Localized Renal Cell Carcinoma Research Articles

NEW BASELINE GLOMERULAR FILTRATION RATE ESTIMATION AS A GUIDANCE FOR NEPHRECTOMY STRATEGY IN LOCALIZED RENAL CELL CARCINOMA

Objective: This literature review aims to explain the role of nephrectomy in the treatment of localized RCC and its effects on postoperative renal function, as well as the role of the new baseline glomerular filtration rate (NBGFR) estimation method in the determination of the RCC method. Material & Methods: Articles were obtained through online searches using Pubmed, ScienceDirect, Web of Science, and Wiley Online Library using keywords NBGFR, renal function, nephrectomy, or localized renal cell carcinoma. Results: The development of several diagnostic factors as well as operative factors has made partial nephrectomy (PN) replace radical nephrectomy (RN) which for decades has been the main therapy in localized RCC. Postoperative determination of renal function is a crucial factor in the selection of therapies and several methods of determining NBGFR have been proposed in several previous studies. Conclusion: The NBGFR measurement method can be an accurate guide in the determination of nephrectomy methods in the treatment of localized RCC while use of computer software can help improve accuracy in the implementation of radical nephrectomy in RCC.

MR texture analysis in the differentiation of renal oncocytoma with localized renal cell carcinoma subtypes.

We aimed to explore the diagnostic efficacy of MR texture analysis and imaging signs in the differentiation of renal oncocytoma from renal cell carcinoma (RCC). From January 2015 to March 2019, a total of 168 localized solid renal masses (37 oncocytomas, 131 RCCs) were retrospectively included. Two radiologists reviewed complete MR images and recorded imaging presentation. Texture parameters were extracted from 3D ROIs on axial FSE-T2WI. Univariate and multivariate logistic regressions were used for feature selection and nomogram construction. The diagnostic performances were assessed by receiver operating characteristic (ROC) curves. Cystic change, hemorrhage, SEI and four texture parameters significantly correlated with oncocytoma in the training cohort. For differentiating oncocytoma from RCC, the nomogram yielded an AUC of 0.874 in the training cohort and 0.830 in the testing cohort. For differentiating oncocytoma from chRCC, the nomogram had an AUC of 0.889 in the training cohort and 0.861 in the testing cohort. For differentiating oncocytoma from pRCC, the nomogram had an AUC of 0.932 in the training cohort and 0.792 in the testing cohort. For differentiating oncocytoma from ccRCC, the nomogram had an AUC of 0.829 in the training cohort and 0.813 in the testing cohort. The diagnostic nomogram combining MR texture parameters with imaging signs performed well in differentiating oncocytomas with localized RCC and its subtypes. Few articles reported using the combination of MR texture analysis with imaging signs in differentiating RCC from oncocytoma. Our study established a useful nomogram in subtype characterization.

Influence of metabolic syndrome on survival of patients with localized renal clear cell carcinoma: A retrospective cohort study in China.

To assess the effects of metabolic syndrome (MetS) and its components on the survival and prognosis of patients with localized clear cell renal cell carcinoma (ccRCC). This retrospective cohort study in Chongqing, China, identified patients with localized ccRCC from two medical centers of Chongqing Medical University between January 1, 2011, and December 31, 2020. The Chinese Medical Association Diabetes Society criteria of 2004 were used to diagnose MetS. Univariate and multivariate Cox proportional hazards regression analyses were conducted to identify independent risk factors for ccRCC. The outcomes were overall survival (OS), progression-free survival (PFS), and cancer-specific survival (CSS). In our cohort, 378 eligible patients with localized ccRCC were included (median age, 56; range, 30-85; 255 men [67.5%]), and 87 patients (23.0%) were diagnosed with MetS. The median follow-up time was 66 months (1-126 months). Kaplan-Meier and log-rank analyses showed shorter PFS (P = 0.043) and CSS (P = 0.009) in patients with MetS. Univariate and multivariate Cox regression analyses found that MetS and dyslipidemia were independent risk factors for CSS in patients with localized ccRCC (P = 0.047; P = 0.035). When we analyzed MetS separately, the 4 components of MetS (hypertension, hyperglycemia, overweight/obesity, and dyslipidemia) did not show significant differences in OS, PFS, and CSS. MetS and dyslipidemia are independent adverse prognostic factors for CSS in patients with localized ccRCC. It is suggested to assign comprehensive therapy and follow-up to this patient population.

NeoAdjuvant pembrolizumab and STEreotactic radiotherapy prior to nephrectomy for renal cell carcinoma (NAPSTER): A phase II randomised clinical trial

BackgroundSurgery remains the standard of care for localised renal cell carcinoma (RCC). Nevertheless, nearly 50% of patients with high-risk disease experience relapse after surgery, with distant sites being common. Considering improved outcomes in terms of disease-free survival with adjuvant immunotherapy with pembrolizumab, we hypothesise that neoadjuvant SABR with or without the addition of pembrolizumab before nephrectomy will lead to improved disease outcomes by evoking better immune response in the presence of an extensive reserve of tumor-associated antigens. Methods and analysisThis prospective, open-label, phase II, randomised, non-comparative, clinical trial will investigate the use of neoadjuvant stereotactic ablative body radiotherapy (SABR) with or without pembrolizumab prior to nephrectomy. The trial will be conducted at two centres in Australia that are well established for delivering SABR to primary RCC patients. Twenty-six patients with biopsy-proven clear cell RCC will be recruited over two years. Patients will be randomised to either SABR or SABR/pembrolizumab. Patients in both arms will undergo surgery at 9 weeks after completion of experimental treatment. The primary objectives are to describe major pathological response and changes in tumour-responsive T-cells from baseline pre-treatment biopsy in each arm. Patients will be followed for sixty days post-surgery. Outcomes and significanceWe hypothesize that SABR alone or SABR plus pembrolizumab will induce significant tumor-specific immune response and major pathological response. In that case, either one or both arms could justifiably be used as a neoadjuvant treatment approach in future randomized trials in the high-risk patient population.

Role of lymphadenectomy during primary surgery for kidney cancer.

Lymph node dissection (LND) during radical nephrectomy (RN) for renal cell carcinoma (RCC) is not considered as a standard. The emergence of robot-assisted surgery and effective immune checkpoint inhibitors (ICI) in recent years may change this and lymph node (LN) staging has become easier and has a clinical impact. In this review, we aimed to reconsider the role of LND today. Although the extent of LND has still not been well established, removal of more LN seems to provide better oncologic outcomes for a select group of patients with high-risk factors such as clinical T3-4. Adjuvant therapy using pembrolizumab has been shown to improve disease free survival if complete resection of metastatic lesions as well as the primary site is obtained in combination. Robot assisted RN for localized RCC has been widespread and the studies regarding LND for RCC has been recently appeared. The staging and surgical benefits and its extent of LND during RN for RCC remains unclear, but it is becoming increasingly important. Technologies that allow an easier LND and adjuvant ICI that improve survival in LN-positive patients are engaging the role of LND, a procedure that was needed, but almost never done, is now indicated sometimes. Now, the goal is to identify the clinical and molecular imaging tools that can help identify with sufficient accuracy who needs a LND and which LNs to remove in a targeted personalized approach.

Machine learning based prediction for oncologic outcomes of renal cell carcinoma after surgery using Korean Renal Cell Carcinoma (KORCC) database

We developed a novel prediction model for recurrence and survival in patients with localized renal cell carcinoma (RCC) after surgery and a novel statistical method of machine learning (ML) to improve accuracy in predicting outcomes using a large Asian nationwide dataset, updated KOrean Renal Cell Carcinoma (KORCC) database that covered data for a total of 10,068 patients who had received surgery for RCC. After data pre-processing, feature selection was performed with an elastic net. Nine variables for recurrence and 13 variables for survival were extracted from 206 variables. Synthetic minority oversampling technique (SMOTE) was used for the training data set to solve the imbalance problem. We applied the most of existing ML algorithms introduced so far to evaluate the performance. We also performed subgroup analysis according to the histologic type. Diagnostic performances of all prediction models achieved high accuracy (range, 0.77–0.94) and F1-score (range, 0.77–0.97) in all tested metrics. In an external validation set, high accuracy and F1-score were well maintained in both recurrence and survival. In subgroup analysis of both clear and non-clear cell type RCC group, we also found a good prediction performance.

Retroperitoneoscopic resection with preoperative selective embolization and indocyanine green fluorescence visualization of vessels in kidney cancer

Background. Currently, kidney cancer is considered one of the most common oncological pathologies, accounting for 2–3 % of all cancers. In 2018, the total number of primary renal cell carcinoma patients in Ukraine was 4,805 cases, with 1,878 patients dying from this disease. Surgical treatment is the only way for 68 % of patients with localized kidney cancer. The main question remains unanswered — an effective surgical treatment of patients with localized renal cell carcinoma. Our aim was to study the kidney function parameters in localized kidney cancer after retroperitoneoscopic resection with preoperative selective embolization compared to standard kidney resection using thermal ischemia. Materials and methods. Data of 65 patients with localized kidney cancer who underwent nephron-sparing surgery were analyzed. They were divided into two groups. The first one included 40 people with localized kidney cancer who underwent standard organ-sparing surgery with duration of thermal ischemia of less than 20 minutes. The second group consisted of 25 patients with localized kidney cancer who underwent computed tomography with renal vessels reconstruction in the preoperative stage. Branch of the renal artery that feeds the area of the kidney with the tumor was identified. As a next step, selective embolization was performed. Retroperitoneoscopic resection was carried out the next day with fluorescence imaging in the infrared light using indocyanine green. Results. Analysis of the data shows that renal function after surgery for local cancer in case of retroperitoneoscopic resection with preoperative selective embolization of renal vessels is more functionally suitable compared to kidney resection using thermal ischemia. Conclusions. Our data suggest that superselective X-ray vascular embolization and intraoperative indocyanine green fluorescence in the surgical treatment of localized kidney cancer has significant advantages over the standard method of surgical treatment.

Abstract 722: Epidemiological characterization of renal cell carcinoma in Hispanics: A single US center cohort study

Abstract Background: Annually, there are over 400,000 new cases of renal cell carcinoma (RCC) and more than 170,000 deaths worldwide. RCC is one of the top ten more prevalent malignancies in the United States, with 76,000 new cases each year and almost 14,000 deaths. Over the past half-century, RCC has more than doubled in incidence. RCC seems to have a greater incidence among Hispanics with a nearly three-fold increase. The epidemiology of RCC in the Caucasian population has been previously studied. However, there is a knowledge gap on disparities in RCC on minority populations. Studying the epidemiology of RCC in Hispanics is integral to our community where Hispanics make up 70%. Methods: We conducted a retrospective cohort study to describe the characteristics and rates of recurrence of RCC among patients treated at Sylvester Comprehensive Cancer Center in Miami (which serves four counties in South Florida) between June 2010 to June 2022. We identified ethnicity as Hispanic/Latino (HL) or non-Hispanic/Latino (NHL). Clinical presentation was classified based on the last encounter as local RCC without recurrence, metastatic RCC after nephrectomy, and metastatic RCC at diagnosis/de novo. Results: We analyzed a total of 2049 patients aged 18 and older diagnosed with RCC, from which 1014 patients (47.90%) were identified as NHL and 933 (48.02%) as HL. A subtotal of 435 patients (22.86%) had metastatic RCC at diagnosis/de novo, from which 245 (55.60%) were NHL, and 176 (40.57%) were HL. A subtotal of 1614 patients (77.14%) were diagnosed with local RCC and underwent nephrectomy, from which 769 (45.61%) were identified as NHL and 787 (50.22%) as HL. From the NHL group that underwent nephrectomy, 223 patients (28.28%) had recurrent disease, and 546 patients (71.72%) did not. From the HL group, 176 patients (21.81%) had recurrent disease, and 611 (78.19%) did not. Overall, 409 patients had metastasis after nephrectomy, of which 176 (44.5%) were HL, and 203 (52.42%) were NHL. Conclusions: In this cohort of patients with RCC, almost 50% of patients diagnosed with metastasis were HL. NHL appeared to have more disease recurrence after nephrectomy and higher rates of metastatic disease at diagnosis compared to Hispanics. Further histopathological differences, clinical outcomes, genomic characterization, and rates of clinical trial participation between the NHL and HL cohorts will be presented at the meeting, along with comparisons between US and foreign-born HLs. Citation Format: Abner A. Murray, Jesus A. Ocejo Gallegos, Sandra Jones, Jose Noy, Rosa L. Frias, Leticia E. Campoverde, Jaime R. Merchan. Epidemiological characterization of renal cell carcinoma in Hispanics: A single US center cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 722.

PD08-01 FINANCIAL TOXICITY IN NON-METASTATIC RENAL CELL CARCINOMA PATIENTS

You have accessJournal of UrologyCME1 Apr 2023PD08-01 FINANCIAL TOXICITY IN NON-METASTATIC RENAL CELL CARCINOMA PATIENTS Michael Staehler, Hedyeh Ebrahimi, Severin Rodler, Ulka Vaishampayan, Pavlos Msouel, Mark Ball, Ithaar Derweesh, and Dena Battle Michael StaehlerMichael Staehler More articles by this author , Hedyeh EbrahimiHedyeh Ebrahimi More articles by this author , Severin RodlerSeverin Rodler More articles by this author , Ulka VaishampayanUlka Vaishampayan More articles by this author , Pavlos MsouelPavlos Msouel More articles by this author , Mark BallMark Ball More articles by this author , Ithaar DerweeshIthaar Derweesh More articles by this author , and Dena BattleDena Battle More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003239.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Little is known about the financial impact of renal cell carcinoma (RCC). We sought to ascertain real world data on financial implications and how FT impacts quality of life in patients following surgery for localized RCC. METHODS: An online survey was conducted by the Kidney Cancer Research Alliance (KCCure), a non-profit patient advocacy organization, from 7/22 to 9/22. The survey included questions about costs and financial concerns related to the diagnosis of cancer, and the COST questionnaire. Pearson’s correlation (r) and Kendal’s tau test were used to analyze the COST questionnaire, financial burden and hardship. RESULTS: Out of 1062 responders 623 had initially localized RCC. Out of these patients 395 did not recure and 204 were willing to answer questions related to cost and financial hardship. Median age was 54 (range 19-84). Patients identified as white (89%), living in the US (84%) and had a bachelor's degree or beyond (53%). 15%, 59%, and 26% lived in urban, suburban, and rural locations. The approximate annual household income was <50.000US$ in 13%, <100,000US$ in 32% and >200,000US$ in 17%. 65% had private insurance, 13% are on Medicare, 3% on Medicaid and 0.5% were uninsured. 55% of patients work full time, 11% work part time, 4% are unemployed looking for work, 8% unemployed not looking for work, 18% are retired and 4% are on disability. 28% of patients reported that their medical diagnosis has not reduced their income at all and 26% report that their diagnosis has reduced their income very much. 31% of patients reported experiencing insurance denials for imaging scans, 30% faced delays in care due to pre-approval requirements, 45% reported facing high out-of-pocket costs for medical care, 18% reported being unable to go outside of a provider network. 25% reported spending over $100 a month on health-related products not covered by insurance. To cover medical costs 24% of patients reported taking a hardship withdrawal from a retirement account, 28% stopped funding or lowered contributions to an existing retirement account, 20% borrowed from friends or family. Median COST score was 32 (range 19-44)) and was significantly correlated to age, NCCN distress score, risk of recurrence and supplement intake (p<0.05). CONCLUSIONS: Patients diagnosed with localized RCC are impacted by financial hardship and financial toxicity, with more than a quarter of patients reporting that the diagnosis significantly reduced their income. More research is needed to characterize the full extent and root cause of financial implications to this group of patients. Financial counseling should be recommended as part of every cancer diagnosis regardless of stage. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e232 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Staehler More articles by this author Hedyeh Ebrahimi More articles by this author Severin Rodler More articles by this author Ulka Vaishampayan More articles by this author Pavlos Msouel More articles by this author Mark Ball More articles by this author Ithaar Derweesh More articles by this author Dena Battle More articles by this author Expand All Advertisement PDF downloadLoading ...

MP47-11 PATIENTS EXPERIENCE WITH RECURRENT RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP47-11 PATIENTS EXPERIENCE WITH RECURRENT RENAL CELL CARCINOMA Severin Rodler, Melanie Goetz, Annabel Graser, Sumanta Kumar Pal, Ulka Vaishampayan, Dena Battle, and Michael Staehler Severin RodlerSeverin Rodler More articles by this author , Melanie GoetzMelanie Goetz More articles by this author , Annabel GraserAnnabel Graser More articles by this author , Sumanta Kumar PalSumanta Kumar Pal More articles by this author , Ulka VaishampayanUlka Vaishampayan More articles by this author , Dena BattleDena Battle More articles by this author , and Michael StaehlerMichael Staehler More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The gold-standard for localized renal cell carcinoma (RCC) is partial or radical nephrectomy. However, recurrence remains a challenge after curative treatment and patients´ experience and perception as well as the role of medical teams during this time is unclear. METHODS: The Kidney Cancer Research Alliance (KKCure) developed a survey with the support of a multidisciplinary team of urologic surgeons, medical oncologists and patient advocates. Patients with RCC were surveyed via website, mailing lists and social media platforms between 07/2022 and 09/2022. Anonymized IP address tracking was used to prevent multiple responses from the same patient. 1,062 patients with RCC participated, of which 623 patients self-identified with localized RCC (Stage I-III) at initial diagnosis. RESULTS: The median age of the cohort of patients with localized disease (n=623) was 61 (19-89) years. During follow-up, 184 (29.5%) revealed a recurrence. In the majority of patients (81.42%) recurrence occurred within 5 years after surgery, but 34 (18.58%) patients revealed recurrence of RCC more than 5 years after surgery. Most patients reported that recurrence was observed during routine follow-up scans, but recurrence was also revealed due to symptoms in 22 cases (11.96%) and found incidentally when undergoing scans for other reasons than RCC (n=16, 8.70%). The majority of patients (n=108, 61.02%) stated that they did all they could to try to prevent recurrence, while 16 (9.04%) disagreed. 61 (34.08%) patients agreed that their medical team has prepared them for recurrence and 68 (37.99%) patients disagree. 116 (65.17%) patients agreed to have a medical team in place. Only 42 patients (23.33%) felt rushed to find a medical team at the time of recurrence. CONCLUSIONS: The varity of recurrence time points in this large real-world collective show the importance and challenges of follow-up scans especially more than 5 years after surgery. Medical teams play a crucial part during recurrence and can prepare patients for this event. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e648 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Severin Rodler More articles by this author Melanie Goetz More articles by this author Annabel Graser More articles by this author Sumanta Kumar Pal More articles by this author Ulka Vaishampayan More articles by this author Dena Battle More articles by this author Michael Staehler More articles by this author Expand All Advertisement PDF downloadLoading ...

Cause-specific mortality among patients with renal cell carcinoma in the United States from 2000 to 2018.

There has been little focus on the non-cancer causes of death in patients with renal cell carcinoma (RCC). Therefore, we aimed to assess the frequency and risk of different causes of death, stratified by tumor stage, and demographics, after a diagnosis of RCC in the United States. Data on eligible patients with RCC from January 1, 2000, to December 31, 2018, in the United States were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Standardized mortality ratios for causes of death were calculated using the SEER*Stat software 8.3.9.2 for the overall population and stratified subgroups. A total of 165,969 patients with RCC were included and 60,290 (36.3%) died during follow-up. The majority of deaths were due to kidney cancer (51.3%) but a significant proportion was non-cancer causes (37.6%). The proportion of deaths attributed to RCC decreased with increasing follow-up with non-cancer causes becoming dominant after the fifth year following RCC diagnosis. Overall, cardiovascular diseases and cerebrovascular diseases were the most common non-RCC-related causes of death. AJCC stage I and localized RCC had the most deaths attributed to non-cancerous causes (66.2% and 61.2%, respectively) while AJCC stage IV and distant RCC had the most deaths due to RCC (86.2% and 86.5%, respectively). A large proportion of RCC patients die of non-cancerous causes especially early-stage patients and advanced-stage patients who survive >5 years. Coordination of multidisciplinary care with relevant specialists depending on the stage of the disease is needed to better prevent death overtime from non-cancer causes.

MP28-19 PATIENT PERCEPTIONS OF ADJUVANT THERAPY IN RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP28-19 PATIENT PERCEPTIONS OF ADJUVANT THERAPY IN RENAL CELL CARCINOMA Michael Staehler, Severin Rodler, Ulka Vaishampayan, Mark Ball, Ithaar Derweesh, Pavlos Msaouel, and Dena Battle Michael StaehlerMichael Staehler More articles by this author , Severin RodlerSeverin Rodler More articles by this author , Ulka VaishampayanUlka Vaishampayan More articles by this author , Mark BallMark Ball More articles by this author , Ithaar DerweeshIthaar Derweesh More articles by this author , Pavlos MsaouelPavlos Msaouel More articles by this author , and Dena BattleDena Battle More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003256.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Adjuvant pembrolizumab is currently considered the standard of care for patients with high-risk localized renal cell carcinoma (RCC). However, since approval, multiple trials testing checkpoint inhibitors in the adjuvant setting have failed to meet their primary endpoints, casting doubt on the oncological benefit of therapies that carry the risk of life-long toxicity. We sought to assess how patients perceive the benefits and risks of adjuvant therapy. METHODS: The survey was developed by the Kidney Cancer Research Alliance (KCCure), with multidisciplinary representation from urologic surgeons, medical oncologists and patient advocates. The survey was broadcast between 07/2022 and 09/2022 to patients via website, mailing lists and social media platforms. Multiple responses from the same patient were prohibited via anonymized IP address tracking. Out of 1,062 participants 639 patients self-identified with localized RCC and 223 patients had stage III RCC at initial diagnosis. RESULTS: Median age was 57 years (24-86). 113 patients were offered adjuvant therapy by their doctor, 74 patients were on or had adjuvant therapy (18% TKI, 82% IO). Patients with stage 3 disease assessed their average personal risk of recurrence to be 47% - 10% higher than what they reported their doctor assessed risk to be (37%). The most important factors related to adjuvant decision making, were Risk of Dying from Cancer (76%), severity of possible side effects (43%), chance of having side effects (35%), time required for treatment (24%), cost of treatment (7%). 49% of patients believe that treatment reduces the risk of recurrent disease by more than 30% and 25% believe it reduces risk by more than 50%. Adjuvant therapy was completed by 46%, 17% stopped early due to side effects and 14% recurred while on therapy. Side effects were asymptomatic or mild in 38%, moderate without invasive intervention or hospitalization in 48%, severe, requiring hospitalization in 8% and life-threatening in 7%. 18% of patients were told that their side effects would be life-long. CONCLUSIONS: Patients with high-risk localized disease estimate their risk significantly higher than what their doctors assess their risk to be. Thus, weighing decisions about adjuvant therapy, patients rank risk of dying from cancer over the risk of developing side effects and the severity of side effects. One quarter of patients believe that adjuvant therapy will reduce their risk of recurrence by 50 percent or more. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e378 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Staehler More articles by this author Severin Rodler More articles by this author Ulka Vaishampayan More articles by this author Mark Ball More articles by this author Ithaar Derweesh More articles by this author Pavlos Msaouel More articles by this author Dena Battle More articles by this author Expand All Advertisement PDF downloadLoading ...

MP58-09 TRUE LOCAL RECURRENCE FOLLOWING PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP58-09 TRUE LOCAL RECURRENCE FOLLOWING PARTIAL NEPHRECTOMY Cameron J. Britton, Vidit Sharma, Christine M. Lohse, Aaron M. Potretzke, Stephen A. Boorjian, R. Houston Thompson, and Bradley C. Leibovich Cameron J. BrittonCameron J. Britton More articles by this author , Vidit SharmaVidit Sharma More articles by this author , Christine M. LohseChristine M. Lohse More articles by this author , Aaron M. PotretzkeAaron M. Potretzke More articles by this author , Stephen A. BoorjianStephen A. Boorjian More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , and Bradley C. LeibovichBradley C. Leibovich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003311.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: True local recurrence (LR) in the partial nephrectomy (PN) bed is uncommon, with reported rates of 1-3%. To date, there is sparse literature examining oncologic outcomes in this population. Our study seeks to define oncologic outcomes and determine if there is an association of LR with distant metastasis and cancer-specific survival (CSS). METHODS: We identified 2,164 adults treated with PN for unilateral, sporadic, localized (M0) renal cell carcinoma (RCC) from 2000 to 2019. LR was defined as new enhancing tumor growth within the PN bed on MRI or CT. Survival rates were estimated using the Kaplan-Meier method. Associations with death from RCC following PN were evaluated using Cox proportional hazards regression models. The association of LR with CSS was analyzed in the subset of patients with clear cell RCC. RESULTS: A total of 106 true LR were identified. Median time to LR was 3.3 years (IQR 1.7-5.1). Management of LR included 89 surgeries, 5 systemic therapy, 4 surveillance, 8 others. Forty-five patients died at a median of 3.5 years (IQR 1.6-5.3), including 26 from RCC at a median of 1.9 years (IQR 0.8-4.0). Median duration of post-recurrence follow-up was 5.1 years (IQR 2.3-9.1). Among 83 patients who remained M0 at LR, 26 subsequently developed metastases at a median of 1.5 years (IQR 0.3-2.4). Estimated MFS and CSS following LR are summarized in Table 1. When analyzed as a time-dependent covariate, LR was associated with death from RCC following PN (HR 12.45; 95% CI 6.65-23.31; p<0.001), and after adjusting for tumor size, pT classification, and grade, LR was associated with development of metastasis (HR 6.25; 95% CI 3.5-11; p<0.001). When adjusting for metastasis, LR remained significantly associated with risk of death from RCC (HR 1.93; 95% CI 1.07-3.50; p=0.03). Multivariable associations of select features with LR in the clear cell RCC cohort are presented in Table 2. CONCLUSIONS: True LR is uncommon and is associated with adverse pathologic features including high stage and grade, histology, and margin status. Our data suggests aggressive management of LR may prevent metastasis and RCC related death. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e798 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cameron J. Britton More articles by this author Vidit Sharma More articles by this author Christine M. Lohse More articles by this author Aaron M. Potretzke More articles by this author Stephen A. Boorjian More articles by this author R. Houston Thompson More articles by this author Bradley C. Leibovich More articles by this author Expand All Advertisement PDF downloadLoading ...

MP47-07 PATIENT-SPECIFIC PREDICTORS OF NEPHRECTOMY COMPLICATIONS IN T1B-T2 RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP47-07 PATIENT-SPECIFIC PREDICTORS OF NEPHRECTOMY COMPLICATIONS IN T1B-T2 RENAL CELL CARCINOMA Yash Shah, Rishabh Simhal, Kerith Wang, Hanan Goldberg, Costas Lallas, and Thenappan Chandrasekar Yash ShahYash Shah More articles by this author , Rishabh SimhalRishabh Simhal More articles by this author , Kerith WangKerith Wang More articles by this author , Hanan GoldbergHanan Goldberg More articles by this author , Costas LallasCostas Lallas More articles by this author , and Thenappan ChandrasekarThenappan Chandrasekar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The decision between partial (PN) versus radical nephrectomy (RN) for localized T1b-T2 renal cell carcinoma (RCC) remains unclear, particularly in cases of oncologic equivalence. PN offers nephron-sparing benefits but has increased risk of complications. RN putatively maximizes oncologic benefit with complex tumors. We analyzed a new nephrectomy-specific database from the National Surgical Quality Improvement Program to determine if patient-specific factors may predict perioperative outcomes to facilitate treatment choice for T1b-T2 RCC. METHODS: We identified 2,094 localized T1b-T2 RCC patients undergoing nephrectomy from 2019-2020. Variables of interest include surgical procedure and approach, staging, comorbidities, prophylaxis, and 19 specific perioperative complications. 30-day reoperations and readmissions were also captured. Descriptive statistics were compared using Fisher’s exact test and Pearson’s chi-square test. Multivariable logistic regression models were generated to evaluate complication risks following correction for relevant factors. All statistical tests were two-tailed. p<0.05 was considered statistically significant. RESULTS: 816 patients received PN while 1,278 received RN. Reoperation rates were comparable; however, PN patients more commonly experienced 30-day readmissions (7.0% vs. 4.7%, p=0.026), bleeds (9.19% vs. 5.56%, p=0.001), renal failure requiring dialysis (1.23% vs. 0.31%, p=0.013) and urine leak or fistulae (1.10% vs. 0.31%, p=0.025). Rates of infectious, pulmonary, cardiac, and venothromboembolic events were comparable between the PN and RN cohorts. PN remained predictive of all four complications upon multivariable adjustment. Robotic surgery reduced incidence of several complications, readmissions, and reoperations. Several baseline comorbidities were found to increase risk of 11 separate complications, including bleeds and readmissions. CONCLUSIONS: This population-based cohort explicates perioperative outcomes following nephrectomy for pT1b-T2 RCC. In cases of oncologic equivalence, the findings may inform surgical decision making using patient-specific factors. Risk stratification may inform management to improve post-operative quality of life (QOL) and RCC outcomes. Source of Funding: AUA Summer Medical Student Fellowship: Herbert Brendler, MD Research Fund © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e646 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yash Shah More articles by this author Rishabh Simhal More articles by this author Kerith Wang More articles by this author Hanan Goldberg More articles by this author Costas Lallas More articles by this author Thenappan Chandrasekar More articles by this author Expand All Advertisement PDF downloadLoading ...

MP58-19 DETECTION OF PULMONARY LESION DURING FOLLOW-UP AFTER SURGERY FOR LOCALIZED RENAL CELL CARCINOMA: DISEASE PROGRESSION OR A PRIMARY LUNG CANCER?

MP58-19 DETECTION OF PULMONARY LESION DURING FOLLOW-UP AFTER SURGERY FOR LOCALIZED RENAL CELL CARCINOMA: DISEASE PROGRESSION OR A PRIMARY LUNG CANCER?

MP58-02 EVALUATION OF AMERICAN UROLOGICAL ASSOCIATION RENAL CELL CARCINOMA RISK GROUPS FOR CHROMOPHOBE RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP58-02 EVALUATION OF AMERICAN UROLOGICAL ASSOCIATION RENAL CELL CARCINOMA RISK GROUPS FOR CHROMOPHOBE RENAL CELL CARCINOMA Cameron J. Britton, Christine M. Lohse, Andrew Zganjar, John C. Cheville, R. Houston Thompson, Bradley C. Leibovich, Stephen A. Boorjian, Vidit Sharma, and Aaron M. Potretzke Cameron J. BrittonCameron J. Britton More articles by this author , Christine M. LohseChristine M. Lohse More articles by this author , Andrew ZganjarAndrew Zganjar More articles by this author , John C. ChevilleJohn C. Cheville More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Bradley C. LeibovichBradley C. Leibovich More articles by this author , Stephen A. BoorjianStephen A. Boorjian More articles by this author , Vidit SharmaVidit Sharma More articles by this author , and Aaron M. PotretzkeAaron M. Potretzke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003311.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients after surgery for localized renal cell carcinoma, prognostic models have been developed for progression-free (PFS) and cancer-specific survival (CSS). Notably, chromophobe RCC (chRCC) is unable to be classified by the American Urological Association (AUA) risk stratification system, as histologic grading of chRCC is not currently recommended. We sought to compare the Mayo risk stratification system (Leibovich 2018, Eur Urol) with three modified versions of the AUA RCC risk stratification system for chRCC. METHODS: We queried the Mayo Clinic Nephrectomy Registry to identify patients treated with radical or partial nephrectomy for unilateral, sporadic, M0, chRCC from 1970 to 2012. AUA risk groups were defined using reported criteria excluding grade. Modified AUA risk groups included two proposed chRCC grading systems, including the Paner grading system and the Mayo extension of the Paner grade (Avulova 2021, Eur Urol). PFS and CSS were estimated using the Kaplan-Meier method. Predictive ability was summarized using c-indexes from Cox proportional hazard regression models. RESULTS: A total of 257 patients with chRCC were identified. PFS and CSS rates at 120 months after surgery were 84% and 90%, respectively. PFS rates using AUA risk groups, ignoring grade, are summarized in Figure 1a, while PFS rates using the Mayo risk groups are presented in Figure 1b. C-indexes for AUA and Mayo risk groups were similar at 0.76 and 0.75, respectively, for PFS, and 0.77 and 0.76, respectively for CSS. Comparisons of the three modified AUA risk stratification systems with and without grading systems are presented in Table 1. CONCLUSIONS: The modified AUA and Mayo risk stratification systems have robust c-indexes for PFS and CSS in patients with chRCC. These models can be used to counsel patients based on the final pathologic analysis. Incorporation of proposed chRCC grading systems rarely results in re-stratification. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e794 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cameron J. Britton More articles by this author Christine M. Lohse More articles by this author Andrew Zganjar More articles by this author John C. Cheville More articles by this author R. Houston Thompson More articles by this author Bradley C. Leibovich More articles by this author Stephen A. Boorjian More articles by this author Vidit Sharma More articles by this author Aaron M. Potretzke More articles by this author Expand All Advertisement PDF downloadLoading ...

Paraneoplastic Glomerulonephropathy Associated With Renal Cell Carcinoma: A Descriptive Analysis of Published Reports.

Paraneoplastic glomerulonephropathy (PGN) is a rare paraneoplastic syndrome that is associated with a variety of malignancies. Patients with renal cell carcinomas (RCCs) often develop paraneoplastic syndromes including PGN. To date, objective diagnostic criteria of PGN are not defined. As a result, the true occurrences are unknown. Many RCC patients develop renal insufficiency in the course of their disease, and diagnosis of PGN in this population is challenging and often delayed, which may lead to significant morbidity and mortality. Here, we provide a descriptive analysis of the clinical presentation, treatment, and outcomes of 35 published patient cases of PGN associated with RCCs over the past four decades in PubMed-indexed journals. Most patients with PGN were male (77%), over 60 years of age (60%), and diagnosed with PGN prior to or concurrent with their diagnosis of RCC (20% prior, 71% concurrent). Membranous nephropathy (34%) was the most common pathologic subtype. Among the patients with localized RCCs, 16 (67%) of 24 patients had improvement in PGN compared to 4 (36%) of 11 patients with metastatic RCCs. All 24 patients with localized RCCs underwent nephrectomy, but patients who were treated with nephrectomy with immunosuppression (7/9, 78%) had a better outcome than patients who were treated with nephrectomy alone (9/15, 60%). Among the patients with metastatic RCCs, patients who were treated with systemic therapy along with immunosuppression (4/5, 80%) had a better outcome than those who were treated with systemic therapy, nephrectomy, or immunosuppression alone (1/6, 17%). Our analysis demonstrates the importance of cancer-specific therapy; nephrectomy in localized disease and systemic therapy in metastatic disease, along with immunosuppression, was the effective management of PGN. Immunosuppression alone is not adequate in most patients. This is distinct from other glomerulonephropathy and warrants further study.

Efficacy of partial nephrectomy in patients with localized renal carcinoma: a 20-year experience of 2 046 patients in a single center

Objectives: To analyze the long-term survival of patients with localized renal cell carcinoma after partical nephrectomy. Methods: The clinicopathological records and survival follow-up data of 2 046 patients with localized renal cell carcinoma, who were treated with partial nephrectomy from August 2001 to February 2021 in the Department of Urology, Sun Yat-sen University Cancer Center, were retrospectively analyzed. There were 1 402 males and 644 females, aged (M(IQR)) 51 (19) years (range: 6 to 86 years). The primary end point of this study was cancer-specific survival. Survival curves were estimated using the Kaplan-Meier method, and the difference test was performed by Log-rank test. Univariate and multivariate Cox analysis were fitted to determine factors associated with cancer-specific survival. Results: The follow-up time was 49.2 (48.0) months (range: 1 to 229 months), with 1 974 patients surviving and 72 dying. The median cancer-specific survival time has not yet been reached. The 5- and 10-year cancer specific survival rates were 97.0% and 91.2%, respectively. The 10-year cancer-specific survival rates for stage pT1a (n=1 447), pT1b (n=523) and pT2 (n=58) were 95.3%, 81.8%, and 81.7%, respectively. The 10-year cancer-specific survival rates of patients with nuclear grade 1 (n=226), 2 (n=1 244) and 3 to 4 (n=278) were 96.6%, 89.4%, and 85.5%, respectively. There were no significant differences in 5-year cancer-specific survival rates among patients underwent open, laparoscopic, or robotic surgery (96.7% vs. 97.1% vs. 97.5%, P=0.600). Multivariate analysis showed that age≥50 years (HR=3.93, 95%CI: 1.82 to 8.47, P<0.01), T stage (T1b vs. T1a: HR=3.31, 95%CI: 1.83 to 5.99, P<0.01; T2+T3 vs. T1a: HR=2.88, 95%CI: 1.00 to 8.28, P=0.049) and nuclear grade (G3 to 4 vs. G1: HR=2.81, 95%CI: 1.01 to 7.82, P=0.048) were independent prognostic factors of localized renal cell carcinoma after partial nephrectomy. Conclusions: The long-term cancer-specific survival rates of patients with localized renal cancer after partial nephrectomy are satisfactory. The type of operation (open, laparoscopic, or robotic) has no significant effect on survival. However, patients with older age, higher nuclear grade, and higher T stage have a lower cancer-specific survival rate. Grasping surgical indications, attaching importance to preoperative evaluation, perioperative management, and postoperative follow-up, could benefit achieving satisfactory long-term survival.

Novel Biomarkers for Early Detection of Acute Kidney Injury and Prediction of Long-Term Kidney Function Decline after Partial Nephrectomy

Identifying acute kidney injury (AKI) within few hours of onset is certainly helpful. However, early prediction of a long-term eGFR decline may be an even more important goal. Our aim was to identify and compare serum [creatinine, kineticGFR, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL)] and urinary (NephroCheck, NGAL, proteinuria, albuminuria, acantocytes at urinary sediment) predictors of AKI that might efficiently predict long-term GFR decline after robotic Nephron-Spearing Surgery (rNSS). Monocentric prospective observational study. Patients scheduled for rNSS for suspected localized Renal Cell Carcinoma from May 2017 to October 2017 were enrolled. Samples were collected preoperatively and postoperatively (timepoints: 4 h, 10 h, 24 h, 48 h), while kidney function was re-assessed up to 24 months. 38 patients were included; 16 (42%) developed clinical AKI. The eGFR decline at 24 months was more pronounced after postoperative AKI (-20.75 vs. -7.20, p < 0.0001). KineticGFR at 4 h (p = 0.008) and NephroCheck at 10 h (p = 0.001) were, at multivariable linear regression analysis, efficient predictors of post-operative AKI and long-term eGFR decline if compared to creatinine (R2 0.33 vs. 0.04). NephroCheck and kineticGFR have emerged as promising noninvasive, accurate, and early biomarkers of postoperative AKI and long-term GFR decline after rNSS. Combining NephroCheck and kineticGFR in clinical practice would allow to identify high risk of postoperative AKI and long-term GFR decline as early as 10 h after surgery.

Cardiovascular profile of contemporary treatments of renal cell carcinoma: A single-center prospective study

BackgroundTyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) have revolutionized the treatment of metastatic renal cell carcinoma (mRCC). Emerging data suggest that these agents can result in clinically significant cardiotoxicity, compromising the care. MethodsWe conducted a prospective longitudinal study to evaluate the incidence of de novo cardiac dysfunction as assessed by echocardiography and blood biomarkers in mRCC patients receiving TKI with or without ICI followed at baseline, 3-month and 6-month. We recruited consecutive newly diagnosed mRCC patients treated at our institution between 2015 and 2018 as well as patients with localized RCC not treated with systemic therapies and healthy control (HC) subjects for comparison. ResultsTwenty-eight patients were enrolled in the mRCC group (a mean age of 65.2 ± 7.5 years), 29 patients in the localized RCC group (63.6 ± 8.9 years), and 20 volunteers in the HC group (52.9 ± 9.6 years). At baseline, patients from all three groups had normal cardiac function as measured by left ventricular ejection fraction (LVEF), although patients with mRCC or localized RCC had significantly lower mean LVEF compared to HC (61.9%, 62.4%, and 68.1% respectively). Otherwise, there were no statistically significant changes in echocardiographic parameters or incidence of clinical heart failure from baseline to 6-months in patients with mRCC. Cardiac blood biomarkers including troponin I, brain natriuretic peptide, and galectin-3 remained stable over time. ConclusionOur findings suggest that contemporary treatment strategies of mRCC at this single institution are well tolerated without clinically meaningful overt declines in cardiac function over time. Further studies are warranted to include a larger number of patients to better assess the overall cardiovascular safety associated with contemporary treatments of mRCC.