Surgery For Renal Cell Carcinoma Research Articles

MP50-05 ORDER OF THROMBECTOMY FOR MANAGEMENT OF RENAL CELL CARCINOMA WITH INFERIOR VENA CAVA THROMBUS

You have accessJournal of UrologyCME1 May 2022MP50-05 ORDER OF THROMBECTOMY FOR MANAGEMENT OF RENAL CELL CARCINOMA WITH INFERIOR VENA CAVA THROMBUS Yudai Ishiyama, Tsunenori Kondo, Kazuhiko Yoshida, Junpei Iizuka, Kazunari Tanabe, and Toshio Takagi Yudai IshiyamaYudai Ishiyama More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , Kazuhiko YoshidaKazuhiko Yoshida More articles by this author , Junpei IizukaJunpei Iizuka More articles by this author , Kazunari TanabeKazunari Tanabe More articles by this author , and Toshio TakagiToshio Takagi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002625.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Currently there is no consensus on whether to perform thrombectomy before kidney mobilization (“thrombus first”) or vice versa (“thrombus last”) for patients with renal cell carcinoma and inferior vena cava thrombus. The aim is to compare the perioperative outcomes between these two approaches. METHODS: We retrospectively evaluated 130 patients who underwent nephrectomy and thrombectomy at two institutions between 1992 and 2020. The cohort was classified into the thrombus-first and thrombus-last groups according to the order of the techniques used. Outcomes including the operative time, blood loss, and complications, especially the occurrence of intraoperative and postoperative pulmonary embolism, were compared. RESULTS: The thrombus-first and thrombus-last groups comprised 48 and 82 patients, respectively. Characteristics such as age, performance status, Charlson Comorbidity Index, renal function, and level of tumour thrombus were comparable between the two groups. Approximately 41% of the patients had distant metastasis. There were four cases (3.1%) of intraoperative pulmonary embolism, all from the thrombus-last group. Seven patients overall (5.4%) experienced pulmonary embolism postoperatively with six in the thrombus-last group (7.3%) and one in the thrombus-first (2.1%) group (p=0.259). The surgical time (291.0 min vs. 369.0 min, p<0.001) and the blood loss (1323.0 mL vs. 2100.0 mL, p<0.001) were significantly smaller for the thrombus-first group than for the thrombus-last group. Occurrence of complications was 25.0% and 43.9% in thrombus-first and thrombus-last groups, respectively (p=0.029), and 8.3% and 23.2% for events graded ≥3 (p=0.035). CONCLUSIONS: In surgery for renal cell carcinoma with inferior vena cava thrombus, performing thrombectomy before nephrectomy may serve to lessen complications, blood loss, and surgical time compared to nephrectomy before thrombectomy. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e865 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yudai Ishiyama More articles by this author Tsunenori Kondo More articles by this author Kazuhiko Yoshida More articles by this author Junpei Iizuka More articles by this author Kazunari Tanabe More articles by this author Toshio Takagi More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP12-07 THE ANATOMICAL LOCATION OF LYMPHADENOPATHIES AT IMAGING PREDICTS THE RISK OF LYMPH NODE INVASION AT FINAL PATHOLOGY IN PATIENTS WITH RENAL CELL CARCINOMA

MP12-07 THE ANATOMICAL LOCATION OF LYMPHADENOPATHIES AT IMAGING PREDICTS THE RISK OF LYMPH NODE INVASION AT FINAL PATHOLOGY IN PATIENTS WITH RENAL CELL CARCINOMA

"Thrombus-first" or "thrombus-last" approach for surgical management of renal cell carcinoma with inferior vena cava thrombus.

To compare the perioperative outcomes between thrombectomy first then nephrectomy ("thrombus-first") and vice-versa ("thrombus-last") approaches for patients with renal cell carcinoma and inferior vena cava thrombus. We retrospectively evaluated 130 patients who underwent nephrectomy and thrombectomy at two institutions between 1992 and 2020. The cohort was classified into the thrombus-first and thrombus-last groups according to the techniques used. Outcomes including the operative time, blood loss, and complications, especially the occurrence of intraoperative tumor embolism of pulmonary artery and postoperative pulmonary embolism, were compared. The thrombus-first and thrombus-last groups comprised 48 and 82 patients, respectively. Characteristics such as age, performance status, Charlson Comorbidity Index, renal function, and level of tumour thrombus were comparable between the two groups. Approximately 41% of the patients had distant metastasis. There were four cases (3.1%) of intraoperative tumor embolism, all from the thrombus-last group. Three patients overall (2.3%) experienced pulmonary embolism postoperatively with two in the thrombus-last group (2.4%) and one in the thrombus-first group (2.1%) (P > 0.999). The surgical time (291.0 min vs 369.0 min, P < 0.001) and the blood loss (1323.0 vs 2100.0 mL, P < 0.001) were significantly smaller for the thrombus-first group than for the thrombus-last group. Occurrence of complications was 25.0% and 43.9% in thrombus-first and thrombus-last groups, respectively (P = 0.029), and 8.3% and 23.2% for events graded ≥3 (P = 0.035). In surgery for renal cell carcinoma with inferior vena cava thrombus, performing thrombectomy before nephrectomy may serve to lessen complications, blood loss, and surgical time compared to nephrectomy before thrombectomy.

Surgical outcomes for older patients with renal cell carcinoma and inferior vena cava thrombus.

To compare the surgical and oncological outcomes of older patients undergoing surgery for renal cell carcinoma (RCC) with a tumor in the inferior vena cava (IVC) and those of younger patients. We retrospectively evaluated 123 patients who underwent surgery for RCC-IVC at two institutions between 2008 and 2019. We classified them into the ≥70 years and the <70 years group, based on their age during surgery. The patients' perioperative outcomes as well as survival (overall survival [OS] and cancer-specific survival [CSS]) were evaluated and compared before and after 1:1 propensity score matching. Sensitivity analyses were performed at age thresholds of 75 and 80 years. The ≥70 and the <70 groups comprised 43 and 80 patients, respectively. Most patients in the ≥70 group demonstrated an American Society of Anesthesiologists score of 2 or 3. They were more likely to have a statistically insignificant high (≥3) Charlson Comorbidity index score (16.3 vs. 6.3%) and a lower hemoglobin level (10.4 vs. 11.7 g/dL) than the <70 group. Eighteen (41.9%) and 32 (40.0%) patients had at least one distant metastasis at the time of surgery in the ≥70 and <70 group, respectively. The complication rates (any grade and grade ≥3), the length of hospitalization, readmission rates, and mortality were comparable between the groups, both before and after matching (all, non-specific). There was no statistically significant difference in the OS (median 66.6 vs. not reached [N.R.], P = 0.695) or CSS (N.R. vs. N.R., P = 0.605) between the groups before matching. The OS and CSS results were similar and comparable following matching (both, non-specific). Further, OS and CSS were comparable between the ≥75 and <75 groups, and between the ≥80 and <80 age groups, respectively. The surgical outcomes of older patients with RCC-IVC were not inferior to those of younger patients. With careful patient selection, surgery can still be a treatment option.

Influential Factors and Personalized Prediction Model of Acute Pain Trajectories after Surgery for Renal Cell Carcinoma.

Background: Renal cell carcinoma (RCC) is the most common neoplasm in kidneys, and surgical resection remains the mainstay treatment. Few studies have investigated how the postoperative pain changes over time and what has affected its trajectory. This study aimed to characterize the variations in postoperative pain over time and investigate associated factors after RCC surgery. Methods: This retrospective study was conducted in a single medical center in Taiwan, where maximal pain scores in a numeric rating scale were recorded daily in the first five postoperative days (PODs) after RCC surgery. Latent curve models were developed, using two latent variables, intercept and slope, which represented the baseline pain and rate of pain resolution. These models explain the variations in postoperative pain scores over time. A predictive model for postoperative pain trajectories was also constructed. Results: There were 861 patients with 3850 pain observations included in the analysis. Latent curve analysis identified that female patients and those with advanced cancer (stage III and IV) tended to have increased baseline pain scores (p = 0.028 and 0.012, respectively). Furthermore, patients over 60 years, without PCA use (both p < 0.001), and with more surgical blood loss (p = 0.001) tended to have slower pain resolution. The final predictive model fit the collected data acceptably (RMSEA = 0.06, CFI = 0.95). Conclusion: Latent curve analysis identified influential factors of acute pain trajectories after RCC surgery. This study may also help elucidate the complex relationships between the variations in pain intensity over time and their determinants, and guide personalized pain management after surgery for RCC.

A0377 - Pancreatic metastases after surgery for renal cell carcinoma

A0377 - Pancreatic metastases after surgery for renal cell carcinoma

Association Between Epidural Analgesia and Cancer Recurrence or Survival After Surgery for Renal Cell Carcinoma: A Propensity Weighted Analysis.

Whether epidural anesthesia and analgesia (EA) is beneficial for postoperative cancer outcomes remains controversial and we conducted this historical cohort study to evaluate the association between EA and long-term outcomes following surgery for renal cell carcinoma (RCC). We collected patients receiving RCC surgery from 2011 to 2017 and followed up them until February 2020. Patient attributes, surgical factors and pathological features were gathered through electronic medical chart review. The association between EA and recurrence-free and overall survival after surgery was evaluated using Cox regression models with inverse probability of treatment weighting (IPTW) to balance the observed covariates. The median follow-up time for the 725 included patients was 50 months (interquartile range: 25.3–66.5) and 145 of them (20%) received perioperative EA. We demonstrated EA use was associated with better recurrence-free survival [IPTW adjusted hazard ratio (HR): 0.64, 95% confidence interval (CI): 0.49–0.83, p < 0.001] and overall survival [IPTW adjusted HR: 0.66, 95% CI: 0.49–0.89, p = 0.006] in patients receiving surgical resection for RCC. More prospective studies are needed to verify this connection between EA and superior cancer outcomes after RCC surgery.

Impact of frailty on perioperative and oncologic outcomes in patients undergoing surgery or ablation for renal cancer: a systematic review.

Frailty has been recognized as a major risk factor for adverse perioperative and oncological outcomes in patients with genitourinary malignancies. Yet, the evidence supporting such an association in patients with renal cell carcinoma (RCC) is still sparse. Herein we provide an updated comprehensive overview of the impact of frailty on perioperative and oncologic outcomes in patients undergoing surgery or ablation for RCC. A systematic review of the English-language literature was conducted using the MEDLINE (via PubMed), Web of Science and the Cochrane Library databases according to the principles highlighted by the EAU Guidelines Office and the PRISMA statement recommendations. The review protocol was registered on PROSPERO (CRD42021242516). The overall quality of evidence was assessed according to GRADE recommendations. Overall, 18 studies were included in the qualitative analysis. Most of these were retrospective single-center series including patients undergoing surgery for non-metastatic RCC. The overall quality of evidence was low. A variety of measures were used for frailty assessment, including the Canadian Study of Health and Aging Frailty Index, the five-item frailty index, the Modified Rockwood's Clinical Frailty Scale Score, the Hopkins Frailty score, the Groningen Frailty Index, and the Geriatric nutritional risk index. Sarcopenia was defined based on the Lumbar skeletal muscle mass at cross-sectional imaging, the skeletal muscle index, the total psoas area, or the Psoas Muscle Index. Overall, available studies point to frailty and sarcopenia as potential independent risk factors for worse perioperative and oncological outcomes after surgery or ablation for different RCC stages. Increased patient's frailty was indeed associated with higher risk of perioperative complications, healthcare resources utilization, readmission rates and longer hospitalization periods, as well as potentially lower cancer specific or overall survival. Frailty has been consistently associated with worse outcomes after surgery for RCC, reinforcing the value of preoperative frailty assessment in carefully selected patients. Given the low quality of the available evidence (especially in the setting of tumor ablation), prospective studies are needed to standardize frailty assessments and to identify patients who are expected to benefit most from preoperative geriatric evaluation, aiming to optimize decision-making and postoperative outcomes in patients with RCC.

Robotic surgery for renal cell carcinoma with inferior vena cava thrombosis: balancing feasibility and safety toward individualized decision-making

article: Robotic surgery for renal cell carcinoma with inferior vena cava thrombosis: balancing feasibility and safety toward individualized decision-making - Minerva Urology and Nephrology 2021 August;73(4):544-8 - Minerva Medica - Journals

MP45-16 THE IMPACT OF VENOUS THROMBOEMBOLISM PRESENCE AT THE TIME OF NEPHRECTOMY FOR RENAL MASS ON COMPLICATIONS, COSTS, AND SURVIVAL

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I (MP45)1 Sep 2021MP45-16 THE IMPACT OF VENOUS THROMBOEMBOLISM PRESENCE AT THE TIME OF NEPHRECTOMY FOR RENAL MASS ON COMPLICATIONS, COSTS, AND SURVIVAL Hiren Patel, Joshua Sterling, Arnav Srivastava, Brian Shinder, Miral Grandhi, David August, Saum Rahimi, Isaac Kim, Saum Ghodoussipour, Thomas Jang, Benjamin Chung, Steven Chang, and Eric Singer Hiren PatelHiren Patel More articles by this author , Joshua SterlingJoshua Sterling More articles by this author , Arnav SrivastavaArnav Srivastava More articles by this author , Brian ShinderBrian Shinder More articles by this author , Miral GrandhiMiral Grandhi More articles by this author , David AugustDavid August More articles by this author , Saum RahimiSaum Rahimi More articles by this author , Isaac KimIsaac Kim More articles by this author , Saum GhodoussipourSaum Ghodoussipour More articles by this author , Thomas JangThomas Jang More articles by this author , Benjamin ChungBenjamin Chung More articles by this author , Steven ChangSteven Chang More articles by this author , and Eric SingerEric Singer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002066.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Venous thromboembolism (VTE), defined as pulmonary embolism (PE) or deep vein thrombosis (DVT), are often seen with advanced malignancy. Recent studies have demonstrated that the presence of bland IVC or renal vein thrombus at the time of renal cell carcinoma (RCC) surgery is associated with worse outcomes. However, the impact of VTE at time of RCC surgery remains to be understood, particularly among patients without an IVC or renal vein thrombus. We evaluated the morbidity and mortality associated with having concurrent VTE at the time of surgical resection of a renal mass. Costs of care were also compared. METHODS: We identified 122,342 patients undergoing elective surgical resection for a renal mass from 2013 to 2017 using the Premier Healthcare database. The cohort was subdivided based on the presence of VTE at the time of admission for radical nephrectomies (RN) and partial nephrectomies (PN). Patients with renal vein thrombus and/or IVC thrombus were excluded from the analysis. The association of VTE with 90-day non-fatal minor (Clavien 1-2) and major (Clavien 3-4) complication rates, mortality, and direct hospital costs (2019 US dollars) was determined with multivariable logistic regression and quantile regression models, respectively, adjusting for patient, hospital, and surgical characteristics. RESULTS: Of the total study population, 83,692 patients underwent RN and 38,650 patients had PN. The predicted probability for a non-fatal minor complication in patients with VTE was significantly higher than patients with no VTE undergoing RN and PN (RN: 34.2% vs 21.1%; PN: 36.9% vs 22.5%; p<0.001). The predicted probability for a non-fatal major complication in patients with VTE was significantly higher than patients with no VTE undergoing RN and PN (RN: 10.6% vs 5.2%; PN: 21.5% vs 5.0%; p<0.001). The predicted probability of mortality in patients with VTE was significantly higher than patients with no VTE undergoing RN and PN (RN: 2.6% vs 1.0%; PN: 1.3% vs 0.3%; p<0.001). The 90-day median costs were greater in patients with VTE compared to no VTE undergoing RN and PN (RN: $24,648 vs $13,951; PN: $19,338 vs $13,694; p<0.001). CONCLUSIONS: VTE at the time of renal surgery for suspected RCC is associated with significantly higher rates of major complications, increased mortality, and higher overall costs. Taken together, these findings may have important implications for the counseling and management of patients with renal masses and VTE. Source of Funding: This work is supported by a grant from the National Cancer Institute (P30CA072720) © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e809-e810 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiren Patel More articles by this author Joshua Sterling More articles by this author Arnav Srivastava More articles by this author Brian Shinder More articles by this author Miral Grandhi More articles by this author David August More articles by this author Saum Rahimi More articles by this author Isaac Kim More articles by this author Saum Ghodoussipour More articles by this author Thomas Jang More articles by this author Benjamin Chung More articles by this author Steven Chang More articles by this author Eric Singer More articles by this author Expand All Advertisement Loading ...

MP42-11 ASSOCIATION BETWEEN RACE AND SURVIVAL AMONG SURGICALLY MANAGED KIDNEY CANCER PATIENTS IN THE VETERANS AFFAIRS HEALTH SYSTEM

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III (MP42)1 Sep 2021MP42-11 ASSOCIATION BETWEEN RACE AND SURVIVAL AMONG SURGICALLY MANAGED KIDNEY CANCER PATIENTS IN THE VETERANS AFFAIRS HEALTH SYSTEM Diego Aguilar Palacios, Sarah Markt, Fredrick Schumacher, Brigid Wilson, Steven Campbell, and Robert Abouassaly Diego Aguilar PalaciosDiego Aguilar Palacios More articles by this author , Sarah MarktSarah Markt More articles by this author , Fredrick SchumacherFredrick Schumacher More articles by this author , Brigid WilsonBrigid Wilson More articles by this author , Steven CampbellSteven Campbell More articles by this author , and Robert AbouassalyRobert Abouassaly More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002063.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Racial disparities has been reported in multiple urological cancers including renal cell carcinoma (RCC). Herein, we evaluated weather Black patients diagnosed with RCC who have undergone partial (PN) or radical nephrectomy (RN) within the Veterans Affairs (VA) Health System have worse survival than White patients METHODS: A retrospective review of administrative VA data of RCC patients managed with PN/RN (2005-2015) was performed. The association between race and overall mortality (OM) and cancer-specific mortality (CSM) was evaluated with Cox regression analyses. Multivariable analysis adjusted for relevant demographics, comorbidities, tumor characteristics and nephrectomy type. RESULTS: A total of 6317 (79%) White and 1714 (21%) Black patients were analyzed. For White patients: mean age was 62 years, 97% were male, mean tumor-size was 5.3cm and 37 % had a PN. Pathology revealed localized (T1/T2) tumors in 79% of White patients and with predominance of clear cell histology (83%). In contrast, Black patients were younger (mean age 60 years), with smaller tumors (mean tumor-size was 4.7cm), localized disease was more common (88% of patients) and 43% underwent PN. In Black patients, pathology demonstrated clear cell and papillary histology in 62% and 30% respectively. With a median follow-up of 7 years, 674 (11%) and 1050 (17%) of Whites died of RCC or other causes versus 132 (8%) and 259 (15%) of Blacks, respectively. On multivariable analyses, compared with Whites, Black patients HR (95%CI) for CSM and OM were 0.98 (0.78-1.23) and 0.93 (0.83-1.04), respectively. CONCLUSIONS: Our data suggest that there is no evidence of survival disparities between Black and White patients undergoing surgery for RCC in a health system with equal access to care. Future analyses will investigate potential disparities in stage at presentation and treatment selection across the trajectory of cancer care. Source of Funding: Merit Pilot Award #PPO 17-216, VA Grant © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e775-e776 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Diego Aguilar Palacios More articles by this author Sarah Markt More articles by this author Fredrick Schumacher More articles by this author Brigid Wilson More articles by this author Steven Campbell More articles by this author Robert Abouassaly More articles by this author Expand All Advertisement PDF DownloadLoading ...

Robotic surgery for cT2 kidney cancer: analysis of the National Cancer Database.

Robotic surgery for renal cell carcinoma (RCC) is increasingly adopted for cT1 disease, but its utilization for cT2 disease remains unexplored. We aimed to characterize the trend in robotic approach for cT2 RCC. The National Cancer Database was queried for patients who were diagnosed with cT2N0M0 RCC from 2010 to 2016 and underwent subsequent radical (RN) or partial (PN) nephrectomy. Analysis of treatment trends was performed and logistic regression (LR) undertaken for predictors of surgical approach. 21,258 patients met inclusion criteria for analysis; 1698 (8%) underwent a PN and 19,560 (92%) underwent RN. Use of robotics in PN increased 346% (12.3-42.6%) and 351% (6.2-21.8%) for RN during the studied time period. Robotic PN or RN was associated with shorter hospital stay compared to non-robotic approaches (p < 0.001). Academic institutions were more likely to perform a robotic procedure and the uninsured were less likely to receive robotic approach. There was no association between age, sex, race, or income and surgical approach. On LR, robotic approach was independently associated with academic institutions and a more recent year of diagnosis. There was no significant difference in the rate of positive margins, 30-day readmission, or 30/90-day mortality between approaches. Robotic PN and RN is becoming an increasingly popular approach in the treatment of cT2 RCC. Utilization of robotics is associated with academic institutions and results in a shorter hospital stay without significant differences rate of positive margins, readmission rates, or 30/90-day mortality.

Impact of comorbidities on acute kidney injury and renal function impairment after partial and radical tumor nephrectomy

Background To test for the impact of patient comorbidities and medical risk factors on kidney function after partial (PN) or radical nephrectomy (RN) in renal cell carcinoma (RCC) patients with normal preoperative renal function. Materials and Methods From January 2011 to December 2014, 195 consecutive RCC patients with a preoperative estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73 m2 underwent PN or RN. Stratification was performed according to postoperative acute kidney injury (AKI) vs. no AKI. Moreover, logistic regression models tested for risk factors predicting postoperative AKI and subsequent new-onset chronic kidney disease (eGFR < 60 or < 45 ml/min/1.73 m2). Results Of all eligible patients, 127 (65.1%) exhibited AKI. AKI patients underwent more frequently RN (44.9 vs. 13.2% PN) and harbored more often preoperative diabetes (17.3 vs. 5.9% no diabetes), hypertension (46.5 vs. 23.5% no hypertension) and larger median tumor size (4.5 vs. 2.5 cm, all p < 0.05) than non-AKI patients. Moreover, after median follow-up of 14 months, 18.9% of AKI patients exhibited an eGFR < 60 ml/min/1.73 m2 vs. 7.4% non-AKI patients (p = 0.01). In multivariable models, hypertension and RN were risk factors for postoperative AKI (both p < 0.01). Age > 60 years and RN as well as preoperative diabetes were risk factors for postoperative eGFR < 60 or < 45 ml/min/1.73 m2 (all p < 0.05), respectively. Conclusions Postoperative AKI is a non-negligible event especially after RN that can be further triggered by comorbidities such as diabetes and hypertension. Comorbidities should be considered in clinical decision-making for RCC surgery and patients need to be counseled about the increased risk of consecutive renal function impairment.

Low Preoperative Mean Platelet Volume/Platelet Count Ratio Indicates Worse Prognosis in Non-Metastatic Renal Cell Carcinoma.

Objectives: Multiple blood parameters are used to determine the prognosis of renal cell carcinoma (RCC). Mean platelet volume/platelet count (MPV/PC) ratio is related to disease progression in various cancers. Our study tried to evaluate the prognostic value of the MPV/PC ratio in RCC patients who underwent surgery. Methods: We retrospectively reviewed 89 patients who underwent radical or partial nephrectomy for RCC in a single institution. Baseline characteristics and MPV/PC ratios were analyzed. The optimal cut-off value of the MPV/PC ratio was determined by a receiver operating characteristic (ROC) curve, and our patients were divided into low and high MPV/PC ratio groups. The Kaplan–Meier survival curve and Cox proportional hazards model were applied for progression-free survival (PFS) and overall survival (OS) analyses. Harell’s C-index was used to compare the prognostic values of the MPV/PC ratio, MPV and PC. Results: Lower MPV/PC ratios were correlated with more advanced tumor stages and worse outcomes. The optimal cut-off value of the preoperative MPV/PC ratio was 0.034 (sensitivity 84.6%, specificity 56.6%). The Kaplan–Meier survival curve revealed that low MPV/PC ratios were associated with worse PFS (p = 0.007) and OS (p = 0.017). Multivariate analysis showed that low MPV/PC ratios were an independent unfavorable factor for PFS (p = 0.044) and OS (p = 0.015). Harell’s C-indexes showed that the prognostic value of the MPV/PC ratio was significantly better than MPV and PC (p < 0.001). Conclusion: Low MPV/PC ratios are an independent, unfavorable risk factor for disease progression and overall survival in patients undergoing surgery for RCC.

Standardized Incidence Rate, Risk and Survival Outcomes of Second Primary Malignancy Among Renal Cell Carcinoma Survivors: A Nested Case-Control Study.

PurposeSecond primary malignancy (SPM) is challenging for treatment and long-term survival. We sought to investigate the standardized incidence rate (SIR), risk factors, and survival outcomes for SPM after renal cell carcinoma (RCC) treatment.MethodA nested case-control study was designed, we identified all T1-4N0-1M0 RCC patients diagnosed between 2004 and 2015 in the Surveillance, Epidemiology, and End Results database and followed them for SPM diagnosis for up to 13 years. Patients with SPM diagnosis ≥6 months after treatment of primary T1-4N0-1M0 RCC were identified as the case cohort and SPM-free patients were the control cohort. SIRs and the excess risk were calculated. A competing risks and Cox model were used to evaluate the risk factors of SPM and overall survival (OS).ResultsA cohort of 6,204 RCC patients with SPM were matched with a control group of 31,020 RCC patients without SPM. The median time-to-SPM interval was 54.5 months in RCC patients with SPM diagnosis. Besides, an SPM of T3/4 or/and M1 stage diagnosis was positively associated with a longer time-to-SPM interval. SIR of SPM increased by follow-up time and decreased with age at diagnosis (Pfor all <0.001). SPM in the kidney had the highest SIR (54.6, P <0.001) among all SPMs. Prostate cancer (29.8%) in males and breast cancer (23.5%) in females were the most common SPM. Older age, black ethnicity, male sex, higher family income, papillary RCC, and lower TNM stage were significant risk factors for SPM diagnosis. The proportion of deaths from SPM exceeds that of deaths from RCC 3 years after the first RCC treatment. Patients with SPM and early time-to-SPM interval shortens the OS compared with SPM-free patients. The 5-year OS was 85.9% and 58.9% from the first RCC and the SPM diagnosis, respectively. Besides, patients with low-grade/early-stage SPM could benefit from aggressive surgical treatment for solid tumors.ConclusionsCollectively, our study described the epidemiological characteristics of SPM among RCC survivors and identified the independent predictors of the SPM diagnosis and its survival outcomes. This study highlights the importance of patient education and follow-up after the surgery for RCC.

Rate of incisional hernia after minimally invasive and open surgery for renal cell carcinoma: a nationwide population-based study

Objectives To determine the rate of incisional hernia after surgery for renal cell carcinoma, to compare the rate after open vs minimally invasive surgery and radical nephrectomy vs partial nephrectomy and to identify risk factors for incisional hernia. Materials and methods From the Renal Cell Cancer Database Sweden we identified all patients (n = 9,638) diagnosed with renal cell carcinoma in Sweden between January 2005 and November 2015. Of these, 6,417 were included in the analyses to determine comorbidity and subsequent diagnosis of or surgery for incisional hernia. Results In all, 6,417 patients underwent surgery for renal cell carcinoma between January 2005 and November 2015, of these 5,216 (81%) underwent open surgery and 1,201 (19%) underwent minimally invasive surgery. Altogether 140 patients were diagnosed with incisional hernia. The cumulative rate of incisional hernia after 5 years was 5.2% (95% confidence interval [CI] = 4.0–6.4%) after open surgery and 2.4% (95% CI = 1.0–3.4%) after minimally invasive surgery (p < 0.05). In Cox proportional hazard analysis, age and left-sided surgery were associated with incisional hernia in the open surgery group (both p < 0.05), whereas in the minimally invasive group, no statistically significant risk factors for incisional hernia were found. Conclusions Open surgery for renal cell carcinoma is associated with a significantly higher risk for developing incisional hernia. If open surgery is the only option, care should be taken when choosing the approach and closing the wound. More studies are needed to find strategies to reduce the risk of abdominal wall complications following open kidney surgery.

Cystatin C predicts renal function impairment after partial or radical tumor nephrectomy

PurposeTo test the value of preoperative and postoperative cystatin C (CysC) as a predictor on kidney function after partial (PN) or radical nephrectomy (RN) in renal cell carcinoma (RCC) patients with normal preoperative renal function.MethodsFrom 01/2011 to 12/2014, 195 consecutive RCC patients with a preoperative estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73m2 underwent surgical RCC treatment with either PN or RN. Logistic and linear regression models tested for the effect of CysC as a predictor of new-onset chronic kidney disease in follow-up (eGFR < 60 ml/min/1.73m2). Moreover, postoperative CysC and creatinine values were compared for kidney function estimation.ResultsOf 195 patients, 129 (66.2%) underwent PN. In postoperative and in follow-up setting (median 14 months, IQR 10–20), rates of eGFR < 60 ml/min/1.73m2 were 55.9 and 30.2%. In multivariable logistic regression models, preoperative CysC [odds ratio (OR): 18.3] and RN (OR: 13.5) were independent predictors for a reduced eGFR < 60 ml/min/1.73m2 in follow-up (both p < 0.01), while creatinine was not. In multivariable linear regression models, a difference of the preoperative CysC level of 0.1 mg/dl estimated an eGFR decline in follow-up of about 5.8 ml/min/1.73m2. Finally, we observed a plateau of postoperative creatinine values in the range of 1.2–1.3 mg/dl, when graphically depicted vs. postoperative CysC values (‘creatinine blind area’).ConclusionPreoperative CysC predicts renal function impairment following RCC surgery. Furthermore, CysC might be superior to creatinine for renal function monitoring in the early postoperative setting.

Abstract LB107: Identification of a promising renal cell carcinoma target using a unique in silico approach

Abstract In 2020, kidney cancers accounted for more than 4.1% of new cancer cases worldwide. Among these, more than 90% were renal cell carcinoma (RCC), a very heterogenous disease consisting of 3 major subtypes: chromophobe , papillary and clear cell. These subtypes differ in histology, genetic alterations, clinical outcome and therapeutic response. Over the last decades, great advances in the treatment of RCC have been made with additional targeting agents inhibiting RTKs, VEGFR and mTORC1. However, for local RCC surgery remains the main treatment modality whereas metastatic RCC is still difficult to treat due to chemoresistance. Antibody drug conjugates (ADC) or small molecule drug conjugates (SMDC) are emerging approaches for the treatment of cancer patients. By coupling highly potent chemotherapeutic agents to a specific antibody/small molecule, tumor cells can be selectively targeted allowing treatment with higher drug doses leading to an enhanced efficacy, while maintaining low toxicity in healthy tissues. 4HF Biotec has developed a proprietary database containing, among others, curated molecular data from tumor patient samples, preclinical models (cell lines, cell line-derived xenografts, and patient-derived xenografts) and normal tissues. Using this platform, we established a unique methodology to identify and prioritize genes that could be targeted by ADCs/SMDCs. By performing bioinformatics analyses of this molecular data, we identified genes that are differentially expressed across cancer (sub)types. We further selected those that are overexpressed in the tumor entity compared to matching normal tissue and in the tumor entity compared to all normal tissues. The overlapping genes were assessed in preclinical models to confirm their tumor-specificity. For the final selection, we investigated target druggability by curating data regarding protein function, targetability and localization. With this approach, we identified a total of 374 potential drug targets across 15 cancer (sub)types for the development of ADCs or SMDCs. Analyses of kidney cancer identified Semaphorin 5B (SEMA5B) among the top candidates. SEMA5B was significantly upregulated in patient samples of the kidney compared to other tumor entities. Comparison with normal kidney samples revealed a significant higher expression in tumor samples. In addition to the expression profiles, association between SEMA5B expression and clinical and molecular features will be presented. Furthermore, we will present curated information about protein function and structure that will facilitate antibody generation. Our findings indicate that targeting SEMA5B on tumor cells could represent a new therapeutic option in the treatment of renal cancer. Citation Format: Alexandra Musch, Anne-Lise Peille, Hoor Al Hasani, Heinz-Herbert Fiebig, Vincent Vuaroqueaux. Identification of a promising renal cell carcinoma target using a unique in silico approach [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB107.

Nephron-Sparing Surgery for Renal Cell Carcinoma with Tumor Thrombus

Objective: The aim of the study was to describe our experience in patients who underwent nephron-sparing surgery (NSS) with tumor thrombectomy. Patients and Methods: Three consecutive patients who underwent NSS and tumor thrombectomy for localized single/multifocal renal cell carcinomas (RCCs) in conjunction with tumor thrombus between 2007 and 2011 were included. Open partial nephrectomy and thrombectomy was performed. Reconstruction included main renal vein, collecting system, and remaining parenchymal closure. One of the cases required additional artery repair and flushing with preservation solution. Results: Ischemic time was kept for 30–40 min. Mean estimated blood loss was 183.3 cc (range:100–300). One patient required the transfusion of 1 packed red blood cells unit. One of the patients developed a urinary fistula requiring double-J stenting. Hospital staying ranged between 5 and 8 days. None of the patients required renal replacement therapy either postoperatively or in the follow-up. Serum creatinine level at last follow-up (mean 83 months) ranged from 0.8 to 2.8 mg/dL. Conclusion: Our experience supports the feasibility of imperative partial nephrectomy and tumor thrombectomy for cases of RCC with renal vein involvement by tumor thrombus. In experienced hands, this approach may offer the patient a low morbidity postoperative course and long-term freedom from disease while maintaining the renal function, thus avoiding the need of renal replacement therapy.

Surgery for renal cell carcinoma extending to the right atrium in Japanese institutions: Focusing on cardiopulmonary bypass with or without deep hypothermic circulatory arrest.

To evaluate the outcomes of Japanese patients with renal cell carcinoma undergoing surgery for tumor thrombus invading the right atrium. We retrospectively evaluated 23 patients who underwent extracorporeal circulation-assisted surgery at two institutions. Perioperative outcomes and survival rates were evaluated and compared between two groups of patients, which were set according to the use or not of deep hypothermic circulatory arrest. Data on systemic treatments were assessed. The median age was 64years; the majority of patients were fit according to the Charlson Comorbidity Index. Five (21.7%) patients had at least one distant metastasis, and 17 (73.9%) received systemic therapy. A total of 16 (69.6%) patients underwent deep hypothermic circulatory arrest. Baseline characteristics were comparable between groups. Patients who underwent deep hypothermic circulatory arrest had a non-significant reduction in blood loss compared with those who did not undergo this procedure (1866.0 vs 3513.0mL, P=0.102). The complication rate, both of any grade (43.8% vs 71.4%, P=0.215) and grade ≥3 (6.3% vs 28.6%, P=0.162), tended to be lower in patients who underwent deep hypothermic circulatory arrest. The mean 90-day mortality rate was 8.7%, with no difference among groups (6.3% vs 14.3%, respectively; P=0.545). The overall median cancer-specific and overall survival were both 64.4months, and did not differ between groups. Renal cell carcinoma patients undergoing extracorporeal circulation-assisted surgery and systemic therapy for right atrial tumor thrombus have acceptable long-term survival rates. Outcomes are comparable regardless of the use of deep hypothermic circulatory arrest.