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1073 CLINICAL PREDICTORS FOR THE DEVELOPMENT OF PULMONARY METASTASES AMONG RCC PATIENTS WITH INDETERMINATE PULMONARY NODULES
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THE JOURNAL OF UROLOGY姞
Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
1073 CLINICAL PREDICTORS FOR THE DEVELOPMENT OF PULMONARY METASTASES AMONG RCC PATIENTS WITH INDETERMINATE PULMONARY NODULES Patrick Kenney*, Jose Karam, Houston, TX; Ryan Levey, Charleston, SC; Graciela Nogueras-Gonzalez, Surena Matin, Pheroze Tamboli, Nizar Tannir, Christopher Wood, Houston, TX
Source of Funding: None
1072 FLUORESCENCE IN SITU HYBRIDIZATION AND ARRAY-COMPARATIVE GENOMIC HYBRIDIZATION FROM PERCUTANEOUS NEEDLE BIOPSY COMPARED TO RENAL MASS HISTOLOGY Kelly Stratton*, Massimiliano Spaliviero, Timothy Donahue, New York, NY; Banumathy Gowrishankar, Charles Ma, Rutherford, NJ; Jeremy Durack, Stephen Solomon, New York, NY; Jane Houldsworth, Rutherford, NJ; Jonathan Coleman, New York, NY INTRODUCTION AND OBJECTIVES: Image-guided percutaneous needle biopsies are increasingly utilized for the diagnosis of renal tumors. Histologic subtypes including clear cell (ccRCC), papillary (pRCC), and chromophobe (chrRCC) renal cell carcinoma, and oncocytomas (OC) can be challenging to diagnosis due to the low cellularity and damaged architecture of needle biopsy specimens. However each subtype exhibits unique genetic aberrations that could assist histologic classification and guide management decisions. We report our initial experience correlating renal mass histology to subtype-associated genomic alterations detected by fluorescence in situ hybridization (FISH) and array-comparative genomic hybridization (aCGH) of percutaneous needle biopsy specimens. METHODS: In an ongoing IRB-approved blinded study, 17 samples obtained from 15 patients with known renal masses were submitted to FISH (FReCaDTM) and targeted aCGH (UroGenRATMKidney). Specimens were classified using a subtype classification decision tree algorithm based on the presence/absence of genomic abnormalities. The results were compared to biopsy histology and surgical specimen when available. RESULTS: Histology revealed ccRCC in 6 patients, pRCC in 4, OC in 2, Angiomyolipoma in 1, and unclassified type RCC in 2. In 6 of 9 cases FISH achieved a diagnosis, which correlated with histology in 4. FISH incorrectly classified as ccRCC two cases with pRCC on histology. aCGH was diagnostic in 14 of 15 cases and correlated with histology in 13. In one case, aCGH showed a genomic profile not consistent with ccRCC, pRCC, chrRCC, or OC according to the algorithm. CONCLUSIONS: The addition of genetic tumor tissue studies to complement histology from biopsy tissues may supplement or improve the accuracy of classification and biological characterization of renal tumor biopsies and influence treatment planning. In our initial experience, aCGH showed better correlation with histology in subtype classification of malignant and benign renal masses than FISH. Prospective testing will be required to validate these results. Source of Funding: NCI: 1R44CA139667 FISH-based assay for cancer detection
INTRODUCTION AND OBJECTIVES: Indeterminate pulmonary nodules are of uncertain significance in RCC patients. We sought to determine the natural history of indeterminate pulmonary nodules in patients undergoing radical nephrectomy and to identify clinical variables associated with the development of lung metastases. METHODS: We reviewed all radical nephrectomy patients at a single institution from 2005 - 2009 who had ⱖ1 indeterminate non⫺calcified lesion on chest CT within 6 months prior to surgery and no evidence of distant metastatic disease (n⫽273). Patients were excluded for history of metastatic non⫺kidney primary (n⫽16) or if the nephrectomy was not for RCC (n⫽8). Univariate and multivariate analyses were used to model the relationship between developing pulmonary metastasis and potential predictors. RESULTS: Of 249 patients, 62 (21.5%) developed pulmonary metastases. Median follow⫺up was similar in the groups who did and did not develop pulmonary metastases (35.5 vs 38.7 months, p ⫽ 0.168). On univariate analysis, those who developed lung metastases were more often female (74.2 vs. 59.4%, p ⫽0.036), less often had ECOG 0 (14.5 vs. 37.1%, p ⫽ 0.001) and less often had an incidental presentation (12.9 vs. 42.2%, p ⬍ 0.001) than those who did not develop lung metastases. Subsequent pulmonary metastases were also associated with larger primary tumors (median 8.6 vs 7.0 cm, p⬍0.001), higher creatinine (median 1.2 vs. 1.0 mg/dL, p⫽0.008), and lower hemoglobin (median 12.8 vs. 13.4 g/dL, p ⫽ 0.001). There was a trend toward lower LDH among patients who developed pulmonary metastases (median 418 vs 471 IU/L, p ⫽ 0.050). Those who developed lung metastases had more indeterminate nodules (median 4 vs 3, p ⫽ 0.003) and larger maximum nodule size (median 5.0 vs 4.0 mm, p ⫽ 0.007). There was no difference in the rates of co⫺existing effusion or calcified nodules. On multivariate analysis, larger primary tumor was associated with developing pulmonary metastases (OR 1.16, p ⫽ 0.010), but nodule number and size were not. Male gender was associated with reduced risk (OR 0.45, p ⫽ 0.046) and ECOG performance status ⱖ1 was associated with increased risk (OR 2.76, p ⫽ 0.019) of future lung metastases. CONCLUSIONS: A minority of RCC patients with indeterminate pulmonary nodules prior to radical nephrectomy develop pulmonary metastases. Independent preoperative predictors of developing pulmonary metastases include size of primary tumor, female gender, and ECOG performance status ⱖ1 . Source of Funding: None
1074 IMPACT OF CLINICAL AND HISTOPATHOLOGICAL PARAMETERS ON DISEASE-SPECIFIC SURVIVAL IN PATIENTS WITH COLLECTING DUCT RENAL CELL CARCINOMA Sabine Brookman-May*, Munich, Germany; Matthias May, Straubing, Germany; Shahrokh Shariat, New York, NY; Richard Zigeuner, Graz, Austria; Luca Cindolo, Vasto, Italy; Sascha Pahernik, Heidelberg, Germany; Alessandro Volpe, Novara, Italy; Christian Stief, Munich, Germany; Vincenzo Ficarra, Padua, Italy; Andreas Becker, Hamburg, Germany; Sven Gunia, Stendal, Germany; Felix Chun, Hamburg, Germany; Giacomo Novara, Padua, Italy INTRODUCTION AND OBJECTIVES: Collecting duct renal cell carcinoma (CDRCC) is a rare and aggressive histological RCC subtype. Few studies have evaluated the oncological outcome of CDRCC patients based on clinical and pathological parameters. The aim of the present study was to assess parameters prognostic for disease-specific mortality (DSM) in CDRCC patients based on the largest database reported today with exception of population-based studies.
THE JOURNAL OF UROLOGY姞
Vol. 189, No. 4S, Supplement, Monday, May 6, 2013
1073 CLINICAL PREDICTORS FOR THE DEVELOPMENT OF PULMONARY METASTASES AMONG RCC PATIENTS WITH INDETERMINATE PULMONARY NODULES Patrick Kenney*, Jose Karam, Houston, TX; Ryan Levey, Charleston, SC; Graciela Nogueras-Gonzalez, Surena Matin, Pheroze Tamboli, Nizar Tannir, Christopher Wood, Houston, TX
Source of Funding: None
1072 FLUORESCENCE IN SITU HYBRIDIZATION AND ARRAY-COMPARATIVE GENOMIC HYBRIDIZATION FROM PERCUTANEOUS NEEDLE BIOPSY COMPARED TO RENAL MASS HISTOLOGY Kelly Stratton*, Massimiliano Spaliviero, Timothy Donahue, New York, NY; Banumathy Gowrishankar, Charles Ma, Rutherford, NJ; Jeremy Durack, Stephen Solomon, New York, NY; Jane Houldsworth, Rutherford, NJ; Jonathan Coleman, New York, NY INTRODUCTION AND OBJECTIVES: Image-guided percutaneous needle biopsies are increasingly utilized for the diagnosis of renal tumors. Histologic subtypes including clear cell (ccRCC), papillary (pRCC), and chromophobe (chrRCC) renal cell carcinoma, and oncocytomas (OC) can be challenging to diagnosis due to the low cellularity and damaged architecture of needle biopsy specimens. However each subtype exhibits unique genetic aberrations that could assist histologic classification and guide management decisions. We report our initial experience correlating renal mass histology to subtype-associated genomic alterations detected by fluorescence in situ hybridization (FISH) and array-comparative genomic hybridization (aCGH) of percutaneous needle biopsy specimens. METHODS: In an ongoing IRB-approved blinded study, 17 samples obtained from 15 patients with known renal masses were submitted to FISH (FReCaDTM) and targeted aCGH (UroGenRATMKidney). Specimens were classified using a subtype classification decision tree algorithm based on the presence/absence of genomic abnormalities. The results were compared to biopsy histology and surgical specimen when available. RESULTS: Histology revealed ccRCC in 6 patients, pRCC in 4, OC in 2, Angiomyolipoma in 1, and unclassified type RCC in 2. In 6 of 9 cases FISH achieved a diagnosis, which correlated with histology in 4. FISH incorrectly classified as ccRCC two cases with pRCC on histology. aCGH was diagnostic in 14 of 15 cases and correlated with histology in 13. In one case, aCGH showed a genomic profile not consistent with ccRCC, pRCC, chrRCC, or OC according to the algorithm. CONCLUSIONS: The addition of genetic tumor tissue studies to complement histology from biopsy tissues may supplement or improve the accuracy of classification and biological characterization of renal tumor biopsies and influence treatment planning. In our initial experience, aCGH showed better correlation with histology in subtype classification of malignant and benign renal masses than FISH. Prospective testing will be required to validate these results. Source of Funding: NCI: 1R44CA139667 FISH-based assay for cancer detection
INTRODUCTION AND OBJECTIVES: Indeterminate pulmonary nodules are of uncertain significance in RCC patients. We sought to determine the natural history of indeterminate pulmonary nodules in patients undergoing radical nephrectomy and to identify clinical variables associated with the development of lung metastases. METHODS: We reviewed all radical nephrectomy patients at a single institution from 2005 - 2009 who had ⱖ1 indeterminate non⫺calcified lesion on chest CT within 6 months prior to surgery and no evidence of distant metastatic disease (n⫽273). Patients were excluded for history of metastatic non⫺kidney primary (n⫽16) or if the nephrectomy was not for RCC (n⫽8). Univariate and multivariate analyses were used to model the relationship between developing pulmonary metastasis and potential predictors. RESULTS: Of 249 patients, 62 (21.5%) developed pulmonary metastases. Median follow⫺up was similar in the groups who did and did not develop pulmonary metastases (35.5 vs 38.7 months, p ⫽ 0.168). On univariate analysis, those who developed lung metastases were more often female (74.2 vs. 59.4%, p ⫽0.036), less often had ECOG 0 (14.5 vs. 37.1%, p ⫽ 0.001) and less often had an incidental presentation (12.9 vs. 42.2%, p ⬍ 0.001) than those who did not develop lung metastases. Subsequent pulmonary metastases were also associated with larger primary tumors (median 8.6 vs 7.0 cm, p⬍0.001), higher creatinine (median 1.2 vs. 1.0 mg/dL, p⫽0.008), and lower hemoglobin (median 12.8 vs. 13.4 g/dL, p ⫽ 0.001). There was a trend toward lower LDH among patients who developed pulmonary metastases (median 418 vs 471 IU/L, p ⫽ 0.050). Those who developed lung metastases had more indeterminate nodules (median 4 vs 3, p ⫽ 0.003) and larger maximum nodule size (median 5.0 vs 4.0 mm, p ⫽ 0.007). There was no difference in the rates of co⫺existing effusion or calcified nodules. On multivariate analysis, larger primary tumor was associated with developing pulmonary metastases (OR 1.16, p ⫽ 0.010), but nodule number and size were not. Male gender was associated with reduced risk (OR 0.45, p ⫽ 0.046) and ECOG performance status ⱖ1 was associated with increased risk (OR 2.76, p ⫽ 0.019) of future lung metastases. CONCLUSIONS: A minority of RCC patients with indeterminate pulmonary nodules prior to radical nephrectomy develop pulmonary metastases. Independent preoperative predictors of developing pulmonary metastases include size of primary tumor, female gender, and ECOG performance status ⱖ1 . Source of Funding: None
1074 IMPACT OF CLINICAL AND HISTOPATHOLOGICAL PARAMETERS ON DISEASE-SPECIFIC SURVIVAL IN PATIENTS WITH COLLECTING DUCT RENAL CELL CARCINOMA Sabine Brookman-May*, Munich, Germany; Matthias May, Straubing, Germany; Shahrokh Shariat, New York, NY; Richard Zigeuner, Graz, Austria; Luca Cindolo, Vasto, Italy; Sascha Pahernik, Heidelberg, Germany; Alessandro Volpe, Novara, Italy; Christian Stief, Munich, Germany; Vincenzo Ficarra, Padua, Italy; Andreas Becker, Hamburg, Germany; Sven Gunia, Stendal, Germany; Felix Chun, Hamburg, Germany; Giacomo Novara, Padua, Italy INTRODUCTION AND OBJECTIVES: Collecting duct renal cell carcinoma (CDRCC) is a rare and aggressive histological RCC subtype. Few studies have evaluated the oncological outcome of CDRCC patients based on clinical and pathological parameters. The aim of the present study was to assess parameters prognostic for disease-specific mortality (DSM) in CDRCC patients based on the largest database reported today with exception of population-based studies.