Clinical T1a Research Articles

Gender Differences in the Clinical Management of clinical T1a Renal Cell Carcinoma

To evaluate gender differences in the management of clinical T1a (cT1a) renal cell carcinoma (RCC) before and after release of the AUA guidelines for management in 2009, which prioritized nephron-sparing approaches. Patients aged ≥66 years diagnosed with cT1a RCC from 2004 to 2013 in Surveillance, Epidemiology, and End Results-Medicare were analyzed. Multivariable mixed-effects logistic regression models were used to evaluate factors associated with radical nephrectomy (RN) for cT1a RCC before (2004 to 2009) and after (2010 to 2013) guidelines release. Predictors of pathologic T3 upstaging and high grade pathology in the postguidelines period were examined using multivariable logistic regression among patients who underwent RN or partial nephrectomy. Twelve thousand four hundred and two patients with cT1a RCC were identified, 42% of whom were women. Overall, the likelihood of RN decreased postguidelines (odds ratio [OR]=0.44, P <.001), but women were at increased odds of undergoing RN both before and after guideline release (OR=1.27, P <.001 and OR=1.37, P <.001, respectively) upon multivariable mixed-effects logistic regression. Tumor size >2 cm was also associated with increased likelihood of RN before and after guidelines (OR=2.61, P <.001 and OR=2.51, P <.001, respectively). In the postguidelines period, women had significantly lower odds of pathologic upstaging (OR=0.75, P=.024) and harboring high grade pathology (OR=0.71, P <.001) compared to men. Gender differences persist in the management of cT1a RCC, with women having higher odds of undergoing RN, even after release of AUA guidelines and despite having lower odds of pathologic upstaging and high-grade disease.

PT163 - Multicenter comparison of outcomes for clinical and pathologic T3a renal cell carcinoma

PT163 - Multicenter comparison of outcomes for clinical and pathologic T3a renal cell carcinoma

Is Local Endoscopic Resection a Viable Therapeutic Option for Early Clinical Stage T1a and T1b Esophageal Adenocarcinoma?: A Propensity-matched Analysis.

The aim of this study was to evaluate the outcome of endoscopic resection (ER) versus esophagectomy in node-negative cT1a and cT1b esophageal adenocarcinoma. The role of ER in the management of subsets of clinical T1N0 esophageal adenocarcinoma is controversial. Data from the National Cancer Database (2010-2015) were used to identify patients with clinical T1aN0 (n = 2545) and T1bN0 (n = 1281) esophageal adenocarcinoma that received either ER (cT1a, n = 1581; cT1b, n = 335) or esophagectomy (cT1a, n = 964; cT1b, n = 946). Propensity score matching and Cox analyses were used to account for treatment selection bias. ER for cT1a and cT1b disease was performed more commonly over time. The rates of node-positive disease in patients with cT1a and cT1b esophageal adenocarcinoma were 4% and 15%, respectively. In the matched cohort for cT1a cancers, ER had similar survival to esophagectomy [hazard ratio (HR): 0.85, 95% confidence interval (CI): 0.70-1.04, P = 0.1]. The corresponding 5-year survival for ER and esophagectomy were 70% and 74% (P = 0.1), respectively. For cT1b cancers, there was no statistically significant difference in overall survival between the treatment groups (HR: 0.87, 95% CI: 0.66-1.14, P = 0.3). The corresponding 5-year survival for ER and esophagectomy were 53% versus 61% (P = 0.3), respectively. This study demonstrates ER has comparable long-term outcomes for clinical T1aN0 and T1bN0 esophageal adenocarcinoma. However, 15% of patients with cT1b esophageal cancer were found to have positive nodal disease. Future research should seek to identify the subset of T1b cancers at high risk of nodal metastasis and thus would benefit from esophagectomy with lymphadenectomy.

PD11-05 MULTICENTER COMPARISON OF OUTCOMES FOR CLINICAL AND PATHOLOGIC T3A RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD11)1 Apr 2020PD11-05 MULTICENTER COMPARISON OF OUTCOMES FOR CLINICAL AND PATHOLOGIC T3A RENAL CELL CARCINOMA Aaron Bradshaw*, Robert Uzzo, Umberto Capitanio, Brian Lane, Dattatraya Patil, Kazutaka Saito, Fady Ghali, Alexander Kutikov, Alessandro Larcher, Sabrina Noyes, Raksha Dutt, Cathrine Keiner, Nathan Miller, Fang Wan, Margaret Meagher, Devin Patel, Yasuhisa Fujii, Francesco Montorsi, Viraj Master, and Ithaar Derweesh Aaron Bradshaw*Aaron Bradshaw* More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Brian LaneBrian Lane More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Fady GhaliFady Ghali More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Sabrina NoyesSabrina Noyes More articles by this author , Raksha DuttRaksha Dutt More articles by this author , Cathrine KeinerCathrine Keiner More articles by this author , Nathan MillerNathan Miller More articles by this author , Fang WanFang Wan More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Devin PatelDevin Patel More articles by this author , Yasuhisa FujiiYasuhisa Fujii 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.0000000000000845.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The identification of imaging characteristics associated with T3a renal cell carcinoma (RCC) can may be challenging on pre-operative imaging. A substantial number of patients are upstaged to T3a following intervention. The impact of upstaging to pT3a disease on ultimate outcomes in comparison with clinical T3a RCC is unclear. We compared survival outcomes between patients with clinical T3a versus those upstaged to pT3a RCC. METHODS: This is a retrospective, multicenter analysis of patients with RCC of cT3a or pT3a staging who underwent operative management. Primary outcome was recurrence-free survival (RFS). Secondary outcomes were overall survival (OS) and cancer-specific survival (CSS). Cox regression multivariable analysis (MVA) was utilized for primary outcome. Kaplan-Meier analyses (KMA) were conducted to describe RFS, OS, and CSS with log-rank test comparing survival between clinical and upstaged T3a groups. RESULTS: 1314 patients were included in analysis (cT3a 309, pT3a 1005). Upstaged pT3a patients were more likely to be female (p=0.02) and have a higher BMI (p<0.01). Average tumor size was similar between groups (cT3a 7.7 vs. pT3a 7.2 cm, p=0.26), however a higher proportion of cT3a underwent radical nephrectomy (90.9% vs. 56.7% pT3a, p<0.01). Positive surgical margin rate was higher among pT3a (9.6% vs 2.3% cT3a, p<0.01) with a similar proportion having pathologically positive nodes (11.5% pT3a vs. 11.7% cT3a, p=0.96). MVA for RFS revealed increasing age (HR 1.01, p=0.03), clear cell RCC (HR 1.32, p=0.03), and positive node status (HR 3.83, p<0.01) to be independent risk factors of recurrence while sex (p=0.13), cT3a vs. pT3a staging (p=0.08), positive surgical margins (p=0.30), and type of surgery (p=0.95) were not significant. KMA demonstrated 5-year RFS of 52.2% and 55.6% for cT3a and pT3a respectively (p=0.04). KMA demonstrated 5-year OS rates of 69.0% and 59.0% (p=0.20) and 5-year CSS of 76.7% and 72.6% for cT3a and pT3a respectively (p=0.70) (Figure). CONCLUSIONS: Pathologic upstaging was not an independent risk factor for recurrence in T3a RCC. Despite an increased recurrence rate in clinical T3a RCC versus pathologically upstaged T3a, no difference in oncological outcomes were noted and pathologic upstaging does not compromise oncologic outcomes compared to clinical T3a disease. Source of Funding: Stephen Weissman Kidney Cancer Research Fund © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e254-e255 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Bradshaw* More articles by this author Robert Uzzo More articles by this author Umberto Capitanio More articles by this author Brian Lane More articles by this author Dattatraya Patil More articles by this author Kazutaka Saito More articles by this author Fady Ghali More articles by this author Alexander Kutikov More articles by this author Alessandro Larcher More articles by this author Sabrina Noyes More articles by this author Raksha Dutt More articles by this author Cathrine Keiner More articles by this author Nathan Miller More articles by this author Fang Wan More articles by this author Margaret Meagher More articles by this author Devin Patel More articles by this author Yasuhisa Fujii 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 ...

MP57-02 PREDICTIVE FACTORS FOR RECURRENCE AFTER PARTIAL NEPHRECTOMY FOR CLINICAL T1 RENAL CELL CARCINOMA: A RETROSPECTIVE STUDY OF 1568 CASES FROM A SINGLE INSTITUTION

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP57)1 Apr 2020MP57-02 PREDICTIVE FACTORS FOR RECURRENCE AFTER PARTIAL NEPHRECTOMY FOR CLINICAL T1 RENAL CELL CARCINOMA: A RETROSPECTIVE STUDY OF 1568 CASES FROM A SINGLE INSTITUTION Kazuhiko Yoshida*, Toshio Takagi, Arisa Ebinuma, Tsunenori Kondo, Hironori Fukuda, Hiroki Ishihara, Hirohito Kobayashi, Junpei iizuka, Masayoshi Okuimi, Hideki Ishida, and Kazunari Tanabe Kazuhiko Yoshida*Kazuhiko Yoshida* More articles by this author , Toshio TakagiToshio Takagi More articles by this author , Arisa EbinumaArisa Ebinuma More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , Hironori FukudaHironori Fukuda More articles by this author , Hiroki IshiharaHiroki Ishihara More articles by this author , Hirohito KobayashiHirohito Kobayashi More articles by this author , Junpei iizukaJunpei iizuka More articles by this author , Masayoshi OkuimiMasayoshi Okuimi More articles by this author , Hideki IshidaHideki Ishida More articles by this author , and Kazunari TanabeKazunari Tanabe More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000926.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) is a standard surgical approach for T1 renal tumors. Several studies have evaluated oncological outcome after PN. Identifying the predictive factors for tumor recurrence after PN is also useful to determine patients who require careful observation after surgery. Therefore, we investigated recurrence after partial nephrectomy (PN) in patients with clinical T1 renal cell carcinoma (RCC) and analyzed predictive factors for recurrence-free survival (RFS). METHODS: Patients with clinical stage 1 RCC who underwent PN between 1990 and 2018 were included. Patients without sufficient medical records for at least 6 months or those with genetically confirmed hereditary RCCs were excluded. Finally, 1568 patients were included in the analysis. The primary outcome of this study was recurrence-free survival (RFS), which was defined as the time from surgery to the date of recurrence. Recurrence included distant metastasis and local recurrence. Local recurrence was defined as tumor recurrence at the resected bed. RESULTS: The median patient age was 59 years, and the median tumor size was 30 mm. Although 1202 (77%) and 366 (23%) patients had clinical T1a and T1b RCCs, respectively, 21 patients (1.3%) were upstaged to pathological T3a. A positive surgical margin was found in 22 (1.4%) patients. The distribution of surgical approaches was open surgery in 656 (42%) patients and minimally invasive surgery in 912 (58%) patients. With a median follow-up of 30 months, 55 (3.5%) patients, including 17 with local recurrence, 13 with recurrence in the ipsilateral kidney, and 35 with distant metastasis, developed recurrence. Five-year RFS was 95%, and the median recurrence time from PN was 31 months. Multivariate analysis identified high grade tumor, multifocal tumors, and upstaging to pT3a as significant predictors for worse RFS (table). CONCLUSIONS: Patients with high grade tumors, multifocal tumors, and tumors upstaged to pT3 had a high risk of worse RFS, which suggested that careful monitoring is required for such patients after PN, even if a good prognosis is achieved in patients with clinical T1 RCC. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e857-e858 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kazuhiko Yoshida* More articles by this author Toshio Takagi More articles by this author Arisa Ebinuma More articles by this author Tsunenori Kondo More articles by this author Hironori Fukuda More articles by this author Hiroki Ishihara More articles by this author Hirohito Kobayashi More articles by this author Junpei iizuka More articles by this author Masayoshi Okuimi More articles by this author Hideki Ishida More articles by this author Kazunari Tanabe More articles by this author Expand All Advertisement PDF downloadLoading ...

Factors Associated With Receipt of Partial Nephrectomy or Minimally Invasive Surgery for Patients With Clinical T1a and T1b Renal Masses: Implications for Regionalization of Care.

To identify factors associated with receipt of partial nephrectomy (PN) and minimally invasive surgery (MIS) in patients with clinical T1 renal cell carcinoma (RCC) using the National Cancer Data Base (NCDB). We queried the NCDB from 2010 to 2014 identifying patients treated surgically for cT1a-bN0M0 RCC. Logistic regression was used to examine associations between socioeconomic, clinical, and treatment factors, and receipt of MIS or PN within the T1 patient population. Our cohort included 69,694 patients (cT1a, n= 44,043; cT1b, n= 25,651). For cT1a tumors, 70% of patients received PN and 65% underwent MIS. For cT1b tumors, 32% of patients received PN and 62% underwent MIS. cT1a and cT1b patients with household income< $62,000, without private insurance, and treated outside academic centers were less likely to receive MIS or PN. cT1a patients traveling > 31 miles were more likely to undergo MIS. For both cT1a/b, the farther a patient traveled for treatment, the more likely a PN was performed. Data showed an increase in utilization of MIS and PN from 2010 to 2014. However, patients in the lowest socioeconomic groups were less likely to travel and were more likely to receive more invasive treatments. On the basis of these findings, additional research is needed into how regionalization of RCC surgery affects treatment disparities.

Multicenter comparison of outcomes for clinical and pathologic T3a renal cell carcinoma.

758 Background: The identification of venous thrombus in patients with renal cell carcinoma (RCC) is particularly challenging, with a substantial number upstaged to pathologic T3a following intervention. We compared survival outcomes between patients with initial cT3a status versus those upstaged to pT3a. Methods: This is a retrospective, multicenter analysis of patients with cT3a or pT3a RCC who underwent operative management. Primary outcome was recurrence-free survival (RFS). Secondary outcomes were overall survival (OS) and cancer-specific survival (CSS). Cox regression multivariable analysis (MVA) was utilized for primary outcome. Kaplan-Meier analyses (KMA) were conducted to describe RFS, OS, and CSS with log-rank test comparing clinical and upstaged pathologic T3a groups. Results: 770 patients were analyzed (cT3a 184, pT3a 586, median follow-up 28 months). Average pathologic tumor size was smaller in pT3a (7.2 cm vs 8.7 cm, p &lt; 0.01), with no significant differences in clinical variables. A similar proportion underwent radical nephrectomy (vs. partial) (89.7% cT3a and 85.0% pT3a, p = 0.11) with no significant different in positive margin rate (3.8% cT3a, 4.8% pT3a, p = 0.23). However, a higher proportion of patients with cT3a disease were pathologically node positive (19.0% vs. 10.8%, p &lt; 0.01) and demonstrated a higher rate of recurrence (cT3a 51.1% vs. pT3a 34.1%, p &lt; 0.01) despite shorter mean follow-up (cT3a 33.0 vs. pT3a 50.7 mo, p &lt; 0.01). MVA for RFS revealed cT3a staging (pT3a referent, HR 1.72, p &lt; 0.01), positive margins (HR 2.85, p &lt; 0.01), and clear cell histology (HR 1.68, p &lt; 0.01) to be independently associated with higher recurrence rate, while partial nephrectomy (radical referent, HR 0.259, p &lt; 0.01) was associated with a decreased rate. KMA revealed 5-year RFS of 34.4% and 60.6% for cT3a and pT3a respectively (p &lt; 0.01). KMA for secondary outcomes revealed 5-year OS rates of 56.7% and 62.0% (p = 0.02) and 5-year CSS of 74.4% and 67.7% for cT3a and pT3a respectively (p = 0.01). Conclusions: Patients with cT3a RCC have poorer oncologic outcomes than those with upstaged pT3a RCC. Suspected venous involvement on pre-operative imaging may indicate more aggressive or advanced disease than that found during surgery.

Association of robotic partial nephrectomy for clinical T2a renal mass with improved trifecta outcome compared to open partial nephrectomy: A single surgeon comparative analysis.

653 Background: We compared surgical quality and functional outcomes of robotic partial nephrectomy (RPN) and open PN (OPN) for cT2a renal masses (cT2aRM). Methods: Retrospective analysis of 150 consecutive patients [RPN 59/OPN 91] from 6/2008 to 6/2016. Main outcome was achievement of Trifecta [negative surgical margin, no major urologic complications, and ≥90% preservation of estimated glomerular filtration rate (eGFR)]. Multivariable analysis was performed to identify factors of Trifecta attainment. Results: Mean tumor size (RPN 7.9 vs. OPN 8.4 cm, p=0.139) and median RENAL score (p=0.361) were similar. No difference was noted for positive margins (RPN 3.4% vs. OPN 1.1%, p=0.561), DeGFR (RPN -6.2 vs. OPN -7.8, p=0.543), and ≥90% eGFR recovery (RPN 54.1% vs. OPN 47.2%, p=0.504). RPN had lower blood loss (p=0.015), hospital stay (p=0.013), and Clavien ≥3 complications (RPN 5.1% vs. OPN 16.5%, p=0.041). Trifecta rate was significantly higher in RPN (47.5% vs. 34.0%, p=0.041). Multivariable analysis demonstrated decreasing RENAL score (OR 1.11, p&lt;0.001), RPN (OR 1.2, p=0.013), and decreasing EBL (OR 1.02, p=0.016) to be associated with Trifecta attainment. Conclusions: RPN provided similar functional and oncologic precision to OPN, while being associated with improvements in major complications, the latter of which was reflected in a higher rate of Trifecta achievement for RPN. RPN may be considered to be a first-line option for select patients with cT2aRM when feasible and safe.

Predictive factors for recurrence after partial nephrectomy for clinical T1 renal cell carcinoma: a retrospective study of 1227 cases from a single institution.

Identifying the predictive factors for tumor recurrence after partial nephrectomy (PN) is useful to determine patients who require careful observation after surgery. Therefore, we investigated recurrence after partial nephrectomy (PN) in patients with clinical T1 renal cell carcinoma (RCC) and analyzed predictive factors for recurrence-free survival (RFS). This study included 1227 patients who underwent PN for clinical T1 RCC and retrospectively investigated patients' characteristics and tumor factors that are associated with tumor recurrence. The median patient age was 59years, and the median tumor size was 30mm. Although 970 (74%) and 319 (26%) patients had clinical T1a and T1b RCCs, respectively, 20 patients (1.6%) were upstaged to pathological T3a. A positive surgical margin was found in 19 (1.5%) patients. The distribution of surgical approaches was open surgery in 428 (35%) patients and minimally invasive surgery in 799 (65%) patients. With a median follow-up of 35months (Interquartile range 19-55months), 39 (3.2%) patients, including ten with local recurrence, five with recurrence in the ipsilateral kidney, and 28 with other organs or lymph-nude, developed recurrence. The 3-year RFS was 99%, and the median recurrence time from PN was 19months (interquartile range: 11-37months). Multivariate analysis identified high grade tumor and upstaging to pT3a as significant predictors for worse RFS. Patients with high grade tumors and tumors upstaged to pT3 had a high risk of worse RFS, which suggested that careful monitoring is required for such patients after PN, even if a good prognosis is achieved in patients with clinical T1 RCC.

Factors affecting renal function preservation among patients not achieving trifecta after laparoscopic partial nephrectomy for clinical T1a renal masses.

The goal of partial nephrectomy for renal tumors is complete tumor removal with the preservation of renal function and no complications. Trifecta (total ischemia time < 25 minutes, negative surgical margins, and no surgical complications) is widely used to evaluate success after partial nephrectomy. We investigated factors affecting renal function preservation among patients not achieving trifecta after laparoscopic partial nephrectomy. Sixty-six patients who underwent laparoscopic partial nephrectomy for clinical T1a renal masses between December 2006 and March 2016 were examined. We defined preserved renal function as the preservation of an estimated glomerular filtration rate ≥ 90% 1 year after surgery. We examined factors affecting renal function preservation among patients not achieving trifecta after laparoscopic partial nephrectomy. Thirty out of 66 patients (45%) did not achieve trifecta. In an evaluation of 66 patients, a multivariate analysis identified tumor size (P = .04) as an independent predictor affecting the achievement of trifecta. Tumor size was significantly smaller in the trifecta achievement group (1.9 ± 0.1 cm) than in the non-achievement group (2.2 ± 0.6 cm) (P = .04). We found that renal function was preserved 1 year after surgery in 14 out of the 30 patients not achieving trifecta. In univariate analysis, age (P = .01) was significantly associated with affecting the preservation of renal function among these patients. Patients with preserved renal function were significantly younger (47.8 ± 2.5 years) than those without (58.5 ± 2.9 years) (P = .01). Renal function may be preserved in younger patients even if they do not achieve trifecta after partial nephrectomy for small renal masses.

The incidence, predictors, and survival of disappearing small renal masses on active surveillance

ObjectiveTo evaluate the incidence, predictors, and survival for those small renal masses (SRM, solid mass ≤4 cm suspicious for a clinical T1a renal cell carcinoma) that disappear on imaging while undergoing active surveillance (AS). Subjects/patients and methodsThe Delayed Intervention and Surveillance for SRM registry prospectively enrolled 739 patients with SRMs. Patients having at least 1 image showing no lesion were considered to have a “disappearing” SRM. Logistic regression assessed predictors of having a disappearing SRM and Kaplan-Meier estimates illustrated relative survival. ResultsOf 374 patients enrolled in AS, 22 (5.9%) experienced a disappearing SRM. Mean time to tumor disappearance was 2.0 years (SD = 1.9) and 50.0% reappeared on subsequent CT imaging. SRM disappearance, most commonly encountered on ultrasound imaging surveillance, was independently associated with tumors <1 cm on multivariable analysis (OR = 10.6 (95% CI: 1.1–100.3), P = 0.04). Furthermore, patients with disappearing SRMs were healthier than other patients on AS with no compromise in overall survival during follow-up (5-year survival = 100% vs. 73.2%, P = 0.06). ConclusionsApproximately 5% of SRM on AS will disappear during follow-up on surveillance imaging. Most of these represent artifacts of heterogeneous imaging modalities, including ultrasound, and the SRM will reappear on subsequent imaging. Given the indolent nature of these lesions, disappearance events do not require reflex repeat imaging and patients should continue AS with their original surveillance schedule intact. A smaller percentage of patients undergoing AS for a SRM may have a mass the permanently disappears.

Renal volume matters: Assessing the association between excisional volume loss and renal function after partial nephrectomy

To investigate the oncological and functional outcomes after partial nephrectomy for clinical stage T1 (cT1) renal cell carcinoma (RCC), and assess the association between excisional volume loss (EVL) and postoperative renal function. We retrospectively reviewed 150 patients with cT1 RCC undergoing partial nephrectomy from 2002 to 2016. End-point evaluation was assessed by recurrence free survival (RFS), overall survival (OS), stage III and stage IV chronic kidney disease (CKD). Regression models were used to determine the risk factors of CKD after surgery. The relationship between EVL and renal function decline was evaluated using Spearman correlation method. Ninety patients with clinical stage T1a (cT1a) tumors and 60 patients with clinical stage T1b (cT1b) tumors were included. There were no differences in RFS, OS, and risk of stage III and stage IV CKD between the two groups. In Cox regression models, multivariate analysis showed that preoperative estimated glomerular filtration rate (eGFR) was an independent risk factor for developing stage III (hazard ratio 0.937, P<0.001) and stage IV CKD (hazard ratio 0.929, P=0.027). EVL was significantly associated with postoperative eGFR decrease. (Correlation Coefficient=0.325, P=0.003). Patients with cT1a and cT1b RCC have comparable oncological and functional outcome after partial nephrectomy, and preoperative eGFR is an independent factor to predict developing CKD. EVL has influence on the postoperative renal function decline.

A Comparison of Cryoablation with Heat-Based Thermal Ablation for Treatment of Clinical T1a Renal Cell Carcinoma: A National Cancer Database Study

PurposeTo compare the overall survival (OS) of patients receiving cryoablation versus heat-based thermal ablation for clinical T1a renal cell carcinoma (RCC) in a large national cohort. Materials and MethodsPatients with RCC from 2004 to 2014 who were treated with ablation were identified from the National Cancer Database. OS was estimated with the use of the Kaplan-Meier method and evaluated by means of log-rank test, univariate and multivariate Cox proportional hazard regression, and propensity score–matched analysis. ResultsA total of 3,936 patients who received cryoablation and 2,322 who received heat-based thermal ablation met the inclusion criteria. The mean age was 67 ± 12 year, and the mean size of tumors was 25 ± 8 mm. The 3-, 5-, and 10-year survival rates were, respectively, 91%, 82%, and 62% for cryoablation and 89%, 81%, and 55% for heat-based thermal ablation. After propensity score matching, cryoablation was associated with longer OS compared with heat-based thermal ablation (median 11.3 vs 10.4 years; hazard ratio 1.175, 95% CI 1.03–1.341; P = .016). For patients with tumors ≤2 cm, propensity score–matched analyses demonstrated no significant difference between the 2 treatment groups (P = .772). ConclusionsOverall, cryoablation may be associated with longer OS compared with heat-based thermal ablation in cT1a RCC. No significant difference in survival rates was observed between the 2 treatments for patients with tumor sizes ≤2 cm. Owing to the inherent limitations of this study, further study with details on technology, local outcome, and complications is needed.

Tumor location does not impact oncologic outcomes for percutaneous microwave ablation of clinical T1a renal cell carcinoma.

To evaluate the impact of anterior tumor location on oncologic efficacy, complication rates, and procedure duration for 151 consecutive biopsy-proven clinical T1a renal cell carcinoma (RCC) treated with percutaneous microwave (MW) ablation. This single-center retrospective study was performed under a waiver of informed consent. One hundred forty-eight consecutive patients (103 M/45 F; median age 67years, IQR 61-73) with 151 cT1a biopsy-proven RCC (median diameter 2.4cm, IQR 1.9-3.0) were treated with percutaneous MW ablation between March 2011 and August 2017. Patient and procedural data collected included Charlson comorbidity index (CCI), RENAL nephrometry score (NS), use of hydrodisplacement, MW antennas/generator output/time, and procedure time (PT). Data were stratified by anterior, posterior, and midline tumor location and compared with the Kruskal-Wallis or chi-squared tests. The Kaplan-Meier method was used for survival analyses. Tumor size, NS, and use/volume of hydrodisplacement were similar for posterior and anterior tumors (p> 0.05). Patients with anterior tumors had a higher CCI (3 vs 4, p= 0.001). Median PT for posterior and anterior tumors was similar (100 vs 108min, p= 0.26). Single session technical success and primary efficacy were achieved for all 151 tumors including 61 posterior and 67 anterior tumors. The 4 (3%) Clavien III-IV complications and 6 (4%) local recurrences were not associated with tumor location (p> 0.05). Three-year RFS, CSS, and OS were 95% (95% CI 0.87, 0.98), 100% (95% CI 1.0, 1.0), and 96% (95% CI 0.89, 0.98), respectively. The safety and efficacy of percutaneous microwave ablation for anterior and posterior RCC are similar. • The safety profile for percutaneous microwave ablation of anterior and posterior T1a renal cell carcinoma is equivalent. • Percutaneous microwave ablation of T1a renal cell carcinoma provides durable oncologic control regardless of tumor location. • Placement of additional microwave antennas and use of hydrodisplacement are associated with longer procedure times.

PD46-09 DEVELOPMENT AND VALIDATION OF A RISK SCORE BASED ON PATIENT CHARACTERISTICS TO PREDICT MAJOR COMPLICATIONS AFTER PARTIAL NEPHRECTOMY

INTRODUCTION AND OBJECTIVES:Partial nephrectomy has become the gold standard in the treatment of clinical T1a renal masses. While tumor characteristics (i.e., nephrometry score) have been found to ...

MP37-08 OUTCOMES OF ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR CLINICAL T3A RENAL MASS: ANALYSIS OF THE ROBOTIC SURGERY FOR LARGE RENAL MASS (ROSULA) GROUP

INTRODUCTION AND OBJECTIVES:Use of partial nephrectomy for clinical T3a renal mass (cT3aRM) is controversial. We sought to evaluate the quality outcomes of robot-assisted partial nephrectomy (RAPN)...

Treatment Trends and Long-Term Survival Associated with Cryotherapy and Partial Nephrectomy for Small Renal Masses in the National Cancer Database Using Propensity Score Matching.

Objective: Trends in the utilization of ablative therapy are unknown for the treatment of small renal masses. Our goal is to utilize the National Cancer Database (NCDB) to both assess the utilization of ablative therapies and long-term survival. Materials and Methods: The NCDB captures 70% of all cancer cases in the United States and was queried between 1998 and 2012 for renal cell carcinomas that were treated with ablative therapy, partial nephrectomy (PN), or radical nephrectomy. The analysis was limited to clinical stage T1a. Propensity score matching was used in 1:1 fashion. Kaplan-Meier survival analysis and a Cox proportional hazards model were used to compare overall survival (OS) for cryotherapy and PN. Results: A total of 119,240 cases of clinical stage T1a renal masses were treated between 1998 and 2012. Cryotherapy peaked at 927 (9.1%) cases in 2010 and had 913 (8.4%) in 2012. PN accounted for 18% of the cases in 1998, but surpassed the utilization of nephrectomy in 2008. By 2012, PN accounted for 6766 (62%) of renal mass cases. After matching, Kaplan-Meier OS was lower for cryotherapy compared with PN at 24 (94.5% vs 96.5%), 48 (86.8% vs 90.9%), and 96 months (66.0% vs 74.9%). Cryotherapy also had a lower OS (hazard ratio 1.46; p < 0.001) on adjusted analysis. Conclusion: Cryotherapy for small renal masses plateaued at 9% utilization in 2009. Cryotherapy had a lower OS than PN for tumors >2 cm on adjusted analysis, but this result should be used with caution until confirmed in randomized studies.

Treatment disparities among patients in the National Cancer Database (NCDB) with clinical TIa and TIb renal masses.

648 Background: AUA guidelines on the management of renal cell carcinoma (RCC) recommend prioritizing partial nephrectomy (PN) for the treatment of clinical T1a (cT1a) tumors, using PN for clinical T1b (cT1b) tumors when feasible, and performing minimally invasive surgery (MIS) when possible. Since cT1 RCC is a heterogeneous disease, we evaluated patterns of care in this population to examine factors associated with receipt of PN and MIS. Methods: We queried the NCDB from 2010-2014 to identify patients treated surgically for cT1N0M0 RCC. Patient socio-demographics, clinical characteristics, and treatment parameters were compared between cT1a and cT1b patients. Logistic regression models examined factors associated with receiving MIS. Results: Our population included 69,694 patients (44,043 cT1a and 25,651 cT1b). For cT1a tumors, 70% of patients received PN, while 30% received RN; 35% of patients underwent an open procedure and 65% underwent MIS. For cT1b tumors, 32% of patients received PN and 68% received RN; 38% of patients underwent an open operation and 62% underwent MIS. In both cohorts, African Americans and those earning &lt;$62,000 were less likely to have MIS. Distance to treatment was not significant in cT1b patients, but cT1a patients who traveled &gt;31 miles were more likely to undergo MIS. Patients treated at a community hospital were less likely to receive MIS compared to those treated at academic centers (cT1a OR: 0.48, 95% CI: 0.44-0.53 and cT1b OR: 0.63, 95% CI: 0.56-0.7). cT1a patients without private insurance were less likely to receive MIS (OR range: 0.58-0.93). However, only uninsured cT1b patients were less likely to undergo MIS (OR: 0.74, 95% CI: 0.64-0.86). Conclusions: PN occurred more frequently for cT1a (70%) vs. cT1b (32%) tumors. Most cT1 tumors received MIS; 35% of cT1a patients and 38% of cT1b patients underwent an open procedure, presenting an opportunity for improvement. cT1a and cT1b patients with lower household income, without private insurance, and those treated outside academic centers were less likely to receive MIS. Based on these findings additional research on the impact of regionalization of RCC surgery on utilization of PN vs. RN, receipt of MIS, and outcomes is warranted.

03:00 PM Abstract No. 83 Cryoablation therapy compared with thermal ablation for clinical T1a renal cell carcinoma: a National Cancer Data Base study

03:00 PM Abstract No. 83 Cryoablation therapy compared with thermal ablation for clinical T1a renal cell carcinoma: a National Cancer Data Base study

338 - Propensity score matched comparison of minimally invasive partial and radical nephrectomy for clinical T2a renal mass: Analysis of the robotic surgery for large renal mass (ROSULA) group

338 - Propensity score matched comparison of minimally invasive partial and radical nephrectomy for clinical T2a renal mass: Analysis of the robotic surgery for large renal mass (ROSULA) group