You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) I (MP14)1 Apr 2020MP14-08 IMPROVING PATIENT SELECTION FOR UPFRONT CYTOREDUCTIVE NEPHRECTOMY BY EVALUATING PREOPERATIVE FACTORS ASSOCIATED WITH EARLY MORTALITY E Jason Abel*, Philippe E Spiess, Jay D Raman, Viraj A Master, Daniel D Shapiro, Wade J Sexton, A Watts, Logan Zemp, Logan Borregales, Sarp Keskin, Alyssa Bilotta, Datta Patil, Glenn O Allen, Surena F Matin, Jose A Karam, and Christopher G Wood E Jason Abel*E Jason Abel* More articles by this author , Philippe E SpiessPhilippe E Spiess More articles by this author , Jay D RamanJay D Raman More articles by this author , Viraj A MasterViraj A Master More articles by this author , Daniel D ShapiroDaniel D Shapiro More articles by this author , Wade J SextonWade J Sexton More articles by this author , A WattsA Watts More articles by this author , Logan ZempLogan Zemp More articles by this author , Logan BorregalesLogan Borregales More articles by this author , Sarp KeskinSarp Keskin More articles by this author , Alyssa BilottaAlyssa Bilotta More articles by this author , Datta PatilDatta Patil More articles by this author , Glenn O AllenGlenn O Allen More articles by this author , Surena F MatinSurena F Matin More articles by this author , Jose A KaramJose A Karam More articles by this author , and Christopher G WoodChristopher G Wood More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000839.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Optimal selection of metastatic renal cell carcinoma (mRCC) for cytoreductive nephrectomy (CN) is challenging because outcomes vary significantly and patients who survive less than one year are less likely benefit from surgery. The purpose of this study was to evaluate preoperative factors associated with early mortality (< 1 year) and develop a basic risk model to compare with selection using IMDC risk model. METHODS: Data was analyzed for mRCC patients treated with CN at 5 centers from 2006-2017 after excluding follow-up <1 year or mortality ≤ 30 days post CN. Multivariable analysis was used to identify associations with early mortality and preoperative factors including Charlson comorbidity index, hemoglobin, calcium, albumin, platelet count, neutrophil count, lymphocyte count, tumor thrombus, total mm metastases, primary tumor size, percentage of primary/metastatic burden, number of metastatic sites, performance status, clinical N stage, and IMDC risk category. Collinear variables and variables included in IMDC criteria not included in final model. RESULTS: A total of 844/1078 (78%) patients were treated with upfront CN. Early mortality according to IDMC risk categories was 7/65 (11%) favorable, 153/542 (28%) intermediate, and 76/237 (32%) poor risk. After MVA, factors that were independently predictive of early mortality included albumin < LLN (HR 2.07 95% CI 1.1- 3.8, p=0.02), neutrophil to lymphocyte ratio >2.5 (HR 1.97 95% CI 1.1-3.5, p=0.02), metastatic burden >3cm (HR 1.65 95% CI 1.0-2.7, p=0.04), and number of metastatic sites >2 (HR 2.78 95% CI 1.6-4.7, p<0.001). IMDC risk category was not associated with early mortality in multivariable model p=0.78. A risk model was created assigning 1 point for independent predictor from multivariable analysis (figure). ROC analysis was used to evaluate predictive accuracy for OS < 1 year, which was higher for the early mortality model (AUC 0.68) compared to IMDC system (AUC 0.53). CONCLUSIONS: Low albumin, high neutrophil to lymphocyte ratio, increased number of metastatic sites and larger metastatic burden are preoperative factors are associated with early mortality, independent of current risk models. Models that integrate these variables may improve patient selection for surgery. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e198-e198 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information E Jason Abel* More articles by this author Philippe E Spiess More articles by this author Jay D Raman More articles by this author Viraj A Master More articles by this author Daniel D Shapiro More articles by this author Wade J Sexton More articles by this author A Watts More articles by this author Logan Zemp More articles by this author Logan Borregales More articles by this author Sarp Keskin More articles by this author Alyssa Bilotta More articles by this author Datta Patil More articles by this author Glenn O Allen More articles by this author Surena F Matin More articles by this author Jose A Karam More articles by this author Christopher G Wood More articles by this author Expand All Advertisement PDF downloadLoading ...