T1aN0M0 Renal Cell Carcinoma Research Articles

Predictive factors for recurrence and outcomes in T1a renal cell carcinoma: Analysis of the INMARC (International Marker Consortium for Renal Cancer) database

ObjectiveStage migration in renal cell carcinoma (RCC) has led to an increasing proportion of diagnosed small renal masses. Emerging knowledge regarding heterogeneity of RCC histologies and consequent impact on prognosis led us to further explore outcomes and predictive factors in surgically-treated T1a RCC. MethodsThe INMARC database was queried for T1aN0M0 RCC. Patients were stratified into groups based on recurrence. Primary outcome was overall survival (OS). Multivariable analyses (MVA) were performed for factors associated with recurrence, cancer-specific (CSM), and all-cause mortality (ACM). Kaplan-Meier analyses (KMA) assessed survival by histology and grade. Subset analysis for time to recurrence was conducted for grade and histologic groups and compared with recent AUA follow-up guidelines [low-risk (AUA-LR), intermediate-risk (AUA-IR), high-risk (AUA-HR), and very-high risk (AUA-VHR) groups]. ResultsWe analyzed 1,878 patients (median follow-up 35.2 months); 101 (5.4%) developed recurrence. MVA for recurrence demonstrated increasing age (P = 0.026), male sex (P = 0.043), diabetes (P = 0.007), high/unclassified grade (P < 0.001–0.007), and variant histology (P = 0.017) as independent risk factors for increased risk, while papillary (P = 0.016) and chromophobe (P = 0.049) were associated with decreased risk. MVA identified high/unclassified grade (P = 0.003–0.004) and pT3a upstaging (P = 0.043) as predictive factors for worsened risk of CSM while papillary (P = 0.034) was associated with improved risk. MVA for ACM demonstrated increasing age (P < 0.001), non-white (P < 0.001), high-grade (P = 0.022), variant histology (P = 0.049), recurrence (P = 0.004), and eGFR<45 at last follow-up (P < 0.001) to be independent risk factors. KMA comparing clear cell, chromophobe, papillary, and variant RCC revealed significant differences for 5-year CSS (P = 0.018) and RFS (P < 0.001), but not OS (P = 0.34). Median time to recurrence was 23.8 months for low-grade (AUA-LR), 17.3 months for high-grade (AUA-IR), 18 months for pT3a upstaging (AUA-HR), and 12 months for variant histology (AUA-VHR; P < 0.001). ConclusionWe noted differential outcomes in T1a RCC based on histology and grade for recurrence and CSM, while renal functional decline in addition to pathological factors and recurrence were predictive for ACM. Our findings support recently promulgated AUA follow-up guidelines for low-grade and variant histology pT1a RCC, but call for consolidation of follow-up protocols for high-grade pT1a and pT3a upstaged patients, with intensification of frequency of imaging follow-up in pT1a high-grade RCC.

Cancer-specific mortality in non-metastatic T1a renal cell carcinoma treated with radiotherapy versus partial nephrectomy.

Radiotherapy (RT) represents a treatment option for small renal masses with proven feasibility and tolerability. However, it has never been directly compared to partial nephrectomy (PN) with cancer-specific mortality (CSM) as an endpoint. Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified T1aN0M0 renal cell carcinoma (RCC) patients treated with RT or PN. We relied on 1:1 propensity score matching (PSM) for age, tumor size and histology. Subsequently, cumulative incidence plots and multivariable competing risks regression (CRR) models were fitted. The same methodology was then re-applied to a subset of patients with tumor size 21-40mm. Of 40,355 patients with T1aN0M0 RCC, 40,262 underwent PN (99.8%) vs 93 underwent RT (0.2%). RT patients were older (median age 72 vs 60years, p < 0.001) and harbored larger tumor size (median size 28 vs 25mm, p < 0.001) and a higher proportion of non-clear cell RCC (49% vs 22%, p < 0.001). After 1:1 PSM (92 RT versus 92 PN patients), cumulative incidence plots' derived CSM was 21.3 vs 4%, respectively. In multivariable CRR models, RT independently predicted higher CSM (hazard ratio (HR) 4.3, p < 0.001). In the subgroup with tumor size 21-40mm, after 1:1 PSM (72 RT versus 72 PN patients), cumulative incidence plots derived CSM was 21.3% vs 4%, respectively. In multivariable CRR models, RT also independently predicted higher CSM (HR 4.7, p = 0.001). In T1aN0M0 RCC patients, relative to PN, RT is associated with significantly higher absolute and relative CSM, even in patients with tumor size 21-40mm.

The effectiveness of partial versus radical nephrectomy for pT3aN0M0 renal cell carcinoma: A propensity score analysis.

The survival benefit of partial nephrectomy (PN) in pT3a RCC patients is controversial. Here we aimed to explore the potential benefit of PN for pT3aN0M0 renal cell carcinoma (RCC). Data of patients with pT3aN0M0 RCC who were diagnosed between 2010 and 2012 in the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database were retrospectively collected. Overall survival (OS) and cancer specific survival (CSS) were compared using a Cox proportional hazards model between PN and radical nephrectomy (RN) in pT3aN0M0 RCC. Propensity score (-adjusted, -stratified, -weighted, and -matched) analyses were performed to control for imbalances in individual risk factors. A total of 1277 patients with pT3aN0M0 RCC were identified, of whom 200 patients were treated with PN and 1077 patients were RN. PN showed favorable OS and CSS in 0-4cm pT3aN0M0 RCC (P<0.05), and similar OS and CSS in 4-7cm pT3aN0M0 RCC, compared with RN using un-adjusted analyses. The Propensity score analyses further demonstrated the survival benefit of PN compared with the RN in 0-4cm pT3aN0M0 RCC (P<0.05). In this retrospective study, PN was associated with improved survival compared with RN in 0-4cm pT3aN0M0 RCC. Moreover, survival was comparable between PN and RN in 4-7cm pT3aN0M0 RCC. These data provided evidence that PN could be an alternative choice for T3aN0M0 RCC less than 7cm. Particularly, patients with 0-4cm pT3aN0M0 RCC might benefit from PN.

Abstract CT106: Primary tumor response in T1aN0M0 renal cell carcinoma patients ineligible for surgery and treated with nivolumab and ipilimumab: Results from phase 2 pilot study

Abstract Background: Some patients with primary renal cell carcinoma (RCC) are unable to have surgery for different reasons (functional single kidney with a central, high-complexity RCC, high risk of nephrectomy and dialysis, patients with complex coagulation disorders, etc.). We hypothesize that combination of nivolumab and ipilimumab could eliminate the primary tumor in T1aN0M0 patients ineligible for surgical treatment. Methods: This is a prospective, multicenter, non-randomized phase 2 pilot study. Patients with biopsy-proven clear-cell RCC of ≤4 cm (cT1a), no evidence of any metastases, and unable to have surgery or other nephron-sparing interventions (ablation) or with preference to have no surgery or intervention for any reason received combination of ipilimumab (1 mg/kg intravenously) every 3 weeks for four doses, and nivolumab (240 mg intravenously) every 2 weeks during 16 weeks. The primary endpoint was complete response rate. Simon's two-stage design was used. The null hypothesis that the true complete response rate was 11% and was tested against a one-sided alternative. This design yields a type I error rate of 0.05 and power of 0.9 when the true complete response rate is 60% (alternative hypothesis). The null hypothesis should be rejected if 3 or more responses are observed in 8 patients. Results: Between February 2020 and June 2021, 8 patients were included. Median age was 77.9 years (range 73-89). Patients were Caucasian (100%), predominantly male (75%), 62.5% had centrally located RCC, 25% had ECOG PS 1, and 6 of 8 patients had moderate and severe comorbidities. Median follow-up was 12.7 months (95% CI 5.2-16.5). All patients received immunotherapy during 4 months without grade ≥2 adverse events. No complete responses were observed. Partial responses were found in 2 patients (25%). Median size of the primary tumor at RCC diagnosis and after immunotherapy was 3.11 cm (range 2.2-3.9) and 2.86 cm (range 1.5-4.0), respectively. Any shrinkage of the primary tumor was reported in 4 (50%) patients (change in median sum of diameters -18%). Only one patient had tumor enlargement (+0.5 cm (+13%) after 9 months. SBRT was used in this patient. All other patients are under active surveillance. Next secondary end-point of 3-year progression-free survival will be reported. Conclusions: The activity of immunotherapy against primary tumor was limited in patients with T1aN0M0 RCC ineligible for surgical treatment. Duration of stable disease will be studied with long-term follow-up of these patients. Treatment with nivolumab and ipilimumab was safe in patients with moderate and severe comorbidities. Citation Format: Ilya Tsimafeyeu, Maria Volkova, Rustem Gafanov, Igor Myslevtsev, Andrey Andrianov, Axel Bex. Primary tumor response in T1aN0M0 renal cell carcinoma patients ineligible for surgery and treated with nivolumab and ipilimumab: Results from phase 2 pilot study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT106.

Tumor Size Significantly Affects Prognosis in Pathological T3a Renal Cell Carcinoma.

To evaluate the prognostic value of tumor size in patients with pathological T3aN0M0 renal cell carcinoma (RCC) postoperatively. We retrospectively reviewed charts of patients with pathological T2N0M0 and T3aN0M0 RCC undergoing radical or partial nephrectomy at our Institution from 2000-2020. Survival analysis using Kaplan-Meier analysis and multivariate Cox regression was performed. A total of 165 patients were included and analyzed. We found that patients with pT3a RCC >7 cm experienced worse 5-year recurrence-free survival (43.8% versus 77.3%, p=0.006) and cancer-specific survival (67.6 versus 94%, p=0.003) compared with those with pT3a RCC ≤7 cm. However, there was no significant difference in recurrence-free and cancer-specific survival between patients with pT2 and pT3a RCC ≤7 cm. Based on multivariate analysis, tumor size >7 cm was an independent factor for tumor recurrence and cancer-related death [hazard ratio(HR)=2.654, p=0.005; and HR=5.016, p=0.005, respectively]. Renal vein invasion was associated with poorer 5-year recurrence-free survival than fat invasion (48.1% versus 70.9%, p=0.032) and was a predictor for tumor recurrence (HR=1.987, p=0.043). Tumor size has a significant impact on prognosis for patients with pathological T3aN0M0 RCC and should be taken into consideration when staging disease and predicting outcomes for these patients.

Race/Ethnicity Determines Life Expectancy in Surgically Treated T1aN0M0 Renal Cell Carcinoma Patients

BackgroundLife expectancy (LE) is an important consideration in the clinical decision-making for T1aN0M0 renal cell cancer (RCC) patients. ObjectiveTo test the effect of race/ethnicity (Caucasian, African American, Hispanic/Latino, and Asian) on LE predictions from Social Security Administration (SSA) life tables in male and female T1aN0M0 RCC patients. Design, setting, and participantsWe relied on the Surveillance, Epidemiology, and End Results database. InterventionRadical nephrectomy (RN) and partial nephrectomy (PN). Outcome measurements and statistical analysisFive-year and 10-yr observed overall survival (OS) of pT1aN0M0 RCC patients treated between 2004 and 2006 were compared with the LE predicted from SSA life tables. We repeated the comparison in a more contemporary cohort (2009–2011), with 5-yr follow-up and higher PN rates. Results and limitationsIn the 2004–2006 cohort, PN rate was 40.7%. OS followed the predicted LE in Caucasians, Hispanics/Latinos, and Asians, but not in African Americans, in whom 5-yr OS rates were 5.0% (male) and 8.7% (female) and 10-yr rates were 4.2% (male) and 11.1% (female) lower than predicted. In the 2009–2011 cohort, PN rate was 59.4%. Same observations were made for OS versus predicted LE in Caucasians, Hispanics/Latinos, and Asians. In African Americans, 5-yr OS rates were 1.5% (male) and 4.9% (female) lower than predicted. ConclusionsIn RN- or PN-treated pT1aN0M0 RCC patients, LE predictions closely approximated OS of Caucasians, Hispanics/Latinos, and Asians. In African-American patients, SSA life tables overestimated LE, more in females than in males. The limitations of our study are its retrospective nature, its validity for US patients only, and the under-representation of racial/ethnic minorities. Patient summarySocial Security Administration life tables can be used to estimate long-term life expectancy in patients who are surgically treated for renal cancer (≤4 cm). However, while for Caucasians, Hispanics/Latinos, and Asians, the prediction performs well, life expectancy of African Americans is generally overestimated by life table predictions. Take Home MessageIn the clinical decision-making process for T1aN0M0 renal cell cancer patients eligible for radical or partial nephrectomy, the important influence of patient sex and race/ethnicity on life expectancy should be taken into account, when using Social Security Administration life tables.

The critical impact of tumor size in predicting cancer special survival for T3aM0M0 renal cell carcinoma: A proposal of an alternative T3aN0M0 stage.

ObjectiveBased on the eighth TNM staging system, T3a renal cell carcinoma (RCC) is identified as an anatomical extrarenal invasion and does not consider the size of the tumor; however, it may not fully predict the prognosis of the patient. The objective of this study was to evaluate the prognostic value of tumor size effects on prognosis in T3a RCC and propose an alternative tumor stage system combined with T1‐2.MethodsData relating to T1‐3aN0M0 RCC (n = 49586) were obtained from the Surveillance, Epidemiology, and End Results database (2004–2015). Survival analyses were conducted by Cox regression and Fine and Gray regression. Harrell's concordance index (c‐index) was used to assess the discriminatory ability of the prognostic factors.ResultsA 1‐cm increase in T3a RCC resulted in an 8% increase in all‐cause mortality (hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 1.06–1.10, p < 0.001) and 14% increase in the risk of RCC‐specific mortality (sub‐distribution HR [sHR]: 1.14; 95% CI: 1.11–1.16, p < 0.001). T3a tumor size stratified by the cutoff of 4 cm and 7 cm showed a better prediction of RCC‐special survival (c‐index: 0.644), compared with a cutoff just by 4 cm (c‐index: 0.571) or by 7 cm (c‐index: 0.602). Compared with T1b tumors, T3a RCC ≤4 cm showed no differences in terms of all‐cause mortality (HR: 0.93; 95% CI: 0.79–1.09; p = 0.37) and mortality caused by RCC (sHR: 0.91; 95% CI: 0.70–1.19; p = 0.50). Last, the alternative T‐staging system (T1a, a combination of T1b and T3a [≤4 cm], T2a, T2b, T3a [4–7 cm], and T3a [>7] cm) demonstrated good RCC‐special survival predictive accuracy (c‐index: 0.729), which was higher than that shown by the current eighth edition T‐staging system (c‐index: 0.720).ConclusionTumor size should be taken into consideration for T3aN0M0 RCC rather than based on anatomical features alone.

Comparison of T2N0M0 and T3aN0M0 in Predicting the Prognosis of Patients With Renal Cell Carcinoma.

Background: To investigate the prognostic role of tumor size in patients with pathological T2N0M0 and T3aN0M0 renal cell carcinoma (RCC) treated by radical surgery.Methods: A total of 3,662 cases were retrospectively analyzed from the Surveillance, Epidemiology and End Results (SEER) from 2010 to 2012. Overall survival (OS) and cancer-specific survival (CSS) data were obtained. The log-rank test was used to compare survival distributions and Cox proportional hazards model was used for univariate and multivariate analyses, respectively.Results: In the low-risk T3aN0M0 (perinephric fatty infiltration or sinus fatty infiltration only) group, patients with tumor size ≤ 7 cm were associated with a better OS (P = 0.009) and CSS (P < 0.001) than those with tumor size >7 cm. However, there was no difference in OS (P = 0.129) and CSS (P = 0.539) between T2bN0M0 patients and low-risk T3aN0M0 patients with tumor size ≤ 7 cm. A new T classification grouping patients with both T2bN0M0 and T3aN0M0 with tumor diameter ≤ 7 cm into the same staging category (pT2aN0M0, pT2bN0M0+low-risk pT3aN0M0 [tumor diameter ≤ 7cm], low-risk pT3aN0M0 [tumor diameter >7 cm], high-risk pT3aN0M0) was proposed and it was found as an independent predictive variable for OS and CSS.Conclusions: Findings from the present study suggest that the reclassification of pT2N0M0 and pT3aN0M0 RCC can lead to better prediction of OS and CSS.

Treatment options for localised renal cell carcinoma of the transplanted kidney.

Currently, there is no consensus among the transplant community about the treatment of renal cell carcinoma (RCC) of the transplanted kidney. Until recently, graftectomy was universally considered the golden standard, regardless of the characteristics of the neoplasm. Due to the encouraging results observed in native kidneys, conservative options such as nephron-sparing surgery (NSS) (enucleation and partial nephrectomy) and ablative therapy (radiofrequency ablation, cryoablation, microwave ablation, high-intensity focused ultrasound, and irreversible electroporation) have been progressively used in carefully selected recipients with early-stage allograft RCC. Available reports show excellent patient survival, optimal oncological outcome, and preserved renal function with acceptable complication rates. Nevertheless, the rarity and the heterogeneity of the disease, the number of options available, and the lack of long-term follow-up data do not allow to adequately define treatment-specific advantages and limitations. The role of active surveillance and immunosuppression management remain also debated. In order to offer a better insight into this difficult topic and to help clinicians choose the best therapy for their patients, we performed and extensive review of the literature. We focused on epidemiology, clinical presentation, diagnostic work up, staging strategies, tumour characteristics, treatment modalities, and follow-up protocols. Our research confirms that both NSS and focal ablation represent a valuable alternative to graftectomy for kidney transplant recipients with American Joint Committee on Cancer stage T1aN0M0 RCC. Data on T1bN0M0 lesions are scarce but suggest extra caution. Properly designed multi-centre prospective clinical trials are warranted.

PD11-03 ASSESSMENT OF OTHER-CAUSE MORTALITY IN T1AN0M0 RENAL CELL CARCINOMA PATIENTS WITH 15 YEARS OF FOLLOW-UP: A SEER-BASED ANALYSIS

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD11)1 Apr 2020PD11-03 ASSESSMENT OF OTHER-CAUSE MORTALITY IN T1AN0M0 RENAL CELL CARCINOMA PATIENTS WITH 15 YEARS OF FOLLOW-UP: A SEER-BASED ANALYSIS Angela Pecoraro*, Sophie Knipper, Carlotta Palumbo, Giuseppe Rosiello, Stefano Luzzago, Marina Deuker, Zhe Tian, Shahrokh F. Shariat, Fred Saad, Alberto Briganti, Cristian Fiori, Francesco Porpiglia, and Pierre I. Karakiewicz Angela Pecoraro*Angela Pecoraro* More articles by this author , Sophie KnipperSophie Knipper More articles by this author , Carlotta PalumboCarlotta Palumbo More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Stefano LuzzagoStefano Luzzago More articles by this author , Marina DeukerMarina Deuker More articles by this author , Zhe TianZhe Tian More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , Fred SaadFred Saad More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Cristian FioriCristian Fiori More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , and Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000845.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Five-year other cause mortality (OCM) after nephrectomy for non-metastatic renal cell carcinoma (nmRCC) should be marginal in properly selected surgical candidates. We examined 5-year OCM rates as a quality of care indicator for patient selection. METHODS: Within the Surveillance, Epidemiology, and End Results database (1997-2011), we identified 59267 RCC patients treated with either radical (RN, 27804, 46.9%) or partial nephrectomy (PN, n=31463, 53.1%). Temporal trends and multivariable Cox regression analyses assessed 5-year OCM. Data were stratified according to age group (<60 vs. 60-70 vs. >70 years), year of diagnosis (1997-2001 vs. 2002-2006 vs. 2007-2011), race, marital status, gender, and socio-economic status (SES). RESULTS: The overall OCM rates for the entire cohort at 5 years of follow-up was 4.7% and decreased from 9.4 to 5.6% over the study span (-3.8%, p<0.001). The greatest decrease in 5-year OCM rates over time was recorded in patients >70 years (17.0-9.6%, slope: -0.6%/year), as well as in African-Americans (12.0-6.2%, slope: -0.3%/year) and in males (8.9-4.7%, slope: -0.3%, all p<0.001). Multivariable Cox regression models corroborated these findings. CONCLUSIONS: An important OCM decrease was recorded over the study span. Nonetheless, further improvement may be accomplished, especially in African-Americans, unmarried and older individuals, who exhibited higher OCM rates than others. These three groups may represent ideal targets for better patient selection based on OCM considerations. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e253-e254 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angela Pecoraro* More articles by this author Sophie Knipper More articles by this author Carlotta Palumbo More articles by this author Giuseppe Rosiello More articles by this author Stefano Luzzago More articles by this author Marina Deuker More articles by this author Zhe Tian More articles by this author Shahrokh F. Shariat More articles by this author Fred Saad More articles by this author Alberto Briganti More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Pierre I. Karakiewicz More articles by this author Expand All Advertisement PDF downloadLoading ...

A phase II pilot study of the efficacy and safety of nivolumab and ipilimumab in T1aN0M0 renal cell carcinoma patients ineligible for surgical treatment.

TPS769 Background: Surgery remains the standard curative-intent therapy for localized renal cell carcinoma (RCC). Thus, systemic therapy for RCC should only be considered in patients who have contraindications to surgery. The phase 3 CheckMate 214 trial showed that a combination of nivolumab and ipilimumab has a significant impact on tumor burden in intermediate- and poor-risk metastatic RCC patients with a complete response rate of 11%. Median time to objective response was 2.8 months. Among all complete responders to nivolumab plus ipilimumab in the intention-to-treat population, 5% achieved a complete response at the first scan. We hypothesize that this combination could eliminate the primary tumor in T1aN0M0 patients ineligible for surgical treatment. Methods: This is a prospective, multicenter, non-randomized phase 2 pilot study. Patients with biopsy-proven clear-cell RCC of ≤4 cm (cT1a), no evidence of any metastases, and unable to have surgery or other nephron-sparing interventions (ablation) for any reason (functional single kidney with a central, high-complexity RCC, high risk of nephrectomy and dialysis, patients with complex coagulation disorders, etc.) or with preference to have no surgery or intervention for any reason will receive combination of ipilimumab (1 mg/kg intravenously) every 3 weeks for four doses, and nivolumab (240 mg intravenously) every 2 weeks during 16 weeks. The primary endpoint is complete response rate. Simon's two-stage design (Simon, 1989) is used. The null hypothesis that the true complete response rate is 11% will be tested against a one-sided alternative. This design yields a type I error rate of 0.05 and power of 0.9 when the true complete response rate is 60% (alternative hypothesis). In the first stage, 3 patients will be accrued. If there are no complete responses in these 3 patients, the study will be stopped. Otherwise, 5 additional patients will be accrued for a total of 8. The null hypothesis will be rejected if 3 or more responses are observed in 8 patients. Clinical trial information: NCT04134182.

Assessment of the effectiveness of radiofrequency ablation as a technique for destroying small renal tumors in patients older than 70.

IntroductionDuring the past few decades, the percentage of older people in the population has been steadily growing due to the tendency of extended life expectancy. The efficacy of radiofrequency ablation (RFA) and tumor enucleoresection (TE) in the treatment of selected older patients with renal cell carcinoma (RCC) T1aN0M0 sized ≤4.0 cm has been a popular topic in many recent studies.The aim of this study was to access the effectiveness of radiofrequency ablation in patients older than 70 with T1aN0M0 RCC.Material and methodsA total of 86 patients aged 70–84 with histologically confirmed solitary kidney tumors T1aN0M0 who underwent RFA (n = 39) and TE (n = 47) were been included in this study. The patients were assigned to groups based on the impact of their comorbidities. Rockwood’s Clinical Frailty Scale Score (FS) and Charlson Comorbidity Index score (CCI) were used to separate fit from unfit older patients. The RFA group was characterized by an FS and CCI of 4–5 while the TE group had scores of ≤3. Five-year disease-specific survival (DSS), 5-yrs overall survival (OS) and relapse-free survival (RFS) were considered as criteria of treatment.ResultsThe 5-yr DSS in the RFA group was 97.4% vs. 95.7% in the TE group (p >0.05), while 5-yr OS was 74.4% vs. 80.9% (p <0.05) and RFS – 94.9% vs. 93.6% (p >0.05) respectively. Functioning of the operated kidneys did not deteriorate at the 6th and 12th month after RFA/TE as assessed by radioisotope renography.ConclusionsIn patients over 70 years of age, percutaneous RFA might be considered as an effective option for the successful treatment of T1aN0M0 RCC, as it preserves the functioning of the treated kidney and has oncological outcomes similar to TE.

Nivolumab and Ipilimumab in T1aN0M0 Renal Cell Carcinoma Patients Ineligible for Surgical Treatment.

Nivolumab and Ipilimumab in T1aN0M0 Renal Cell Carcinoma Patients Ineligible for Surgical Treatment.

Partial nephrectomy vs cryoablation for T1a renal cell carcinoma: A comparison of survival benefit stratified by tumour size

ObjectiveWe compared the impact on survival outcomes of partial nephrectomy (PN) and cryoablation (CA) for patients diagnosed with T1a renal cell carcinoma (RCC). Patients and MethodsAmong patients diagnosed between 2004 and 2014 in the Surveillance, Epidemiology and End Results program, we identified histologically confirmed T1aN0M0 RCC treated with PN (n = 17644) or CA (n = 868). Propensity score matching (PSM) was performed. Kaplan-Meier method, Cox proportional hazards model were used to calculate cancer specific mortality (CSM) and overall mortality (OM) in the unmatched and matched cohort, and in subgroups based on tumour size (< 2 cm, 2-3 cm, 3-4 cm). Sensitivity analyses were performed. ResultsA total of 18512 patients were identified: PN (93.88%) and CA (6.12%). In the propensity-score matched cohort, for tumours ≤ 2 cm, the CA and PN groups had similar CSM (HR: 1.41, 95% CI: 0.32–6.31, p = 0.65) and OM (HR 0.97, 95%CI: 0.47–2.01, p = 0.93). For tumours 2-3 cm, CA was associated with similar CSM (HR 1.64, 95%CI: 0.67–4.03, p = 0.28) but higher OM (HR 2.05, 95%CI: 1.35–3.11, p < 0.001), compared with PN. For tumours 3-4 cm, CA was associated with increased CSM (HR: 3.76, 95% CI: 1.62–8.69, p = 0.002) and OM (HR 2.17, 95%CI: 1.48–3.18, p < 0.001). ConclusionFor RCC ≤ 2 cm, PN and CA are equal in survival outcomes. For RCC 2-4 cm, PN may have a possible advantage over CA.

P093 - Accurate risk assessment of patients with pathologic T3aN0M0 renal cell carcinoma

P093 - Accurate risk assessment of patients with pathologic T3aN0M0 renal cell carcinoma

Accurate Risk Assessment of Patients with Pathologic T3aN0M0 Renal Cell Carcinoma

To develop a more precise risk-stratification system by investigating the prognostic impact of tumor growth within fatty tissues surrounding the kidney and/or renal vein. We conducted a retrospective review of the medical records of 211 patients with a pathologic diagnosis of T3aN0M0RCC among 4,483 renal cell carcinoma (RCC) patients from February 1988 to December 2015 according to the number of T3a pathologies—extrarenal fat invasion (EFI) and/or renal venous invasion (RVI). During a mean follow-up duration of 38.8 months, the patients with both pathologies (EFI + RVI) had lower recurrence free survival (RFS) rate than those with only a single pathology (p = 0.001). Using multivariable Cox regression analysis, the presence of both factors was shown to be an independent predictor of RFS (HR = 1.964, p = 0.032); cancer specific survival rate was not different among patients with EFI and/or RVI. Patients with pathologic T3aN0M0 RCC presenting with both EFI and RVI were at an increased risk of recurrence following nephrectomy. Therefore, pathologic T3a RCC could be sub-divided into those with favorable and unfavorable disease according to presence of EFI and/or RVI pathologies.

Prognostic heterogeneity in T3aN0M0 renal cell carcinoma according to the site of invasion

PurposeWe investigated the influence of the site of invasion on recurrence and survival in patients with pT3aN0M0 renal cell carcinoma (RCC). Materials and methodsWe reviewed the data of 266 patients with pT3aN0M0 RCC who underwent nephrectomy and divided them into the following 5 groups according to the site of invasion: perinephric invasion (PNI), sinus fat invasion (SFI), PNI and SFI without renal vein invasion (RVI) (i.e., PNI+SFI), RVI, and RVI with PNI and/or SFI (RVI+PNI±SFI). Subgroup analysis was performed to verify the differences in prognosis according to the extent of renal vein invasion using Cox regression models. ResultsA total of 111 patients (41.7%) experienced recurrence and 59 patients (22.2%) died of disease during follow-up (median = 58.1mo; interquartile range: 37.2–86.5). Patients with RVI showed significantly poorer outcomes than those with fat invasion in terms of 5-year recurrence-free survival (34.3% vs. 62.2%, P<0.001) and cancer-specific survival (62.8% vs. 84.1%; P<0.001). In multivariate analysis, RVI was an independent prognostic factor for recurrence and survival. In 94 patients with RVI, the 5-year recurrence-free survival rates were 50.0%, 33.9%, and 8.9% for the thrombus-only, the vascular wall invasion with negative surgical margin, and the vascular wall invasion with positive surgical margin groups, respectively (P<0.001), and the cancer-specific survival rates were 82.3%, 56.6%, and 20.0%, respectively (P<0.001). Wall invasion was the only independent prognostic factor for cancer-specific survival in these patients. ConclusionsPatients with pT3aN0M0 RCC with RVI have a significantly poorer prognosis than those with fat invasion. The prognosis differs according to the extent of RVI. Wall invasion should be considered a negative prognostic indicator in patients with T3a RCC.

Influence of tumor size on oncological outcomes of pathological T3aN0M0 renal cell carcinoma treated by radical nephrectomy.

ObjectiveTo evaluate the prognostic significance of tumor size in pathological T3aN0M0 renal cell carcinoma (RCC) treated by radical nephrectomy.Materials and methodsPatients who underwent radical nephrectomy for sporadic RCC with pathological T3aN0M0 RCC at our institution between January 2006 and June 2015 were identified. The entire cohort was divided into two groups according to the cutoff of tumor size obtained from receiver operating characteristic (ROC) curve. Clinicopathological variables were retrospectively collected and compared. Kaplan-Meier analysis and multivariate Cox regression were conducted to evaluate the effect of tumor size on survival outcomes.Results163 pT3aN0M0 RCC patients were included with a median follow-up period of 31 months. The optimal cutoff for tumor size was 7 cm according to the ROC curve. 90 cases (55.2%) presented tumors which measured 7 cm or less, and 73 cases (44.8%) showed tumor size greater than 7 cm. Patients with larger tumors tended to exhibit higher rates of symptoms and higher Fuhrman grades; they also indicated more necrosis features, and were more likely to invade the collecting system and renal vein. Compared with patients who exhibited tumor size of≤7 cm, those with tumor size>7 cm were associated with shorter estimated five-year cancer-specific survival (CSS, 46.6% versus 75.0%, P = 0.003) and five-year recurrence-free survival (RFS, 35.6% versus 62.7%, P = 0.011). Multivariate Cox analysis revealed that tumor size was retained as an independent factor for CSS (HR = 2.506, 95% CI 1.169–5.373, P = 0.018).ConclusionsThe tumor size significantly affected the survival outcomes of pT3aN0M0 RCC treated by radical nephrectomy, and a cutoff size of 7 cm can help enhance the prognostic discrimination. Thus, the tumor size may be considered in the future TNM classification of stage pT3a.

Sociodemographic disparities in treatment and survival of small localized renal cell carcinoma: surgical resection versus thermal ablation.

To investigate national practice trends in the use of surgical resection (SX) versus thermal ablation (TA) for the management of T1aN0M0 renal cell carcinoma with regard to sociodemographic factors and associated outcomes. Patients diagnosed in 2004-2011 were identified using the Surveillance, Epidemiology and End Results registry. Sociodemographic factors predicting the use of surgery versus TA were determined using logistic regression. Cancer-specific survival was estimated using Kaplan-Meier method. Overall, 19,136 (92.9%) patients underwent SX versus 1468 (7.1%) TA. Patients who were unmarried, diagnosed between 2008 and 2011, Caucasian, aged ≥70 years, insured, residing in Pacific Coast and Northern Plains, and in metropolitan areas with higher median family income had higher likelihoods of undergoing TA. Age-adjusted cancer-specific survival was similar in the two groups. Despite similar survival outcomes between SX versus TA, management of T1a renal cell carcinoma lesions may be influenced by a variety of nonclinical sociodemographic factors.

MP70-17 TUMOR SIZE PREDICTS HIGH-GRADE PATHOLOGY IN PT1A RENAL CELL CANCER

You have accessJournal of UrologyKidney Cancer: Surgical Therapy V1 Apr 2015MP70-17 TUMOR SIZE PREDICTS HIGH-GRADE PATHOLOGY IN PT1A RENAL CELL CANCER Jeffrey Larson, Jihad Kaouk, Craig Rogers, Michael Stifelman, Mohamad Allaf, Michael Johnson, Homayoun Zargar, Alon Mass, Ravi Barod, and Sam Bhayani Jeffrey LarsonJeffrey Larson More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Craig RogersCraig Rogers More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , Mohamad AllafMohamad Allaf More articles by this author , Michael JohnsonMichael Johnson More articles by this author , Homayoun ZargarHomayoun Zargar More articles by this author , Alon MassAlon Mass More articles by this author , Ravi BarodRavi Barod More articles by this author , and Sam BhayaniSam Bhayani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2542AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Fuhrman grade represents a key determinant of the natural history of small renal masses (SRM) that represent renal cell carcinoma. With increasing recognition that the malignant potential of SRMs is heterogeneous, enthusiasm for more conservative management strategies such as ablative techniques and active surveillance (AS) has grown. The decision to ablate or survey is often guided by a renal mass biopsy (RMB), which has limited potential to evaluate pathologic grade due to limited core size and tumor heterogeneity. Therefore the goal of this study was to investigate whether increasing clinical tumor size was predictive of high-grade histologic pathology in patients with a SRM treated with a robotic-assisted partial nephrectomy (RPN). METHODS We identified 975 patients with T1aN0M0 renal cell carcinoma treated with RPN at 5 US centers from 2007 to mid-2014. This cohort was used in univariate and multivariate regression models predicting high Fuhrman grade (III-IV) at partial nephrectomy. RESULTS Baseline patient and tumor characteristics as well as perioperative outcomes are summarized in Table 1. Patients with high-grade pathology were more likely to be older (58.2 yo vs 60 yo, p<0.035) and have larger clinical tumor size (2.56 cm vs 2.84cm, p<0.001) on univariate analysis. Multivariate logistic regression found male gender (OR 1.66, p=0.007), a low Charlson comorbidity index (CCI) (OR 0.45, p=0.014), papillary histology (OR 1.73, p=0.006), and clinical tumor size (OR 1.62, p=<0.001) to be predictive of high-grade pathology, controlling for age, gender, race, body mass index, CCI, histologic subtype and size (Table 2). CONCLUSIONS In our multi-institutional experience, increasing clinical tumor size predicts high-grade pathology in small renal masses. With an increased focus on RMB and surveillance of SRMs, this confirmation of the size to grade correlation in pT1a renal cell cancer allows the urologist to more accurately predict and council the patient on which SRM are appropriate for treat and which might be safely surveyed. Table 1. Baseline characteristics Baseline patient and tumor characteristics Low Grade High Grade p-value Number of patients 709 266 Mean age, years (SD) 58.2 (11.2) 60.0 (11.5) 0.035 Female gender (%) 278/709 (32.9) 72/266 (27) <0.001 Mean BMI, kg/m2 (SD) 30.3 (6.3) 29.8 (6.3) 0.231 CCI, (%) 0 51 (67.9) 24 (32.1) 1 58 (77.3) 17 (22.7) 2 155 (77.1) 46 (22.9) ≥3 286 (73) 106 (27.0) Clinical tumor size, cm (SD) 2.56 (1.02) 2.84 (1.08) <0.001 Pathologic tumor size, cm (SD) 2.31 (0.84) 2.66 (0.86) <0.001 Nephrometry score (SD) 7.1 (1.9) 7.2 (1.7) 0.554 Operative time, min (SD) 168.9 (54.9) 172.5 (57) 0.354 Estimate Blood Loss, mL (SD) 159.8 (133) 172 (149) 0.466 Warm Ischemic Time, min (SD) 18.2 (7.8) 19.4 (8.6) 0.050 BMI = Body mass index, CCI= Charlson comorbidity index Table 2. Multivariate logistic regression for high grade pathology Variable Odds Ratio p-value Clinical tumor size 1.62 <0.001 Age 1.02 0.087 Male vs Female 1.66 0.007 White vs Black 1.02 0.954 BMI 1.00 0.793 CCI: 1 vs 0 0.60 0.177 CCI: 2 vs 0 0.45 0.014 CCI: ≥3 vs 0 0.52 0.050 Papillary vs Clear Cell 1.73 0.006 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e882-e883 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Larson More articles by this author Jihad Kaouk More articles by this author Craig Rogers More articles by this author Michael Stifelman More articles by this author Mohamad Allaf More articles by this author Michael Johnson More articles by this author Homayoun Zargar More articles by this author Alon Mass More articles by this author Ravi Barod More articles by this author Sam Bhayani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...