- Email: [email protected]
MP57-06 LIMITED BENEFIT OF TARGETED THERAPIES ON IVC THROMBUS IN RENAL CELL CARCINOMA
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
Table 2 Surgical outcomes according to clinical T stage Variables
T1
Number
270
In-hospital mortality
9 (3.3%)
Overall perioperative
21 (7.8%)
complications Pulmonary embolism
0 (0.0%)
Cardiacac events
6 (2.2%)
Stroke
0 (0.0%)
Pneumonia
1 (0.4%)
Acute renal failure
1 (0.4%)
Peritonitis
0 (0.0%)
Ileus
3 (1.1%)
Urinary tract infection
0 (0.0%)
Wound dehiscence
2 (0.7%)
Sepsis/DIC
4 (1.5%)
Blood transfusion
37 (13.7%)
Anesthesia time
250 (191-310)
(median, IQR) PLOS (median, IQR)
11 (9-17)
Total cost (US$) (median, IQR)
14539 (11987-18563)
Variables
T2
T3
T4
215
479
110
In-hospital mortality
5 (2.3%)
14 (2.9%)
8 (7.3%)
0.103
Overall perioperative
25 (11.6%)
60 (12.5%)
18 (16.4%)
0.082
0 (0.0%)
1 (0.2%)
1 (0.9%)
0.260
5 (2.3%)
15 (3.1%)
3 (2.7%)
0.876
0 (0.0%)
1 (0.2%)
1 (0.9%)
0.260
0 (0.0%)
2 (0.4%)
1 (0.9%)
0.641
0 (0.0%)
3 (0.6%)
1 (0.9%)
0.617
1 (0.5%)
2 (0.4%)
1 (0.9%)
0.585
5 (2.3%)
2 (0.4%)
2 (1.8%)
0.141
4 (1.9%)
6 (1.3%)
0 (0.0%)
0.106
3 (1.4%)
2 (0.4%)
0 (0.0%)
0.392
4 (1.9%)
15 (3.1%)
6 (5.5%)
Blood transfusion
75 (34.9%)
220 (45.9%)
62 (56.4%)
<0.001
Anesthesia time (median, IQR)
275 (220-356)
356 (250-450)
<0.001
Number
e643
decrease of IVC thrombus height with TMT and those who did not show any decrease. RESULTS: 14 (74%) of the patients were male, and the mean age of the group was 66 years. The left side of the kidney had primary tumors in 11 patients and the right side in 8. Before the therapy thrombus level waszTin 2 patients (11%), zU in 9 (47%), zV in 4 (21%), and zW in 4 (21%). The median duration of therapy was 2 cycles. Following therapy, the tumor thrombus increased in height in 4 patients (21%), remained the same in 1 casei5%j, and decreased in 14 (74%). However, the mean reduction of the thrombus height was only 14mm. The thrombus level decreased only in 3 patients (16%), all of whom were treated with sunitinib. After TMT, 10 patients (43%) received thrombectomy. Comparison of all the data collected between the two groups failed to demonstrate any statistically significant factors, although a high neutrophil count and clinical node metastases were marginally statistic. CONCLUSIONS: Our study showed the clinical benefit of targeted therapies on IVC thrombus of the renal cell carcinoma was limited. Thus targeted therapy in the neoadjuvant setting can be considered in selected patients.
p
complications
PLOS (median, IQR) Total cost (US$) (median, IQR)
317 (251-410)
13 (9-19)
15 (10-26)
18 (11-36)
15193
16768
18682
(12356-20282)
(12676-25935)
(15074-29172)
0.132
<0.001
Source of Funding: none
<0.001
PLOS: postoperative length of stay,DIC: disseminated intravascular coagulation,IQR: interquartile range
Source of Funding: none
MP57-06 LIMITED BENEFIT OF TARGETED THERAPIES ON IVC THROMBUS IN RENAL CELL CARCINOMA Hironori Fukuda*, Tsunenoi Kondo, Kenji Omae, Hirohito Kobayashi, Jumpei Iizuka, Kazunari Tanabe, Tokyo, Japan INTRODUCTION AND OBJECTIVES: The standard treatment for patients with renal cell carcinoma extending into the inferior vena cava is radical nephrectomy and tumor thrombectomy. However, not all patients are eligible for surgery, and in some cases targeted therapies are needed because of their potential to downsize the tumor. But the clinical benefit of targeted therapies on vena caval tumor thrombus of RCC remains unclear. Objective: To evaluate the cytoreductive effects of targeted therapies on renal cell carcinoma with inferior vena caval tumor thrombus (IVC thrombus). METHODS: 19 patients with IVC thrombus who were treated with targeted molecular therapies (TMT) at our hospital were retrospectively analyzed. Sunitinib was administered in 17 patients, sorafenib in 1, and temsirolimus in 1. Thrombus size and level before and after TMT were measured by enhanced CT or MRI. Patients and tumor characteristics were compared between the patients who showed
MP57-07 ELEVATED BLOOD EOSINOPHIL LEVEL PREDICTS BETTER RESPONSE AND LONGER SURVIVAL IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA TREATED BY SORAFENIB Hai-liang Zhang*, Hongkai Wang, Ding-wei Ye, Shanghai, China, People’s Republic of INTRODUCTION AND OBJECTIVES: Previous studies on the predictive or prognostic factors for metastatic renal cell carcinoma (mRCC) have not included blood eosinophil level. It was hypothesized that this biomarker could have predictive value for the patients treated by sorafenib. METHODS: Sorafenib was administered to 146 clear cell subtype mRCC patients according to an institutional treatment protocol from Jun 2006 to Dec 2011. Before treatment and every 2 weeks after first administration of sorafenib, routine blood test including eosinophil level was performed. Oncological evaluation was performed every 8 weeks. ANOVA test was used to compare the treatment response to the blood eosinophil level. Kaplan-Meier and Cox regression analyses on progression free survival were performed. RESULTS: Baseline eosinophil percentage ranged from 0.5% to 4.3%, and 48 (32.9%) patients had an elevated eosinophil level higher than 5.0% at one month after sorafenib treatment. The best responses for the 146 patients were 3 CR (2.1%), 36 PR (24.6%), 96 SD (65.8%), and 11 PD (7.5%), with a median progression free survival (PFS) of 12.3 months and an overall survival time (OS) of 31.6 months. The eosinophil levels at one month after first drug administration were
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
Table 2 Surgical outcomes according to clinical T stage Variables
T1
Number
270
In-hospital mortality
9 (3.3%)
Overall perioperative
21 (7.8%)
complications Pulmonary embolism
0 (0.0%)
Cardiacac events
6 (2.2%)
Stroke
0 (0.0%)
Pneumonia
1 (0.4%)
Acute renal failure
1 (0.4%)
Peritonitis
0 (0.0%)
Ileus
3 (1.1%)
Urinary tract infection
0 (0.0%)
Wound dehiscence
2 (0.7%)
Sepsis/DIC
4 (1.5%)
Blood transfusion
37 (13.7%)
Anesthesia time
250 (191-310)
(median, IQR) PLOS (median, IQR)
11 (9-17)
Total cost (US$) (median, IQR)
14539 (11987-18563)
Variables
T2
T3
T4
215
479
110
In-hospital mortality
5 (2.3%)
14 (2.9%)
8 (7.3%)
0.103
Overall perioperative
25 (11.6%)
60 (12.5%)
18 (16.4%)
0.082
0 (0.0%)
1 (0.2%)
1 (0.9%)
0.260
5 (2.3%)
15 (3.1%)
3 (2.7%)
0.876
0 (0.0%)
1 (0.2%)
1 (0.9%)
0.260
0 (0.0%)
2 (0.4%)
1 (0.9%)
0.641
0 (0.0%)
3 (0.6%)
1 (0.9%)
0.617
1 (0.5%)
2 (0.4%)
1 (0.9%)
0.585
5 (2.3%)
2 (0.4%)
2 (1.8%)
0.141
4 (1.9%)
6 (1.3%)
0 (0.0%)
0.106
3 (1.4%)
2 (0.4%)
0 (0.0%)
0.392
4 (1.9%)
15 (3.1%)
6 (5.5%)
Blood transfusion
75 (34.9%)
220 (45.9%)
62 (56.4%)
<0.001
Anesthesia time (median, IQR)
275 (220-356)
356 (250-450)
<0.001
Number
e643
decrease of IVC thrombus height with TMT and those who did not show any decrease. RESULTS: 14 (74%) of the patients were male, and the mean age of the group was 66 years. The left side of the kidney had primary tumors in 11 patients and the right side in 8. Before the therapy thrombus level waszTin 2 patients (11%), zU in 9 (47%), zV in 4 (21%), and zW in 4 (21%). The median duration of therapy was 2 cycles. Following therapy, the tumor thrombus increased in height in 4 patients (21%), remained the same in 1 casei5%j, and decreased in 14 (74%). However, the mean reduction of the thrombus height was only 14mm. The thrombus level decreased only in 3 patients (16%), all of whom were treated with sunitinib. After TMT, 10 patients (43%) received thrombectomy. Comparison of all the data collected between the two groups failed to demonstrate any statistically significant factors, although a high neutrophil count and clinical node metastases were marginally statistic. CONCLUSIONS: Our study showed the clinical benefit of targeted therapies on IVC thrombus of the renal cell carcinoma was limited. Thus targeted therapy in the neoadjuvant setting can be considered in selected patients.
p
complications
PLOS (median, IQR) Total cost (US$) (median, IQR)
317 (251-410)
13 (9-19)
15 (10-26)
18 (11-36)
15193
16768
18682
(12356-20282)
(12676-25935)
(15074-29172)
0.132
<0.001
Source of Funding: none
<0.001
PLOS: postoperative length of stay,DIC: disseminated intravascular coagulation,IQR: interquartile range
Source of Funding: none
MP57-06 LIMITED BENEFIT OF TARGETED THERAPIES ON IVC THROMBUS IN RENAL CELL CARCINOMA Hironori Fukuda*, Tsunenoi Kondo, Kenji Omae, Hirohito Kobayashi, Jumpei Iizuka, Kazunari Tanabe, Tokyo, Japan INTRODUCTION AND OBJECTIVES: The standard treatment for patients with renal cell carcinoma extending into the inferior vena cava is radical nephrectomy and tumor thrombectomy. However, not all patients are eligible for surgery, and in some cases targeted therapies are needed because of their potential to downsize the tumor. But the clinical benefit of targeted therapies on vena caval tumor thrombus of RCC remains unclear. Objective: To evaluate the cytoreductive effects of targeted therapies on renal cell carcinoma with inferior vena caval tumor thrombus (IVC thrombus). METHODS: 19 patients with IVC thrombus who were treated with targeted molecular therapies (TMT) at our hospital were retrospectively analyzed. Sunitinib was administered in 17 patients, sorafenib in 1, and temsirolimus in 1. Thrombus size and level before and after TMT were measured by enhanced CT or MRI. Patients and tumor characteristics were compared between the patients who showed
MP57-07 ELEVATED BLOOD EOSINOPHIL LEVEL PREDICTS BETTER RESPONSE AND LONGER SURVIVAL IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA TREATED BY SORAFENIB Hai-liang Zhang*, Hongkai Wang, Ding-wei Ye, Shanghai, China, People’s Republic of INTRODUCTION AND OBJECTIVES: Previous studies on the predictive or prognostic factors for metastatic renal cell carcinoma (mRCC) have not included blood eosinophil level. It was hypothesized that this biomarker could have predictive value for the patients treated by sorafenib. METHODS: Sorafenib was administered to 146 clear cell subtype mRCC patients according to an institutional treatment protocol from Jun 2006 to Dec 2011. Before treatment and every 2 weeks after first administration of sorafenib, routine blood test including eosinophil level was performed. Oncological evaluation was performed every 8 weeks. ANOVA test was used to compare the treatment response to the blood eosinophil level. Kaplan-Meier and Cox regression analyses on progression free survival were performed. RESULTS: Baseline eosinophil percentage ranged from 0.5% to 4.3%, and 48 (32.9%) patients had an elevated eosinophil level higher than 5.0% at one month after sorafenib treatment. The best responses for the 146 patients were 3 CR (2.1%), 36 PR (24.6%), 96 SD (65.8%), and 11 PD (7.5%), with a median progression free survival (PFS) of 12.3 months and an overall survival time (OS) of 31.6 months. The eosinophil levels at one month after first drug administration were