treatment practices based on age and cancer stage and grade observed in the Surveillance, Epidemiology, and End Results program in 2010 or (2) selective treatment practices whereby cases with a Gleason score lower than 7 and clinical T2a stage cancer or lower are treated only after clinical progression, and all other cases undergo contemporary treatment practices. National and trial data on PSA growth, screening and biopsy patterns, incidence of prostate cancer, treatment distributions, treatment efficacy, mortality, health-related quality of life, and direct medical expenditure were analyzed. Data were collected from March 18, 2009, to August 15, 2014, and analyzed from November 20, 2012, to December 11, 2015. Eighteen screening strategies that vary by start and stop age, screening interval, and criteria for biopsy referral and contemporary or selective treatment practices. Life-years (LYs), quality-adjusted life-years (QALYs), direct medical expenditure, and cost per LY and QALY gained. All 18 screening strategies were associated with increased LYs (range, 0.03-0.06) and costs ($263-$1371) compared with no screening, with the cost ranging from $7335 to $21 649 per LY. With contemporary treatment, only strategies with biopsy referral for PSA levels higher than 10.0 ng/mL or age-dependent thresholds were associated with increased QALYs (0.002-0.004), and only quadrennial screening of patients aged 55 to 69 years was potentially cost-effective in terms of cost per QALY (incremental cost-effectiveness ratio, $92 446). With selective treatment, all strategies were associated with increased QALYs (0.002-0.004), and several strategies were potentially cost-effective in terms of cost per QALY (incremental cost-effectiveness ratio, $70 831-$136 332). For PSA screening to be cost-effective, it needs to be used conservatively and ideally in combination with a conservative management approach for low-risk disease.

Absence of Pathological Proof of Cancer Associated with Improved Outcomes in Early-Stage Lung Cancer

ObjectivesThe purpose of this study was to assess the trends in use of clinical diagnosis and its impact on treatment outcomes in patients receiving radiation therapy for early-stage lung cancer. MethodsThe Surveillance, Epidemiology, and End Results registry was queried from 2004 to 2012 for patients at least 18 years old in whom stage I (clinical stage T1a–T2a) lung cancer had been diagnosed and who underwent radiation therapy alone. Trends in diagnostic confirmation patterns were characterized. A Cox proportional hazards model was used to assess overall survival, and competing risk regression analysis was used to assess cancer-specific survival (CSS). ResultsA total of 7050 patients were included; the disease of 6399 of them (90.8%) was pathologically diagnosed and that of 651 (9.2%) was clinically diagnosed. There was no significant change in the utilization of clinical versus pathologic diagnosis (p = 0.172) over time. Patients with T1 disease (p < 0.001), tumors 0 to 1.9 cm in size (p < 0.001), and upper lobe tumors (p = 0.004) were more likely to have been clinically diagnosed. On multivariable analysis, clinical diagnosis was associated with an improved CSS (hazard ratio [HR] = 0.82, 95% confidence interval [CI]: 0.71–0.96) but was not associated with an improved overall survival (HR = 1.01, 95% CI: 0.90–1.13). When stratified by T stage, patients whose disease had been clinically diagnosed as stage T1a had an improved CSS (HR = 0.75, 95% CI: 0.58–0.96, p = 0.022). There was a trend toward improved CSS in patients with clinical stage T1b tumors (HR = 0.74, 95% CI: 0.55–1.00, p = 0.052). ConclusionsThe improved CSS in patients with a clinical diagnosis suggests treatment of benign disease, particularly in smaller tumors. Prudent patient selection is needed to reduce the potential for overtreatment.

V5-01 ROBOTIC PARTIAL NEPHRECTOMY FOR INCREASINGLY COMPLEX RENAL MASSES IN SOLITARY KIDNEYS USING OFF CLAMP AND EARLY UNCLAMPING TECHNIQUES

You have accessJournal of UrologyRenal Oncology1 Apr 2016V5-01 ROBOTIC PARTIAL NEPHRECTOMY FOR INCREASINGLY COMPLEX RENAL MASSES IN SOLITARY KIDNEYS USING OFF CLAMP AND EARLY UNCLAMPING TECHNIQUES Manish Patel and Ashok Hemal Manish PatelManish Patel More articles by this author and Ashok HemalAshok Hemal More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.244AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The indications for partial nephrectomy are expanding. The AUA guidelines state that partial nephrectomy is a standard option for healthy patients with clinical T1a and T1b renal masses. While most surgeons can choose the procedure that they are most comfortable with, there are a few imperative indications for partial nephrectomy including solitary kidneys. In this video, we demonstrate our technique of robotic partial nephrecgtomy for patients with solitary kidneys with emphasis of our off clamp and early unclamping techniques to minimize warm ischemia. METHODS Since 2008 we have performed over 450 robotic partial nephrectomies, 12 of which were in solitary kidneys. Our port placement for the da Vinci Si and Xi are in figures 1 and 2. Typically small exopyhtic partial nephrectomies are done off clamp. For more endophytic or hilar tumors, clamping is performed with removal of the clamps as soon as there is hemostasis. For patients with multiple tumors, bulldog clamps are placed with the larger endophytic tumors are done first, then clamps are removed and the smaller and exophytic tumors are removed. Renorrhapy is performed in multiple layers using monocryl for the collecting system and small vessels, and interrupted vicryl for the medulla and cortex. RESULTS The median age of our series was 58 (48-73). The median warm ischemia time was 14 minutes with one ileus and one postoperative urine leak. There were no conversions to open. Postoperatively, 92% of the tumors were malignant with a mean decrease in eGFR of 30% (-68% - 0%) at a median follow up of 32 months. CONCLUSIONS Partial nephrectomy in patient with solitary kidney is a safe and feasible even for complex and multiple masses. The continued spread of technology and techniques may allow more patients to undergo nephron sparing techniques decreasing the risk of CKD and long term morbidity and mortality. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e593-e594 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Manish Patel More articles by this author Ashok Hemal More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP40-18 LONG-TERM ONCOLOGICAL OUTCOMES FOLLOWING RADICAL PROSTATECTOMY FOR CLINICAL T1A AND T1B PROSTATE CANCER

INTRODUCTION AND OBJECTIVES: Prostate cancer (PCa) is incidentally found in 4e16% of patients surgically treated for benign prostatic hyperplasia. It is staged as clinical T1a or T1b based on the percentage of tumor in the specimen: 0.2 ng/mL and/or biopsy-proven local recurrence. Metastasis was determined by imaging. Cause of death was obtained from death certificates. RESULTS: A total of 86 (34%) and 166 (66%) men had cT1a and cT1b PCa, respectively. Compared to cT1b, cT1a men had less positive surgical margins and lower pathological Gleason score (P 0.05). A total of 12 (14%) T1a and 45 (27%) T1b men developed disease recurrence over a median follow-up of 14.8 years. No cT1a and 9 (5%) cT1b men developed metastasis. No cT1a and 6 (4%) cT1b died of PCa. Compared to patients with cT1b tumors, cT1a patients had longer recurrence-free and metastasis-free survival (both P < 0.05) and a trend toward better disease-specific survival (P 1⁄4 0.078; Figure). CONCLUSIONS: cT1a PCa is associated with low stage and low grade disease. Although both cT1a and cT1b have very favorable prognoses after RP, a small but not negligible percentage of cT1b men will develop systemic progression and experience cancer-specific mortality, compared to no progression or PCa deaths in the T1a group. Our findings support active treatment for selected T1b PCa cases. Source of Funding: None

MP78-08 DIAGNOSTIC POTENTIAL OF PROTON MAGNETIC RESONANCE SPECTROSCOPY ON RENAL TUMORS.

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging II1 Apr 2016MP78-08 DIAGNOSTIC POTENTIAL OF PROTON MAGNETIC RESONANCE SPECTROSCOPY ON RENAL TUMORS. Masahiro Sumura, Naoko Arichi, Shigenobu Nakamura, Hiroaki Yasumoto, Takeshi Yoshizako, Hajime Kitagaki, and Hiroaki Shiina Masahiro SumuraMasahiro Sumura More articles by this author , Naoko ArichiNaoko Arichi More articles by this author , Shigenobu NakamuraShigenobu Nakamura More articles by this author , Hiroaki YasumotoHiroaki Yasumoto More articles by this author , Takeshi YoshizakoTakeshi Yoshizako More articles by this author , Hajime KitagakiHajime Kitagaki More articles by this author , and Hiroaki ShiinaHiroaki Shiina More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1964AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Magnetic resonance spectroscopy (MRS) is a noninvasive method for assessment of biochemical tissue characteristics in vivo and has proven its value for differentiation of tumors in brain, breast, and prostate. However, there are few reports of MRS on kidney, because of respiratory displacement of kidney. This problem could be solved with respiratory-triggered examination in our institution. We evaluate the diagnostic potential of MRS on renal tumors. METHODS 28 renal tumors in 28 patients were enrolled in this study (age 60-82 years-old (median 62 years-old), and clinical stage T1a 15 cases, T1b 5cases, T2a 1 case, T3a 6 cases and T4 1 cases). All patients underwent MRS with 1.5 T MR device and phased array type external surface coil, pre-operatively. A respiratory-triggered single voxel MRS was performed with the point-resolved spectroscopy sequence (TR 2000 ms, TE 135 ms). The spectra were analyzed for choline resonances at 3.2 ppm, that were normalized using the noise outside the diagnostic range of the spectra. The spectra obtained from both tumor and benign tumors were compared. Histological results were defined as the standard of reference. RESULTS 26 tumors in 28 tumors were histologically malignant. Two tumors were histologically diagnosed angiomyolipoma (AML). In all cases, spectrum had sufficient quality to diagnose. Mean choline SNR in malignant lesions was 3.4 and 1.01 in AML. Higher choline SNR were observed in tumors with higher grade. CONCLUSIONS We recognized that further studies were essential, but MRS might have the potential to differentiate the malignant renal tumor from benign. Furthermore, choline could be a biomarker of aggressiveness in malignant renal tumors. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1027 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Masahiro Sumura More articles by this author Naoko Arichi More articles by this author Shigenobu Nakamura More articles by this author Hiroaki Yasumoto More articles by this author Takeshi Yoshizako More articles by this author Hajime Kitagaki More articles by this author Hiroaki Shiina More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Life Expectancy and Variation in Treatment for Early Stage Kidney Cancer

Patients with limited life expectancy are at risk for overtreatment of T1a kidney cancer. We sought to determine patterns of treatment for T1a kidney cancer in a nationally representative sample of patients with life expectancy less than 10 and less than 5 years. We sampled 9,825 patients older than 65 years with clinical T1a kidney cancer diagnosed between 2000 and 2010 from the SEER (Surveillance, Epidemiology and End Results)-Medicare database. We performed competing risks regression to model survival by age/comorbidity and identified patients with life expectancy less than 10 and less than 5 years. Multivariate logistic regression was used to determine the probability of aggressive treatment with surgery or ablation among those with limited life expectancy. Life expectancy was less than 10 years in patients 66 to 80 years old with a Charlson score of 3+, in those 80 to 84 years old with a Charlson score of 1+ and in all patients 85 years old or older. Among those with life expectancy less than 10 years the multivariate probability of aggressive treatment was 85%, 84%, 82%, 75% and 50% in those 66 to 69, 70 to 74, 75 to 79, 80 to 84 and 85 years old or older, respectively. In those with life expectancy less than 10 years who were treated aggressively treatment was radical nephrectomy in 61%, partial nephrectomy in 24% and ablation in 14%. Among those with life expectancy less than 5 years (age 85 years or greater with a Charlson score of 3+) the multivariate probability of aggressive treatment was 41% and more often surgery than ablation (68% vs 32% of patients). The majority of patients with life expectancy less than 10 years and a significant minority with life expectancy less than 5 years were treated with surgery or ablation for T1a kidney cancer. Life expectancy should be better incorporated into treatment decision making for early stage kidney cancer.

Diagnostic accuracy of pre-operative imaging findings in presumed clinical T1a renal cell carcinomas.

Despite the development of recent imaging modalities, certain pathological misdiagnoses remain for surgical specimens of presumed small renal cell carcinomas (RCCs). In the present study, a retrospective analysis of benign pathological lesions diagnosed as small RCC prior to surgery was performed. In total, the cases of 196 sporadic renal tumors that was surgically treated as clinical T1a RCCs were reviewed, and the accuracy of the pathological diagnoses was calculated. The pre-operative findings for benign pathological lesions was investigated, and the lesions were observed in 13 (6.63%) of the 196 tumors. Pre-operative computed tomography images were obtained in all cases, and magnetic resonance images were available in 10 cases. The diagnostic accuracy of imaging modalities was significantly lower in the tumors with a diameter of ≤20 mm. In all cases, the possible pathological diagnosis of RCC could not be excluded even by retrospective imaging analysis. Several benign pathological lesions were found in small renal masses presumed to be clinical T1a RCC. In conclusion, there may be limitations to the pre-operative imaging for certain types of small renal mass.

172 A new sub-classification system for decision making with intermediate risk prostate cancer patients treated by radical prostatectomy: A multicenter study

INTRODUCTION AND OBJECTIVES: Prostate cancer (PCa) is incidentally found in 4e16% of patients surgically treated for benign prostatic hyperplasia. It is staged as clinical T1a or T1b based on the percentage of tumor in the specimen: 0.2 ng/mL and/or biopsy-proven local recurrence. Metastasis was determined by imaging. Cause of death was obtained from death certificates. RESULTS: A total of 86 (34%) and 166 (66%) men had cT1a and cT1b PCa, respectively. Compared to cT1b, cT1a men had less positive surgical margins and lower pathological Gleason score (P 0.05). A total of 12 (14%) T1a and 45 (27%) T1b men developed disease recurrence over a median follow-up of 14.8 years. No cT1a and 9 (5%) cT1b men developed metastasis. No cT1a and 6 (4%) cT1b died of PCa. Compared to patients with cT1b tumors, cT1a patients had longer recurrence-free and metastasis-free survival (both P < 0.05) and a trend toward better disease-specific survival (P 1⁄4 0.078; Figure). CONCLUSIONS: cT1a PCa is associated with low stage and low grade disease. Although both cT1a and cT1b have very favorable prognoses after RP, a small but not negligible percentage of cT1b men will develop systemic progression and experience cancer-specific mortality, compared to no progression or PCa deaths in the T1a group. Our findings support active treatment for selected T1b PCa cases. Source of Funding: None

V37 Retro-peritoneal approach for robotic assisted laparoscopic partial nephrectomy of a clinical T2a renal mass

V37 Retro-peritoneal approach for robotic assisted laparoscopic partial nephrectomy of a clinical T2a renal mass

Laparoscopic Radiofrequency Ablation versus Partial Nephrectomy for cT1a Renal Tumors: Long-Term Outcome of 179 Patients

Objectives: To compare the long-term functional and oncological results between laparoscopic radiofrequency ablation (LRFA) and laparoscopic partial nephrectomy (LPN) in selected clinical T1a (cT1a) renal tumor patients. Methods: We retrospectively analyzed the medical records of patients with cT1a renal tumors who had LRFA or LPN at our institution between February 2006 and February 2015. Student's t test was used to compare the perioperative data between the two groups. Survival analyses were calculated using the Kaplan-Meier method. Results: A total of 179 patients were included in the study. Patients in the LRFA cohort were significantly older and had higher American Society of Anesthesiologists sore than in the LPN cohort. The LRFA group had a significantly lower mean blood loss than the LPN group (p = 0.03). The percent decrease of GFR in the LRFA group was significantly lower than in the LPN group (p = 0.021). The 5-year overall, cancer-specific and disease-free survival were 93.3 vs. 94.6%, 98.0 vs. 98.5% and 97.1 vs. 97.3%, for LRFA and LPN, respectively (all p value >0.05). Conclusions: The excellent perioperative results, long-term functional and oncological outcomes of LRFA confirm that this technique is safe, nephron sparing and oncologically effective for the treatment of cT1a renal tumors.

The establishment of KORCC (KOrean Renal Cell Carcinoma) database.

PurposeThe purpose of this article is to report establishment of the 1st Web-based database (DB) system to collect renal cell carcinoma (RCC) data in Korea.Materials and MethodsThe new Web-based DB system was established to collect basic demographic and clinicopahtological characteristics of a large cohort of patients with RCC in Korea. Data from a total of 6,849 patients were collected from 8 tertiary care hospitals that agreed to participate in organizing the Korean Renal Cell Carcinoma (KORCC) study group as of 1 July 2015. Basic demographic and clinicopathological characteristics were collected. The data of patients who underwent surgical treatments were analyzed to characterize Korean RCC.ResultsWe established the 1st Web-based DB of Korean RCC, a database comprising renal mass management cases from multiple centers in Korea. The data of 5,281 patients who underwent surgical management (mean follow-up, 32 months) were analyzed. The most common symptom was incidentally detected renal mass (76.9%). Clinical T1a was the most common (54.3%) stage and mean tumor size was 4.8±4.2 cm. Radical nephrectomy accounted for 62.7% of cases and an open approach was used in 50.7% and 52.2% of radical and partial nephrectomies, respectively. The 5-year overall, cancer-specific and recurrence-free survival rates were 88.1%, 92.2%, and 88.0%, respectively.ConclusionsWe report the 1st establishment of a Web-based DB system to collect RCC data in Korea. This DB system will provide a solid basis for the characterization of Korean RCC.

Efficacy of Partial Nephrectomy for Renal Tumors &amp;gt;4 cm: Comparison With Renal Tumors ≤4 cm

Partial nephrectomy has become a treatment of choice for clinical T1a renal masses. Some international guidelines suggest that partial nephrectomy can be applied also in clinical T1b tumors. The aim of this study was to evaluate the feasibility of partial nephrectomy for tumors larger than 4 cm. We reviewed the medical records of 1280 patients who underwent partial nephrectomy and had pathologically confirmed malignancy. Patients were categorized into two groups by the size of tumors on computed tomography image, with a cutoff value of 4 cm. The oncologic and functional outcomes were compared between the two groups. Recurrence-free survival after surgery was estimated using the Kaplan-Meier method. Of the 1280 patients, 203 patients (15.9%) had renal tumors larger than 4 cm. There were significantly more exophytic tumors (P &amp;lt; 0.001) and the R.E.N.A.L. scores were significantly higher (P &amp;lt; 0.001) in partial nephrectomy &amp;gt;4 cm. Mean ischemic times were significantly different (P &amp;lt; 0.001). After 24 months, mean creatinine level between partial nephrectomy &amp;gt;4 cm and partial nephrectomy ≤4 cm was not different significantly (P = 0.554). And the percent changes of glomerular filtration rate after partial nephrectomy were not different at last follow-up (P = 0.082). The 5-year recurrence-free survival rates were 96.6% in partial nephrectomy ≤4 cm, and 94.5% in partial nephrectomy &amp;gt;4 cm (P = 0.416). Based on the present findings, partial nephrectomy for tumors larger than 4 cm showed comparable feasibility and safety to partial nephrectomy for tumors ≤4 cm considering oncologic and functional outcomes, despite longer operative and ischemic time.

Racial Disparities in Partial Nephrectomy Persist Across Hospital Types: Results From a Population-based Cohort

To assess the national utilization of partial nephrectomy (PN) for T1a renal masses across different racial groups by hospital type. Although clinical guidelines recommend PN for small renal masses (SRMs), racial disparities persist in the use of PN. High-volume and academic hospitals have been associated with greater use of PN for SRMs. However, it is unknown whether racial disparities persist in the use of PN across different types of hospitals. Using the National Cancer Database, we identified patients with localized T1a renal cancer (≤4 cm) from 1998 to 2011. The primary outcome was receipt of PN among patients surgically treated for SRMs. Multivariable logistic regression analyses were used to assess for racial differences in treatment with PN stratified by hospital characteristics. Among 118,207 patients diagnosed with clinical T1a renal masses, 36.5% underwent PN (n = 43,134). Overall, a greater proportion of white patients underwent PN (37.3%) compared with African-American (32.4%) and Hispanic (33.7%) patients with SRMs (P <.001). When stratified by hospital type, disparities persisted in the use of PN; African-American patients had lower adjusted odds ratios for being treated with PN when treated at comprehensive community cancer (odds ratio: 0.90; P = .003) and academic (odds ratio: 0.65; P <.001) hospitals compared with white patients. In this population-based cohort, we found that racial disparities persist across all types of hospitals in the use of PN for SRMs. Further research is needed to identify, and target for intervention, the factors contributing to racial disparities in the surgical management of SRMs.

Oncologic Outcomes of Segmentectomy Versus Lobectomy for Clinical T1a N0 M0 Non-Small Cell Lung Cancer

We retrospectively compared the oncologic outcome after segmentectomy versus lobectomy in patients with clinical (c-) T1a N0 M0 non-small cell lung cancer (NSCLC) detected as a part-solid ground-glass nodule or purely solid nodule on thin-section computed tomography. From 1997 to 2010, 312 patients with c-T1a N0 M0 NSCLC were determined to require a surgical approach categorized as segmentectomy or lobectomy. Preoperatively available data were collected using logistic regression analysis, and propensity matching was performed. Factors affecting local-regional recurrence were assessed by Cox proportional hazards regression analysis and Kaplan-Meier estimates. The 5-year and 10-year overall survival rates for the 80 patients who underwent segmentectomy were 97.5% and 83.5%, respectively, compared with 87.75% and 75.0%, respectively, for the 232 patients who underwent lobectomy (p= 0.019). Local-regional recurrence as the first relapse site was found in 3 the 80 segmentectomies (3.8%) of and in 15 of the 232 lobectomies (6.5%). The difference in local-regional recurrence-free survival in patients undergoing segmentectomy compared with lobectomy was not significant (p= 0.304). In 69 propensity score-matched pairs, there was no significant difference in the overall survival (p= 0.442) or local-regional recurrence-free survival (p= 0.717) between the two groups. Multivariate analysis using the Cox proportional hazards regression model identified lymphatic invasion as the only independent factor predicting local-regional recurrence (relative risk, 10.764; 95% confidence interval, 2.98 to 57.68). Our results suggest that the oncologic outcome of segmentectomy vs lobectomy is similar in thiscohort of c-T1a N0 M0 NSCLC patients. These results will be validated by large-scale, prospective, randomized trials.

Survival After Sublobar Resection versus Lobectomy for Clinical Stage IA Lung Cancer: An Analysis from the National Cancer Data Base

Recent data have suggested possible oncologic equivalence of sublobar resection with lobectomy for early-stage non-small-cell lung cancer (NSCLC). Our aim was to evaluate and compare short-term and long-term survival for these surgical approaches. This retrospective cohort study utilized the National Cancer Data Base. Patients undergoing lobectomy, segmentectomy, or wedge resection for preoperative clinical T1A N0 NSCLC from 2003 to 2011 were identified. Overall survival (OS) and 30-day mortality were analyzed using multivariable Cox proportional hazards models, logistic regression models, and propensity score matching. Further analysis of survival stratified by tumor size, facility type, number of lymph nodes (LNs) examined, and surgical margins was performed. A total of 13,606 patients were identified. After propensity score matching, 987 patients remained in each group. Both segmentectomy and wedge resection were associated with significantly worse OS when compared with lobectomy (hazard ratio: 1.70 and 1.45, respectively, both p < 0.001), with no difference in 30-day mortality. Median OS for lobectomy, segmentectomy, and wedge resection were 100, 74, and 68 months, respectively (p < 0.001). Finally, sublobar resection was associated with increased likelihood of positive surgical margins, lower likelihood of having more than three LNs examined, and significantly lower rates of nodal upstaging. In this large national-level, clinically diverse sample of clinical T1A NSCLC patients, wedge and segmental resections were shown to have significantly worse OS compared with lobectomy. Further patients undergoing sublobar resection were more likely to have inadequate lymphadenectomy and positive margins. Ongoing prospective study taking into account LN upstaging and margin status is still needed.