Underwent Radical Nephrectomy Research Articles

MP47-04 VALIDATION OF A 22-GENE EPITHELIAL-MESENCHYMAL TRANSITION (EMT) PROGNOSTIC SIGNATURE IN CLEAR CELL RENAL CELL CARCINOMA

You have accessJournal of UrologyCME1 May 2022MP47-04 VALIDATION OF A 22-GENE EPITHELIAL-MESENCHYMAL TRANSITION (EMT) PROGNOSTIC SIGNATURE IN CLEAR CELL RENAL CELL CARCINOMA Brittney Cotta, Srinivas Nallandhighal, Judith Stangl-Kremser, Trinh Pham, Jeffrey Tosoian, Kathryn Marchetti, Joel Berends, Mahir Maruf, Scott Tomlins, Todd Morgan, Ganesh Palapattu, Eman Abdulfatah, Aaron Udager, and Simpa Salami Brittney CottaBrittney Cotta More articles by this author , Srinivas NallandhighalSrinivas Nallandhighal More articles by this author , Judith Stangl-KremserJudith Stangl-Kremser More articles by this author , Trinh PhamTrinh Pham More articles by this author , Jeffrey TosoianJeffrey Tosoian More articles by this author , Kathryn MarchettiKathryn Marchetti More articles by this author , Joel BerendsJoel Berends More articles by this author , Mahir MarufMahir Maruf More articles by this author , Scott TomlinsScott Tomlins More articles by this author , Todd MorganTodd Morgan More articles by this author , Ganesh PalapattuGanesh Palapattu More articles by this author , Eman AbdulfatahEman Abdulfatah More articles by this author , Aaron UdagerAaron Udager More articles by this author , and Simpa SalamiSimpa Salami More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002618.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current predictors of metastatic progression after radical nephrectomy for localized clear cell renal cell carcinoma (ccRCC) include clinicopathologic features such as tumor stage and grade. The addition of molecular tumor characteristics in a prognostic score may improve risk stratification and patient selection for enhanced follow up strategies or adjuvant therapies. METHODS: We retrospectively identified consecutive patients with ccRCC who underwent radical nephrectomy (RNx) for localized disease. Those who developed metastasis were identified. Whole-transcriptome mRNA sequencing of primary tumors was performed followed by gene set enrichment analysis (GSEA) for the most significant cancer hallmark pathways enriched in patients who did or did not develop metastasis. For each patient, the 22-gene epithelial mesenchymal transition (EMT) score was calculated (high vs. low), using cut-offs from a prior study using TCGA data. The prognostic impact of the EMT score was evaluated by performing multivariable cox-proportional hazard testing and Kaplan-Meier (KM) survival analysis. RESULTS: We analyzed 82 patients with median age 62 years and median tumor size 6 ±2.9 cm. The median time to metastasis after radical nephrectomy for patients who developed metastasis (n=12) was 18.2 months and median follow up 31.1 months for patients who did not develop metastasis (n=70). We observed a significant enrichment of EMT, myogenesis, inflammatory response and hypoxia hallmark pathways in patients with metastasis vs. those without metastasis. Kaplan-Meier survival analysis showed a significant decrease in metastasis-free survival in patients with a high EMT score (p=0.018). Multivariable analysis controlling for relevant clinicopathologic features such as age, sex, tumor size, tumor stage etc. revealed high EMT score to be significantly associated with development of metastasis [hazard ratio (HR) 7.2; 95% CI 1.15-44.8; p=0.035]. CONCLUSIONS: We validated a prognostic 22-gene epithelial mesenchymal transition (EMT) score in patients treated with radical nephrectomy for localized ccRCC. Pending further studies, the EMT score may improve risk stratification and select patients for adjuvant therapy. Source of Funding: UM-Peking University Joint Institute, NCI T32 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e810 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brittney Cotta More articles by this author Srinivas Nallandhighal More articles by this author Judith Stangl-Kremser More articles by this author Trinh Pham More articles by this author Jeffrey Tosoian More articles by this author Kathryn Marchetti More articles by this author Joel Berends More articles by this author Mahir Maruf More articles by this author Scott Tomlins More articles by this author Todd Morgan More articles by this author Ganesh Palapattu More articles by this author Eman Abdulfatah More articles by this author Aaron Udager More articles by this author Simpa Salami More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD01-10 WHOLE TRANSCRIPTOME SEQUENCING OF CLEAR CELL RENAL CELL CARCINOMA REVEALS A MULTIGENE EXPRESSION PROGNOSTIC SIGNATURE

You have accessJournal of UrologyCME1 May 2022PD01-10 WHOLE TRANSCRIPTOME SEQUENCING OF CLEAR CELL RENAL CELL CARCINOMA REVEALS A MULTIGENE EXPRESSION PROGNOSTIC SIGNATURE Srinivas Nallandhighal, Rohit Mehra, Marcin Cieslik, Amy Kasputis, Brittney Cotta, Todd Morgan, and Simpa Salami Srinivas NallandhighalSrinivas Nallandhighal More articles by this author , Rohit MehraRohit Mehra More articles by this author , Marcin CieslikMarcin Cieslik More articles by this author , Amy KasputisAmy Kasputis More articles by this author , Brittney CottaBrittney Cotta More articles by this author , Todd MorganTodd Morgan More articles by this author , and Simpa SalamiSimpa Salami More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002516.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is a critical need to develop prognostic biomarkers to improve the management of patients with clear cell renal cell carcinoma (ccRCC). This study aims to develop and validate gene expression-based biomarkers associated with recurrent disease to facilitate risk-stratification of ccRCC. METHODS: We retrospectively identified 110 patients who underwent radical nephrectomy for localized ccRCC. Patients who recurred were matched based on grade/stage to patients without recurrence. RNA next-generation sequencing (NGS) was performed on formalin-fixed paraffin-embedded (FFPE) tissue using whole-transcriptome sequencing on the illumina platform. We developed a gene signature to predict recurrence/progression-free survival (PFS) using a 15-fold lasso and elastic-net regularized linear Cox model. We derived Myriad Prolaris™ commercially available 31-gene cell cycle proliferation (mxCCP) score using RNA-seq data for each patient. Validation datasets were assembled: dataset #1 - The Cancer Genome Atlas ccRCC (TCGA, n= 382) and dataset #2 [Seishi Ogawa Japanese (n=87), International Cancer Genome Consortium (ICGC; n=81), GSE22541 (n=20) and Clinical Proteomics Tumor Analysis Consortium (CPTAC; n=91)]. Kaplan-Meier (KM) curves and multivariate Cox proportional hazard testing were then used to validate the independent prognostic impact of the gene signature on PFS and disease specific survival (DSS). RESULTS: After quality control, the training cohort comprised 50 patients with recurrence and 41 patients without, with a median follow-up 26 and 36 months, respectively. There were no significant differences between age, sex, grade, and stage between groups (all p > 0.05). We developed a 15-gene signature which was the only variable independently associated with worse PFS and DSS (PFS: HR=11.08, CI=4.9-25.1; DSS: HR=9.67, CI=3.4-27.7), adjusting for clinical-pathologic variables and mxCCP score. The 15-gene signature was also independently associated with worse PFS and DSS in both validation datasets [Validation #1 (n=382), PFS: HR=2.6, CI=1.6-4.3; DSS: HR=3; CI=1.4-6.1 and Validation #2 (n=279), PFS: HR=1.6, CI=0.7-3.6; DSS: HR=3.1; CI=1.5-6.4] adjusting for clinical-pathologic variables and mxCCP score. CONCLUSIONS: We developed and validated a novel 15-gene prognostic signature to improve risk stratification of patients with ccRCC. This signature has the potential to facilitate optimal treatment allocation and may lead to the development of novel therapeutic targets. Source of Funding: National Comprehensive Cancer Network © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e33 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Srinivas Nallandhighal More articles by this author Rohit Mehra More articles by this author Marcin Cieslik More articles by this author Amy Kasputis More articles by this author Brittney Cotta More articles by this author Todd Morgan More articles by this author Simpa Salami More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP50-02 HOW IMPORTANT ARE MORPHOLOGIC SUBTYPES ON THE PROGNOSIS OF SURGICALLY TREATED NON-METASTATIC PAPILLARY RENAL CELL CARCINOMA? AN ANALYSIS FROM A CONTEMPORARY MULTI-INSTITUTIONAL DATABASE

You have accessJournal of UrologyCME1 May 2022MP50-02 HOW IMPORTANT ARE MORPHOLOGIC SUBTYPES ON THE PROGNOSIS OF SURGICALLY TREATED NON-METASTATIC PAPILLARY RENAL CELL CARCINOMA? AN ANALYSIS FROM A CONTEMPORARY MULTI-INSTITUTIONAL DATABASE Selcuk Erdem, Umberto Capitanio, Riccardo Campi, Daniele Amparore, Maria Carme Mir, Eduard Roussel, Nicola Pavan, Onder Kara, Tobias Klatte, Enes Degirmenci, Resat Aydin, Andrea Minervini, Sergio Serni, Alessandro Berni, Giacomo Rebez, and Faruk Ozcan Selcuk ErdemSelcuk Erdem More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Riccardo CampiRiccardo Campi More articles by this author , Daniele AmparoreDaniele Amparore More articles by this author , Maria Carme MirMaria Carme Mir More articles by this author , Eduard RousselEduard Roussel More articles by this author , Nicola PavanNicola Pavan More articles by this author , Onder KaraOnder Kara More articles by this author , Tobias KlatteTobias Klatte More articles by this author , Enes DegirmenciEnes Degirmenci More articles by this author , Resat AydinResat Aydin More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Sergio SerniSergio Serni More articles by this author , Alessandro BerniAlessandro Berni More articles by this author , Giacomo RebezGiacomo Rebez More articles by this author , and Faruk OzcanFaruk Ozcan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002625.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Papillary renal cell carcinoma (papRCC) is currently divided in 2 morphologic subtypes: type 1 and type 2. The aim of this contemporary multi-institutional study is to investigate the role of morphologic subtypes on the prognosis of surgically treated non-metastatic papRCC. METHODS: This study was conducted using a multi-institutional database consisting of 1219 patients with histopathologically confirmed non-metastatic papRCC after partial or radical nephrectomy collected from 8 tertiary European insitutions. The patients with accurate data for morphologic subtypes (type 1 and type 2) and follow-up records were included into this study. Clinical and histopathological parameters, recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS) were compared between subtypes. Chi-square and Mann-Whitney U tests, and Kaplan-Meier survival analysis were used for the comparisons. Multivariable Cox Regression analysis was used to assess independent predictors on survival outcomes. RESULTS: A total of 879 patients were identified for this study. The patients in the type 2 group were older (64 vs. 66 years, p=0.006), had greater tumor size (3.8 vs. 4.3 cm, p=0.01) and more frequently underwent radical nephrectomy (25.7 vs. 35.2%, p=0.002). Nuclear grade (p<0.001), pathologic T stage (p<0.001) and N stage (p<0.001) were significantly higher in the type 2 group. The median follow-up was 48 (IQR:24-88) months. Kaplan-Meier survival analyses showed that 5 year RFS (90.3% vs. 76.7%, p<0.001), CSS (93.9% vs. 86.6%, p<0.001) and OS (88.1% vs. 81.0%, p=0.011) were significantly lower in type 2 papRCC. Age, grade, pathologic T and N stage adjusted Cox-Regression analyses found that type 2 was independent predictor for RFS (HR:1.78 [95%CI:1.22-2.58], p=0.003), but not for CSS (HR:1.54 [95%CI:0.93-2.56], p=0.094) and OS (HR:1.09 [95%CI:0.77-1.54], p=0.645). CONCLUSIONS: This contemporary multi-institutional study with a large dataset suggested that type 2 was associated with adverse histopathological outcomes, and was an independent predictor of RFS after surgical treatment of non-metastatic papRCC. These findings may guide decision making on follow-up schedule after surgery, and risk stratification for the adjuvant trials, in the individualized medicine era. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e863 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Selcuk Erdem More articles by this author Umberto Capitanio More articles by this author Riccardo Campi More articles by this author Daniele Amparore More articles by this author Maria Carme Mir More articles by this author Eduard Roussel More articles by this author Nicola Pavan More articles by this author Onder Kara More articles by this author Tobias Klatte More articles by this author Enes Degirmenci More articles by this author Resat Aydin More articles by this author Andrea Minervini More articles by this author Sergio Serni More articles by this author Alessandro Berni More articles by this author Giacomo Rebez More articles by this author Faruk Ozcan More articles by this author Expand All Advertisement PDF DownloadLoading ...

The clinicopathological profile of Renal cell carcinoma at BP Koirala Memorial Cancer Hospital

Introduction: Renal cell carcinoma accounts for 3-5%of all oncological diagnoses. In this study, we aim to assess the clinicopathological profile of Renal cell carcinoma in a cancer hospital of Nepal. Method: This is a retrospective study conducted at BP Koirala Memorial Cancer hospital Nepal. All patients with localized and locally advanced RCC who underwent radical or partial nephrectomy at our hospital between Jan 2012 to Dec 2018 were included. Normally distributed continuous variables were expressed as median, mean ± standard deviation (SD). Categorical variables were expressed as frequencies and percentages of an appropriate denominator. Results: Among 94 patients with RCC, the median age was 55 years (53.56 ±12.83). Most of the patients were male (56.4%, n=53) and Hindu by religion (67.02%, n=63). Eighty-three percent (n=78) of patients were smokers, 58.5 % (n=55) were hypertensive and 40.4% (n= 38) had history of diabetes mellitus. The most common symptom was incidental renal mass (42.55%, n=40). Ninety-five percent (n=89) of the patients underwent radical nephrectomy and five percent (n=5) of the patients underwent partial nephrectomy. The median duration of postoperative hospital stay was 8 days. The most common histological finding was Clear cell type (86.17, n=81) followed by papillary cell type (10.63%, n= 10) followed by chromophobe type (2.12%, n=2), and duct of Bellini( 1.06%, n=1). Most of the patients had pathological T2 (41.48%, n=39) disease followed by T3 (26.59%, n=25) disease. Conclusion: Smoker males in the fifth to sixth decade of life are at risk for developing RCC. Radical Nephrectomy is the standard of care with Clear cell carcinoma as the most common histological subtype.

SURGICAL TREATMENT OF MEDICATION RELATED OSTEONECROSIS OF THE JAW USING PRF

Medication related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive therapy with increasing incidence and is defined as a condition of progressive bone destruction in the maxillofacial region of patients. Antiresorptive drugs such as denosumab promotes the inhibition of osteoclast differentiation and function and is commonly used to treat bone cancer1. This report aims to present a case of MRONJ in a 76-year-old male patient who suffered from metastatic clear cell renal cell carcinoma (ccRCC). The patient underwent radical nephrectomy and was given, among other drugs, denosumab. After 1 year, he visited to clinic with exposed and necrotic bone that probes to bone, associated with infection as evidenced by pain in the region of the exposed bone and, subsequently, the diagnosis was MRONJ Stage 2. The necrosis was treated surgically with the addition of an autologous platelet concentrate (platelet-rich fibrin, PRF). Wound healing, pain and oral health-related quality of life were assessed via clinical evaluation after 7, 14, 30 days, 3 and 6 months postoperative. In conclusion, antiresorptive medications have close association to MRONJ in patients with poor oral hygiene and the antiresorptive treatment is recommended that should start after a careful dental preparation. Moreover, concerning MRONJ treatment, this case report indicate that when PRF is combined with successful surgical care, it can improve wound healing and has very promising results in tissue repair, regeneration, and growth.

Survival after minimally invasive vs. open radical nephrectomy for stage I and II renal cell carcinoma

A recently reported phase III randomized trial comparing open and minimally invasive hysterectomy showed significantly higher rates of local recurrence after minimally invasive surgery (MIS) for cervical cancer. This raised concerns regarding patterns of recurrences and survival after MIS in general. This study aims to determine the effect of MIS on all-cause mortality among patients undergoing radical nephrectomy for Stage I and II renal cell carcinoma (RCC). We utilized the National Cancer Database to identify patients diagnosed with clinical stage I-II RCCs between 2010 and 2013. Patients for whom a laparoscopic or robotic radical nephrectomy was attempted were compared to patients who underwent open radical nephrectomy (ORN). Adjusted regression models with inverse probability propensity score weighting (IPW) were utilized to identify independent predictors of receiving MIS. All-cause mortality rates were compared using IPW survival functions and log-rank tests. Adjusted Cox proportional hazard models were fitted to determine independent predictors of OS. 27,642 patients were identified; 11,524 (41.7%) had MIS, while 16,118 (58.3%) had ORN. Kaplan-Meier survival curves in the IPW cohort showed significant OS advantage for patients who underwent MIS (p < 0.001). Furthermore, length of hospital stays (3 vs. 4days), 30day readmission rates (2.4 vs. 2.87%), 30day (0.53 vs. 0.96%) and 90day mortality rates (1.04 vs. 1.77%) were significantly higher in the ORN group (p < 0.001). MIS was associated with better OS outcomes compared to ORN for stage I and II RCC. In addition, MIS had lower post-operative readmission, 30- and 90day mortality rates.

Chronic kidney damage pathology score for systematic assessment of the non-neoplastic kidney tissue and prediction of post-operative renal function outcomes

To establish a systematic histological assessment of non-neoplastic kidney (NNK) tissue at the time of nephrectomy to evaluate a patient's risk of developing post-operative renal dysfunction, a combined prospective pathologic assessment of the NNK and a retrospective clinical chart review was conducted. A blinded nephropathologist performed standardized assessment of glomerular sclerosis, tubulointerstitial fibrosis, arteriosclerosis, and hyaline arteriolosclerosis. Combined these formulated the chronic kidney damage pathology score (CKDPS). Multivariate logistic regression models were developed to assess the effect of CKDPS and other clinical factors on renal function up to 24 months following nephrectomy (partial or radical). 156 patients were included in the analysis with a median age of 60 years. 70% patients underwent radical nephrectomy. A history of hypertension and/or diabetes was present in 55.8% and 22.1%, respectively. Higher CKDPS (particularly glomerular global sclerosis and arteriosclerosis scores), radical nephrectomy, and reduced baseline estimated glomerular filtration rate (eGFR) were associated with worsening post-operative renal function outcomes. The systematic assessment of non-neoplastic kidney tissue at the time of renal surgery can help identify patients at risk of post-operative renal dysfunction. CKDPS represents a standardized and prognostically relevant histologic reporting system for non-neoplastic kidney tissue.

Impact of the neutrophil-to-lymphocyte ratio as a surgical prognostic factor in renal cell carcinoma with inferior-vena-cava tumor thrombus

BackgroundThe aim of this study is to evaluate the efficacy of radical nephrectomy with thrombectomy and to identify the prognostic factors for patients with renal cell carcinoma (RCC) and inferior vena cava tumor thrombus (IVCTT). The role of the neutrophil-to-lymphocyte ratio (NLR), which has been reported to be a useful prognostic predictor for various solid cancers, was also investigated. MethodsFifty-five patients with RCC and IVCTT who underwent radical nephrectomy and thrombectomy in our hospital were retrospectively analyzed. The relationship between clinical characteristics and surgical outcome was examined using the Kaplan–Meier method. Univariate and multivariate analyses were carried out to determine the prognostic factors. ResultsThe median follow-up time after surgery was 44.2 months. Twenty-seven patients died of RCC, and 4 died of other disease at last follow-up. There were no patients with postoperative pulmonary embolism (PE) or deaths from PE. The median cancer-specific survival (CSS) and overall survival (OS) were 81.0 (95% confidence interval [CI]: 42.0–103.2) and 69.0 (95% CI: 34.3–81.5) months, respectively. Significant prognostic factors for CSS were distant metastasis (p = 0.045) and NLR ≥ 2.9 (p = 0.009). The only independent predictor for OS was the NLR ≥ 2.9 (p = 0.034). ConclusionsA high preoperative NLR level was an independent poor prognostic factor influencing CSS and OS of patients with RCC and IVCTT who underwent radical nephrectomy and thrombectomy. The NLR may be an available biomarker that helps with preoperative risk stratification.

Oncologic Outcomes of Renal Cell Carcinoma Patients Undergoing Radical Nephrectomy and Venous Thrombectomy: Prospective Follow-Up from a Single Center.

Purpose To evaluate the long-term oncologic outcomes of renal cell carcinoma (RCC) patients with venous thrombus after radical nephrectomy and venous thrombectomy (RN-VT) and to determine the prognostic factors. Methods and Materials We reported our follow-up data of RCC patients with venous thrombus from January 2014 to September 2020. We used the Kaplan-Meier method to assess the overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). The Cox proportional hazards regression model and competing risk model were used. Results After a median follow-up of 31 mon, eight-five patients (31.5%) died, and cancer-specific deaths occurred in 60 patients (22.2%). The 1 yr and 3 yr CSS were 89.3% and 72.7%, respectively. The median OS was 56.0 mon (95% CI 47.6-64.3 mon), and the 1 yr, 3 yr, and 5 yr OS were 87.0%, 62.1%, and 44.8%, respectively. For M1 patients, the median OS was 27.0 mon (95% CI 22.0-42.0 mon), and the 1 yr, 3 yr, and 5 yr OS were 78.0%, 41.5%, and 23.3%, respectively. For M0 patients, the median RFS was 38.0 mon (95% CI 32.5-43.5 mon), and the 1 yr and 3 yr RFS were 81.2% and 52.3%, respectively. Multivariate analyses showed that papillary RCC (HR 2.95, 95% CI 1.80-4.82, P < 0.001) or other RCC (HR 3.88, 95% CI 2.03-7.41, P < 0.001), perinephric fat invasion (HR 1.53, 95% CI 1.03-2.26, P = 0.04), sarcomatoid differentiation (HR 2.85, 95% CI 1.64-4.95, P < 0.001), Fuhrman grade 3 (HR 2.10, 95% CI 1.28-3.44, P = 0.003) or 4 (HR 3.55, 95% CI 2.09-6.03, P < 0.001), and distant metastasis (HR 1.76, 95% CI 1.18-2.63, P = 0.006) were associated with a worse CSS. Adjuvant therapy (HR 0.63, 95% CI 0.43-0.92, P = 0.02) was associated with a better CSS. Conclusions RCC patients can have an acceptable long-term survival after RN-VT. Prognostic factors influencing CSS included nonclear cell RCC histology, higher Fuhrman grade, sarcomatoid differentiation, perinephric fat invasion, distant metastasis, and adjuvant therapy.

The Latinx Disparity in Surgery for Kidney Cancer: Data from The South Texas Region.

The South Texas region, with a predominantly Latinx population, has a very high incidence of renal cell carcinoma (RCC), including those with tumor extending into the major blood vessels called venous tumor thrombus (VTT). There is currently no data on outcomes of Latinx patients with VTT as most published studies are from predominantly Caucasian population. Therefore, we performed this study to fill an urgent, unmet need. We reviewed patients who underwent radical nephrectomy with removal of VTT (called tumor thrombectomy) between 2015 and 2020. We collected data on demographics, clinical, pathological characteristics and outcomes of patients. Univariate and multivariate Cox regression analyses were used to evaluate the associations between ethnicity and disease progression or survival. We identified 112 patients, of which 67 (62%) were Latinx, and 41 (38%) were non-Latinx. Approximately 60% of patients had Level II-IV VTT; Latinx presented with a higher level of tumor thrombus (p=0.046). Latinx patients had a higher rate of no insurance (11% vs. 27%, p=0.04) and were more likely to lost to follow-up after surgery (22.4% vs. 13.3%, p=0.23) compared to non-Latinx. Fewer Latinx received systemic therapy (28% vs. 42%; p=0.13). Ninety-day mortality for the entire cohort was 3.8%. The Latinx population in the South Texas region present late, with advanced thrombus level, and do not have access to systemic therapy. Given symptomatic disease, surgical treatment, if feasible, is their only option. Our results highlight disparate treatment patterns which require further investigation and health-care policy changes.

Clinical characteristics of patients with collecting duct carcinoma.

297 Background: Collecting duct carcinoma (CDC) is traditionally classified as a rare renal cell carcinoma. It comprised less than 2% of all renal cell carcinoma but presented a highly aggressive clinical course1. The natural history of CDC was merely described in small-sample retrospective studies because of its low incidence. Methods: We retrospectively collected clinicopathological data of patients (pts) diagnosed with CDC in our center from 2006 to the present. Histological diagnoses of all patients with CDC were confirmed by two senior urologic pathologists. Results: CDC was found in 58 pts (60% males and 22% over 65 years old). Most started with hematuria, low back pain, or systemic symptoms; 7 pts (12%) had no clinical symptoms. 67% pts underwent partial or radical resection of the kidney. 39.7% pts had distant metastases at diagnosis. Among the 35 pts with no distant metastasis at diagnosis, 18 (51%) had positive regional lymph nodes, 22 (63%) had locally advanced T stage (T3 or T4), and 18 (51%) were G3/4 by Fuhrman or WHO/ISUP. For pts undergoing radical nephrectomy, the median disease-free survival (DFS) was 6.3 mos (95%CI: 0.2, 12.4), and the median OS was 22.5 mos (95%CI: 16.6, 28.4), which were significantly related to T stage (P = 0.033 and 0.001). For pts after metastasis (56 cases), the most common sites of recurrence and metastasis were lymph nodes (55%), lung (46%), bone (36%), liver (16%), adrenal glands (7%), and local recurrence (20%). The median OS after metastasis was 11.3 mos (95%CI: 9.5, 13.0). Among the locally advanced or metastatic pts, 33 received gemcitabine + cisplatin combined with sorafenib as the first-line therapy. There were 8 PR and 17 SD. The ORR was 24.2%, DCR was 75.8%, and median PFS was 6.1 mos (95% CI: 4.7, 7.5). The median OS was 12.1 mos (95% CI: 8.6, 15.5). In 2 pts receiving anti-PD-1 monoclonal antibody combined with axitinib, 1 case had PR and 1 obtained SD with tumor shrinking. They are still under follow-up. Conclusions: CDC is prone to be diagnosed at a late stage and develop metastases. There is currently no standard treatment for metastatic patients; gemcitabine + cisplatin combined with sorafenib can be tried in the first-line setting. Anti-PD-1 plus axitinib showed promising efficacy in cases of CDC, and a larger sample is needed for verification.

The prognostic role of sarcopenia and albumin in locally advanced renal cell carcinoma with IVC tumor thrombus.

387 Background: Indicators of body composition and nutritional status, such as lumbar skeletal muscle index (SMI, cm2/m2) and hypoalbuminemia, are associated with adverse outcomes following surgery for localized renal cell carcinoma (RCC) but have yet to be described in patients with RCC and venous tumor thrombus. We hypothesize that preoperative sarcopenia, a severe deficit in lean muscle mass, and hypoalbuminemia will be associated with decreased overall survival (OS) and cancer specific survival (CSS) in nonmetastatic RCC patients undergoing radical nephrectomy and tumor thrombectomy. Methods: We retrospectively analyzed 103 nonmetastatic RCC patients who underwent radical nephrectomy and tumor thrombectomy from 2005 to 2020. Optimally fit BMI (kg/m2) and sex-stratified sarcopenia thresholds were calculated (BMI&lt;30: SMI&lt;47 for males, SMI&lt;38 for females; BMI≥30: SMI&lt;54 for males, SMI&lt;47 for females). Sarcopenia and albumin risk groups were created based on their individual hazard ratios on univariable analysis and defined as low-risk (non-sarcopenic, normal albumin), medium-risk (non-sarcopenic, hypoalbuminemia), high-risk (sarcopenic, normal albumin), and very high-risk (sarcopenic, hypoalbuminemia). Associations between independent and combined sarcopenia and hypoalbuminemia (albumin&lt;3.5 g/dL) with OS and CSS were evaluated using multivariable and Kaplan-Meier analyses. Results: Prevalence of sarcopenia and hypoalbuminemia were 51.2% and 44.7%, respectively. Median follow up time was 24.8 months and median time from preoperative imaging to surgery was 21 days. Sarcopenia was an independent predictor of OS (p=0.003) and CSS (p=0.006) whereas hypoalbuminemia was not (OS: p=0.096; CSS: p=0.718). When analyzing sarcopenia and albumin in combination, the high and very high-risk groups were significantly associated with decreased OS (high-risk: p=0.011; very high-risk: p&lt;0.001) and CSS (high-risk: p=0.011; very high-risk: p=0.017). Kaplan-Meier curves showed a stepwise decline in median OS (p=0.0071) and CSS (p=0.0068) times with increasing risk. Conclusions: Simultaneous sarcopenia and hypoalbuminemia were associated with nearly a seven-fold decrease in OS and CSS in patients undergoing surgery for nonmetastatic RCC with IVC tumor thrombus.[Table: see text]

Sarcopenia as a predictor of perioperative morbidity in metastatic renal cell carcinoma patients undergoing radical nephrectomy and IVC tumor thrombectomy.

388 Background: Preoperative sarcopenia, as determined by the lumbar skeletal muscle index (SMI), has shown potential value for predicting adverse survival outcomes in metastatic renal cell carcinoma (mRCC) patients undergoing cytoreductive surgery. However, its utility for predicting perioperative morbidity in mRCC patients with IVC involvement is poorly elucidated. We hypothesize that preoperative sarcopenia, a severe deficiency in lean muscle mass, will be associated with major surgical complications and longer lengths of hospital stay in mRCC patients managed with radical nephrectomy and tumor thrombectomy. Methods: We retrospectively analyzed 99 mRCC patients who underwent radical nephrectomy and tumor thrombectomy from 2005 to 2020. Sarcopenia was diagnosed using optimally fit body mass index (BMI) and sex-stratified thresholds. For patients with a BMI &lt; 30 kg/m², sarcopenia was defined as a SMI &lt; 47 cm2/m2 for males and SMI &lt; 38 cm2/m2 for females and for those with a BMI≥30 kg/m², as a SMI &lt; 54 cm2/m2 for males and SMI &lt; 47 cm2/m2 for females. Outcome measures were the presence of any major complications within 90 days after surgery, major complications within 1 year after surgery, and length of hospital stay post-nephrectomy ≥7 days. Major complications were defined as grade ≥3a on the Clavien-Dindo classification system. Associations between sarcopenia and major surgical complications and length of hospital stay were evaluated using multivariable analysis. Multivariable models were adjusted for age, race, gender, BMI, Charlson comorbidity index, T and N staging, Fuhrman grade, ECOG Score, and extent of IVC tumor thrombus. Results: Median time from preoperative imaging to surgery was 22 days (IQR 15-29). Of the 57 (58%) patients with preoperative sarcopenia in our cohort, 19 (33%) and 20 (35%) patients experienced a major surgical complication within 3 and 12 months after surgery, respectively, and 34 (60%) patients had a length of stay ≥7 days. Preoperative sarcopenia was significantly associated with the occurrence of a major complication within 90 days (OR = 4.84, 95%CI: 1.30-18.06, p = 0.019) and 1 year (OR = 6.43, 95%CI: 1.66-24.89, p = 0.007) after surgery. The presence of sarcopenia did not significantly change the odds of staying in the hospital for more than 7 days post-nephrectomy (OR = 1.41, 95%CI: 0.45-4.41, p = 0.551). Conclusions: Preoperative sarcopenia was associated with major surgical complications occurring within 3 and 12 months among mRCC patients after radical nephrectomy and tumor thrombectomy. Screening for sarcopenia preoperatively may assist in identifying patients at high-risk for increased perioperative morbidity, which ultimately may permit the implementation of preventive therapeutic strategies. Future validation is needed.

Validation of a 22-gene epithelial-mesenchymal transition (EMT) prognostic signature in clear cell renal cell carcinoma.

377 Background: Current predictors of metastatic progression after radical nephrectomy for localized clear cell renal cell carcinoma (ccRCC) include clinicopathologic features such as tumor stage and grade. The addition of molecular tumor characteristics in a prognostic score may improve risk stratification and patient selection for enhanced follow up strategies or adjuvant therapies. Methods: We retrospectively identified consecutive patients with ccRCC who underwent radical nephrectomy (RNx) for localized disease. Those who developed metastasis were identified. Whole-transcriptome mRNA sequencing of primary tumors was performed followed by gene set enrichment analysis (GSEA) for the most significant cancer hallmark pathways enriched in patients who did or did not develop metastasis. For each patient, the 22-gene epithelial mesenchymal transition (EMT) score was calculated (high vs. low), using cut-offs from a prior study using TCGA data. The prognostic impact of the EMT score was evaluated by performing multivariable cox-proportional hazard testing and Kaplan-Meier (KM) survival analysis. Results: We analyzed 82 patients with median age 62 years and median tumor size 6 ±2.9 cm. The median time to metastasis after radical nephrectomy for patients who developed metastasis (n = 12) was 18.2 months and 31.1 months for patients who did not develop metastasis (n = 70). We observed a significant enrichment of EMT, myogenesis, inflammatory response and hypoxia hallmark pathways in patients with metastasis vs. those without metastasis. Multivariable analysis controlling for relevant clinicopathologic features such as age, sex, tumor size, tumor stage etc. revealed high EMT score to be significantly associated with development of metastasis [hazard ratio (HR) 7.2; 95% CI 1.15-44.8; ]. Conclusions: Here we validate a prognostic 22-gene epithelial mesenchymal transition (EMT) score in patients treated with radical nephrectomy for localized ccRCC. Pending further studies, the EMT score may improve risk stratification and select patients for adjuvant therapy.

Impacts of Neighborhood Characteristics and Surgical Treatment Disparities on Overall Mortality in Stage I Renal Cell Carcinoma Patients.

Racial/ethnic minority groups in the United States have high renal cell carcinoma (RCC) mortality rates. This study assessed surgical treatment disparities across racial/ethnic groups and impacts of neighborhood socioeconomic characteristics on surgical treatments and overall mortality. Stage I RCC patients diagnosed between 2004 and 2016 from National Cancer Database were included (n = 238,141). We assessed differences in associations between race/ethnicity and treatment patterns using logistic regression and between race/ethnicity and overall mortality using Cox regression with and without neighborhood characteristics in the regression models. When compared to non-Hispanic Whites (NHWs), American Indians/Alaska Natives and non-Hispanic Blacks (NHBs) were more likely not to receive surgical care and all racial/ethnic minority groups had significantly increased odds of undergoing radical rather than partial nephrectomy, even after adjusting for neighborhood characteristics. Including surgical treatment and neighborhood factors in the models slightly attenuated the association, but NHBs had a significantly increased risk of overall mortality. NHBs who underwent radical nephrectomy had an increased risk of mortality (HR 1.15, 95% CI: 1.08–1.23), but not for NHBs who underwent partial nephrectomy (HR 0.92, 95% CI: 0.84–1.02). Neighborhood factors were associated with surgical treatment patterns and overall mortality in both NHBs and NHWs. Neighborhood socioeconomic factors may only partly explain RCC disparities.

Renal cancer associated with Xp11.2 translocation/TFE3 gene fusion: Clinicopathological analysis of 13 cases

ObjectiveTo explore the clinicopathological characteristics, immunohistochemical phenotype, diagnosis and differential diagnosis of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion. MethodsThe clinical history, pathological morphology, immunohistochemical phenotype and related molecular test results of 13 cases of Xp11.2 translocation/TFE3 gene fusion-related renal cell carcinoma were retrospectively analyzed, and the relevant literature was reviewed. ResultsOf the 13 patients, 5 were males and 8 were females. The age of onset ranges from 8 to 73 years old, most of which were middle-aged and elderly patients. Among them, there were 3 cases of left kidney tumor and 10 cases of right kidney tumor. In the treatment method, 2 of the 13 patients underwent partial nephrectomy, and 11 underwent radical nephrectomy. Histopathological morphology showed papillary, nested, tubular and acinar structures. The cytoplasm was transparent or eosinophilic, and the interstitial fibrosis was accompanied by chronic inflammatory cell infiltration, hemosiderin deposition and foam cell aggregation. The immunohistochemical analysis of 13 patient specimens all expressed TFE3 antibody, and the expression intensity was strongly positive; gene FISH detection technology revealed the breakage and rearrangement of TFE3 gene in 12 assessable cases. One of thirteen patients had a metastasis at follow-up from 3 to 69 months. ConclusionsThis type of kidney cancer was a rare subtype. Because of its complex and changeable shape, it has a high degree of overlap with other kidney cancer subtypes, and the missed diagnosis rate and misdiagnosis rate are extremely high. The diagnosis is mainly based on pathomorphology and immunohistochemistry, TFE3 positive expression and TFE3 gene destruction and rearrangement.

Renal Cell Carcinoma Surgical Treatment Disparities in American Indian/Alaska Natives and Hispanic Americans in Arizona.

American Indians/Alaska Natives (AI/AN) and Hispanic Americans (HA) have higher kidney cancer incidence and mortality rates compared to non-Hispanic Whites (NHW). Herein, we describe the disparity in renal cell carcinoma (RCC) surgical treatment for AI/AN and HA and the potential association with mortality in Arizona. A total of 5111 stage I RCC cases diagnosed between 2007 and 2016 from the Arizona Cancer Registry were included. Statistical analyses were performed to test the association of race/ethnicity with surgical treatment pattern and overall mortality, adjusting for patients’ demographic, healthcare access, and socioeconomic factors. AI/AN were diagnosed 6 years younger than NHW and were more likely to receive radical rather than partial nephrectomy (OR 1.49 95% CI: 1.07–2.07) compared to NHW. Mexican Americans had increased odds of not undergoing surgical treatment (OR 1.66, 95% CI: 1.08–2.53). Analysis showed that not undergoing surgical treatment and undergoing radical nephrectomy were statistically significantly associated with higher overall mortality (HR 1.82 95% CI: 1.21–2.76 and HR 1.59 95% CI: 1.30–1.95 respectively). Mexican Americans, particularly U.S.-born Mexican Americans, had an increased risk for overall mortality and RCC-specific mortality even after adjusting for neighborhood socioeconomic factors and surgical treatment patterns. Although statistically not significant after adjusting for neighborhood-level socioeconomic factors and surgical treatment patterns, AI/AN had an elevated risk of mortality.

Atrophic Kidney Like Lesion: A Provisional Entity With Brief Review of Literature

Atrophic kidney-like lesion (AKLL) is a provisional renal entity with distinct morphological and immunohistochemical features. It characteristically resembles thyroid-like follicular renal cell carcinoma (RCC) of kidney, an emerging renal entity. Very few patients of AKLL have been reported in the literature. We are hereby describing the clinicopathological features of AKLL in a 38-year-old man. The patient was incidentally found to have a renal mass and underwent radical nephrectomy. The morphological and immunohistochemical findings revealed features of AKLL. The patient on 24 months' post-operative period follow-up is alive without recurrence or metastasis.

Retroperitoneoscopic single-site 3D adrenalectomy for left adrenal renal cell carcinoma metastasis 20 years after left laparotomic radical nephrectomy

The aim of the paper is to demonstrate the practicability of retroperitoneoscopic single-site 3D left adrenalectomy after previous homolateral laparotomic renal surgery. We present a case report of a 70-year-old male who underwent radical nephrectomy in 1999. Twenty years after radical nephrectomy, the patient underwent a computed tomography scan for B-cell lymphoma follow-up, which revealed a 30 mm left adrenal mass suspicious for a delayed renal-cell carcinoma metastasis. After multidisciplinary discussion, surgery was chosen as first option. To minimize surgical morbidity as much as possible, a 3D laparoscopic single-site retroperitoneal approach was chosen. The patient had no peri- or intra-operative complications and was discharged on Postoperative Day 3. The final histological report revealed an adrenal clear cell renal-cell carcinoma metastasis. This experience shows that single-site retroperitoneal laparoscopic adrenalectomy is possible in patients who underwent previous abdominal cancer surgery and is an option to consider when determining optimal approaches for adrenal surgery.

Abstract PO-169: Impacts of neighborhood characteristics and surgical treatment disparities on overall mortality in stage I renal cell carcinoma patients

Abstract Background Racial/ethnic minority groups in the United States have high kidney cancer mortality rates. Disparities in treatments may contribute to higher mortality in racial/ethnic minority groups, but the relationship between treatment disparities and kidney cancer mortality is not well understood. In this study, we assessed if there are differences in surgical treatments across racial/ethnic groups and surgical treatments influence disparities in overall mortality. Methods Stage I renal cell carcinoma patients who were diagnosed between 2004 and 2016 from National Cancer Database were included. Logistic regression was performed to assess associations between race/ethnicity and treatment patterns adjusting for neighborhood socioeconomic (SES) and other factors. Cox regression analysis was performed to assess associations between race/ethnicity and overall mortality. Results A total of 238,141 patients were included in the analysis. Compared to non-Hispanic Whites, American Indians/Alaska Natives, and non-Hispanic Blacks (NHBs) were more likely not to receive surgical care even after adjusting for neighborhood SES (OR 1.85, 95% CI: 1.28-2.70 and OR 1.32 95% CI: 1.20-1.45 respectively). Although all racial/ethnic groups had significantly increased odds of undergoing radical nephrectomy rather than partial nephrectomy,. NHBs had the greatest odds of receiving radical rather than partial nephrectomy (OR 1.38, 95% CI: 1.33-1.44).. The associations were slightly attenuated after including healthcare access and neighborhood SESNHBs had an elevated risk of overall mortality, while Asian Americans and Hispanic Americans had reduced risk. Including surgical treatment, health access and neighborhood factors slightly attenuated the association for NHBs, but the associations between race/ethnicity and overall mortality remained significant. Analysis was performed stratifying samples based on surgical treatment to further assess effects of surgical treatment disparities on associations between race/ethnicity and overall mortality. NHBs who had surgical treatment had increased risk of mortality (HR 1.11, 95% CI:1.06-1.17).. Among patients who underwent nephrectomy, NHBs who underwent radical nephrectomy had increased risk of mortality (HR 1.15, 95% CI: 1.08-1.23), but not NHBs who underwent partial nephrectomy (HR 0.92, 95% CI:0.84-1.02). Conclusion Racial/ethnic minority patients were more likely not to receive surgical treatment. When they do, they are likely to have less optimal surgical treatment (radical rather than partial nephrectomy). Surgical treatment disparities account for high kidney cancer mortality in NHBs. Citation Format: Alejandro Cruz, Faith Dickerson, Kathryn R. Pulling, Kyle Garcia, Francine C. Gachupin, Chiu-Hsieh Hsu, Juan Chipollini, Benjamin R. Lee, Ken Batai. Impacts of neighborhood characteristics and surgical treatment disparities on overall mortality in stage I renal cell carcinoma patients [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-169.