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PD48-05 INCREASED B4GALT1 EXPRESSION IS ASSOCIATED WITH ADVERSE ONCOLOGIC OUTCOMES IN LOCALIZED CLEAR CELL RENAL CELL CARCINOMA
THE JOURNAL OF UROLOGYâ
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patients cT1 to pT3a upstaging treated with either partial nephrectomy (PN) or radical nephrectomy (RN); however to date no studies have evaluated comparative outcomes for PN versus RN. We sought to characterize outcomes for cT1 to pT3a lesions treated with these modalities. METHODS: Our institutional renal mass registry was queried for patients with cT1 renal tumors upstaged to pT3a RCC. Cancerspecific survival and recurrence-free survival were evaluated using the Kaplan-Meier method and multivariable Cox proportional hazard regression. RESULTS: A total of 2,034 patients with a cT1 renal mass underwent extirpative surgery and 174 (8.5%) were upstaged to pT3a RCC. Upstaging was due to segmental renal vein invasion in 43 (24.7%), perinephric fat invasion in 100 (57.5%), and/or sinus fat invasion in 40 (23.0%). During a median follow-up of 43 months, upstaged patients had a greater risk of death from RCC (HR 3.3, 95%CI 1.7-6.7, p < 0.001) and recurrence (HR 2.2, 95%CI 1.6-3.1, p > 0.001) compared to non-upstaged patients. Of upstaged patients, 56 (32.2%) underwent PN and 118 (67.8%) underwent RN. On univariate analysis, PN was associated with superior CSS (p < 0.001) and RFS (p<0.001). However, on multivariable analysis, adjusting for tumor diameter, nuclear grade and tumor necrosis, there was no difference in CSS (p ¼ 1.0) or RFS (p ¼ 0.3) between interventions groups. CONCLUSIONS: Patients with cT1 renal tumors upstaged to pT3a RCC have worse oncologic outcomes than non upstaged patients. With intermediate-term follow-up, PN appears to offer equivalent oncologic outcomes to RN while also conveying the benefits of a nephron-sparing approach.
Vol. 195, No. 4S, Supplement, Tuesday, May 10, 2016
CONCLUSIONS: Laparoscopic partial nephrectomy offers same functional and oncological outcomes when compared to open surgery, with equivalent morbidity. In specialized centers, laparoscopic approach should be preferred due to its advantages related to surgical access.
Source of Funding: none
PD48-04 PROSPECTIVE RANDOMIZED TRIAL COMPARING OPEN TO LAPAROSCOPIC PARTIAL NEPHRECTOMY, INTERIM ANALYSIS. (NCT01809119) Giuliano Guglielmetti*, Sanarelly Adonias, Sao Paulo, Brazil; ~o Paulo, Brazil; Mauricio Cordeiro, Leonardo Borges, Rafael Coelho, Sa Roberto Colombo, Rodrigo Pessoa, Luiz Neves, Jose Pontes, Jose Adriano Nesrallah, Miguel Srougi, William Nahas, Sao Paulo, Brazil INTRODUCTION AND OBJECTIVES: Partial nephrectomy (PN) is the treatment of choice for T1a renal tumors (RT) and has progressively gained acceptance for the treatment of T1b and even bigger tumors. Despite no good quality evidence proving that minimally invasive surgery offers as good results as open surgery, it has been widely used for PN and is growing in usage especially after advent of robotic surgery. The objective of this study is to determine if laparoscopic partial nephrectomy can provide good functional and oncological outcomes with acceptable morbidity for the treatment of T1 RT. METHODS: Since 2013, patients with RT smaller than 7 cm are being recruited for the study. Inclusion criteria included: T1 RT, candidates for partial nephrectomy. Exclusion criteria are: anatomical or functional solitary kidney, multiple RTs and glomerular filtration rate (GFR) less than 30ml/min. Patients are randomized in 1:1 proportion into 2 groups: Group 1 e laparoscopic partial nephrectomy, Group 2 e open partial nephrectomy. GFR is measured with 51Cr-EDTA realized before, at 3 and 12 months after surgery. Unexpected events up to 3 months after surgery are considered surgical complications and classified following Clavien-Dindo Grading System. RESULTS: This is an interim analysis performed in may/2015. 110 patients had been randomized. 35 patients were excluded from analysis because didn’t have sufficient follow-up after surgery. Data from 34 patients in group 1 and 41 patients in group 2 were analyzed. Intra-operative and pathological data are presented in table 1. Group 2 patients had significantly less warm ischemia time. There was no difference in terms of surgical complications or GFR decrease 3 or 12 months after surgery (table 2).
Source of Funding: none
PD48-05 INCREASED B4GALT1 EXPRESSION IS ASSOCIATED WITH ADVERSE ONCOLOGIC OUTCOMES IN LOCALIZED CLEAR CELL RENAL CELL CARCINOMA Huyang Xie*, Qiang Fu, Xiaoqun Yang, Jiejie Xu, Dingwei Ye, Shanghai, China, People’s Republic of INTRODUCTION AND OBJECTIVES: B4GALT1 is one of seven beta-1,4-galactosyltransferase (beta4GalT) genes, which encode type II membrane-bound glycoproteins that appear to have exclusive specificity for the donor substrate UDP-galactose. According to previous studies aberrant B4GALT1 expression has distinct functions in different tumors. Here, we evaluate the association of B4GALT1 expression with oncologic outcomes in patients with localized clear cell renal cell carcinoma (ccRCC) managed by surgery. METHODS: A retrospective analysis of 207 and 231 patients with localized ccRCC undergoing RN or NSS at two academic medical centers respectively between 2005 and 2009 was performed. The first cohort with 207 patients was treated as training set and the other as validation set. Tissue microarrays (TMAs) were created in triplicate from formalin-fixed, paraffin embedded specimens. Immunohistochemistry with a commercially available monoclonal B4GALT1 antibody was performed with the intensity (0 to 3) and percentage (0 of 100) of staining recorded. The association of B4GALT1 expression with standard pathologic features and prognosis were evaluated. RESULTS: B4GALT1 expression was significantly associated with tumor T stage (P<0.001 and P<0.001, respectively), Fuhrman grade (P<0.001 and P<0.001, respectively) and necrosis (P¼0.021 and P¼0.002, respectively) in both training and validation sets. Moreover, high B4GALT1 expression indicated poor overall sruvival
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Tuesday, May 10, 2016
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(OS) (P<0.001 and P<0.001, respectively) in the two sets. The incorporation of B4GALT1 into T stage and Fuhrman grade would help to refine individual risk stratification. Furthermore, B4GALT1 expression was identified as an independent adverse prognostic factor for survival. A predictive nomogram was generated with identified independent prognositicators to assess patient overall survival at 5 and 10 years. CONCLUSIONS: Increased B4GALT1 expression is a potential independent adverse prognostic factor for overall survival in patients with localized ccRCC. Inhibting B4GALT1 pathway might be a promising target of postoperative adjuvant therapy for these ccRCC patients.
Source of Funding: none
PD48-06 THE ROLE OF METASTASECTOMY IN PATIENTS WITH RENAL CELL CARCINOMA WITH SARCOMATOID DEDIFFERENTIATION: A MATCHED CONTROLLED ANALYSIS Arun Thomas*, Mehrad Adibi, Rebecca Slack, Borregales Leonardo, Megan Merrill, Pheroze Tamboli, Kanishka Sircar, Eric Jonasch, Surena Matin, Christopher Wood, Jose Karam, Houston, TX INTRODUCTION AND OBJECTIVES: Renal cell carcinoma with sarcomatoid dedifferentiation (sRCC) is an aggressive tumor generally associated with a poor clinical course. Management of metastatic sRCC remains a therapeutic challenge with no standard treatment strategies. Our objective was to evaluate whether metastasectomy has any survival benefit in patients with synchronous or asynchronous metastatic sRCC treated with radical nephrectomy (RN) METHODS: From an institutional database of 273 patients with sRCC treated with nephrectomy, we matched 80 patients with synchronous and asynchronous metastasis for age, ECOG performance status, histology and nodal status. Matched pairs were then retained only if patients who did not undergo metastasectomy were comparably alive at the time of metastasectomy in matched surgical patients to reduce the bias in survival outcomes. Overall survival (OS) from nephrectomy was studied using univariable and multivariable proportional hazards regression. RESULTS: Median OS was 8.3 months (95%CI 6.5-10.5 months) and 18.5 months (95%CI 11.5-42.9 months) for patients with synchronous and asynchronous metastases, respectively. OS for patients undergoing metastasectomy for synchronous metastasis was comparable to non-surgical patients (8.4 and 8.0 months, respectively, p¼0.35). Similarly, within the asynchronous cohort, median OS was 36.2 months (95%CI 7.6-Not Reached) in the metastasectomy group and 13.7 months (95%CI 8.8-41.6) in the nonmetastasectomy group (p¼0.29). On multivariable analysis, positive lymph node (LN) at nephrectomy was associated with increased risk of death in both synchronous and asynchronous patients groups; (HR¼2.1 [95%CI 1.1-4.0] p¼0.03) and (HR¼3.3 [95%CI 1.2-9.2] p¼0.02), respectively CONCLUSIONS: Metastasectomy in patients with synchronous or asynchronous metastases after nephrectomy does not appear to confer significant survival benefit in patients with sRCC, particularly in patients with pathological LN positive disease at nephrectomy
Source of Funding: None
PD48-07 COMPARISON OF PERCUTANEOUS RADIOFREQUENCY ABLATION AND PARTIAL NEPHRECTOMY FOR TREATING T1A RCC IN SOLITARY KIDNEY PATIENTS Stephanie Boret*, Hedrik Dendooven, Maarten Albseren, Hein Van Poppel, Ben Van Cleynenbreugel, Liesbeth Dewever, Steven Joniau, Wouter Everaerts, Leuven, Belgium INTRODUCTION AND OBJECTIVES: Partial nephrectomy (PN) is currently considered the standard treatment option for patients with cT1a RCC. Percutaneous radiofrequency ablation (RFA) is a minimally invasive treatment with minimal morbidity and maximal preservation of renal function, albeit with higher rates of local recurrence, making it an interesting alternative for patients who are poor candidates for surgery or with metachronous tumours. Our aim is to compare the outcomes of percutaneous CT-guided radiofrequency ablation (RFA) versus partial nephrectomy (PN) for patients with T1a RCC lesions in a solitary kidney.
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patients cT1 to pT3a upstaging treated with either partial nephrectomy (PN) or radical nephrectomy (RN); however to date no studies have evaluated comparative outcomes for PN versus RN. We sought to characterize outcomes for cT1 to pT3a lesions treated with these modalities. METHODS: Our institutional renal mass registry was queried for patients with cT1 renal tumors upstaged to pT3a RCC. Cancerspecific survival and recurrence-free survival were evaluated using the Kaplan-Meier method and multivariable Cox proportional hazard regression. RESULTS: A total of 2,034 patients with a cT1 renal mass underwent extirpative surgery and 174 (8.5%) were upstaged to pT3a RCC. Upstaging was due to segmental renal vein invasion in 43 (24.7%), perinephric fat invasion in 100 (57.5%), and/or sinus fat invasion in 40 (23.0%). During a median follow-up of 43 months, upstaged patients had a greater risk of death from RCC (HR 3.3, 95%CI 1.7-6.7, p < 0.001) and recurrence (HR 2.2, 95%CI 1.6-3.1, p > 0.001) compared to non-upstaged patients. Of upstaged patients, 56 (32.2%) underwent PN and 118 (67.8%) underwent RN. On univariate analysis, PN was associated with superior CSS (p < 0.001) and RFS (p<0.001). However, on multivariable analysis, adjusting for tumor diameter, nuclear grade and tumor necrosis, there was no difference in CSS (p ¼ 1.0) or RFS (p ¼ 0.3) between interventions groups. CONCLUSIONS: Patients with cT1 renal tumors upstaged to pT3a RCC have worse oncologic outcomes than non upstaged patients. With intermediate-term follow-up, PN appears to offer equivalent oncologic outcomes to RN while also conveying the benefits of a nephron-sparing approach.
Vol. 195, No. 4S, Supplement, Tuesday, May 10, 2016
CONCLUSIONS: Laparoscopic partial nephrectomy offers same functional and oncological outcomes when compared to open surgery, with equivalent morbidity. In specialized centers, laparoscopic approach should be preferred due to its advantages related to surgical access.
Source of Funding: none
PD48-04 PROSPECTIVE RANDOMIZED TRIAL COMPARING OPEN TO LAPAROSCOPIC PARTIAL NEPHRECTOMY, INTERIM ANALYSIS. (NCT01809119) Giuliano Guglielmetti*, Sanarelly Adonias, Sao Paulo, Brazil; ~o Paulo, Brazil; Mauricio Cordeiro, Leonardo Borges, Rafael Coelho, Sa Roberto Colombo, Rodrigo Pessoa, Luiz Neves, Jose Pontes, Jose Adriano Nesrallah, Miguel Srougi, William Nahas, Sao Paulo, Brazil INTRODUCTION AND OBJECTIVES: Partial nephrectomy (PN) is the treatment of choice for T1a renal tumors (RT) and has progressively gained acceptance for the treatment of T1b and even bigger tumors. Despite no good quality evidence proving that minimally invasive surgery offers as good results as open surgery, it has been widely used for PN and is growing in usage especially after advent of robotic surgery. The objective of this study is to determine if laparoscopic partial nephrectomy can provide good functional and oncological outcomes with acceptable morbidity for the treatment of T1 RT. METHODS: Since 2013, patients with RT smaller than 7 cm are being recruited for the study. Inclusion criteria included: T1 RT, candidates for partial nephrectomy. Exclusion criteria are: anatomical or functional solitary kidney, multiple RTs and glomerular filtration rate (GFR) less than 30ml/min. Patients are randomized in 1:1 proportion into 2 groups: Group 1 e laparoscopic partial nephrectomy, Group 2 e open partial nephrectomy. GFR is measured with 51Cr-EDTA realized before, at 3 and 12 months after surgery. Unexpected events up to 3 months after surgery are considered surgical complications and classified following Clavien-Dindo Grading System. RESULTS: This is an interim analysis performed in may/2015. 110 patients had been randomized. 35 patients were excluded from analysis because didn’t have sufficient follow-up after surgery. Data from 34 patients in group 1 and 41 patients in group 2 were analyzed. Intra-operative and pathological data are presented in table 1. Group 2 patients had significantly less warm ischemia time. There was no difference in terms of surgical complications or GFR decrease 3 or 12 months after surgery (table 2).
Source of Funding: none
PD48-05 INCREASED B4GALT1 EXPRESSION IS ASSOCIATED WITH ADVERSE ONCOLOGIC OUTCOMES IN LOCALIZED CLEAR CELL RENAL CELL CARCINOMA Huyang Xie*, Qiang Fu, Xiaoqun Yang, Jiejie Xu, Dingwei Ye, Shanghai, China, People’s Republic of INTRODUCTION AND OBJECTIVES: B4GALT1 is one of seven beta-1,4-galactosyltransferase (beta4GalT) genes, which encode type II membrane-bound glycoproteins that appear to have exclusive specificity for the donor substrate UDP-galactose. According to previous studies aberrant B4GALT1 expression has distinct functions in different tumors. Here, we evaluate the association of B4GALT1 expression with oncologic outcomes in patients with localized clear cell renal cell carcinoma (ccRCC) managed by surgery. METHODS: A retrospective analysis of 207 and 231 patients with localized ccRCC undergoing RN or NSS at two academic medical centers respectively between 2005 and 2009 was performed. The first cohort with 207 patients was treated as training set and the other as validation set. Tissue microarrays (TMAs) were created in triplicate from formalin-fixed, paraffin embedded specimens. Immunohistochemistry with a commercially available monoclonal B4GALT1 antibody was performed with the intensity (0 to 3) and percentage (0 of 100) of staining recorded. The association of B4GALT1 expression with standard pathologic features and prognosis were evaluated. RESULTS: B4GALT1 expression was significantly associated with tumor T stage (P<0.001 and P<0.001, respectively), Fuhrman grade (P<0.001 and P<0.001, respectively) and necrosis (P¼0.021 and P¼0.002, respectively) in both training and validation sets. Moreover, high B4GALT1 expression indicated poor overall sruvival
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Tuesday, May 10, 2016
e1177
(OS) (P<0.001 and P<0.001, respectively) in the two sets. The incorporation of B4GALT1 into T stage and Fuhrman grade would help to refine individual risk stratification. Furthermore, B4GALT1 expression was identified as an independent adverse prognostic factor for survival. A predictive nomogram was generated with identified independent prognositicators to assess patient overall survival at 5 and 10 years. CONCLUSIONS: Increased B4GALT1 expression is a potential independent adverse prognostic factor for overall survival in patients with localized ccRCC. Inhibting B4GALT1 pathway might be a promising target of postoperative adjuvant therapy for these ccRCC patients.
Source of Funding: none
PD48-06 THE ROLE OF METASTASECTOMY IN PATIENTS WITH RENAL CELL CARCINOMA WITH SARCOMATOID DEDIFFERENTIATION: A MATCHED CONTROLLED ANALYSIS Arun Thomas*, Mehrad Adibi, Rebecca Slack, Borregales Leonardo, Megan Merrill, Pheroze Tamboli, Kanishka Sircar, Eric Jonasch, Surena Matin, Christopher Wood, Jose Karam, Houston, TX INTRODUCTION AND OBJECTIVES: Renal cell carcinoma with sarcomatoid dedifferentiation (sRCC) is an aggressive tumor generally associated with a poor clinical course. Management of metastatic sRCC remains a therapeutic challenge with no standard treatment strategies. Our objective was to evaluate whether metastasectomy has any survival benefit in patients with synchronous or asynchronous metastatic sRCC treated with radical nephrectomy (RN) METHODS: From an institutional database of 273 patients with sRCC treated with nephrectomy, we matched 80 patients with synchronous and asynchronous metastasis for age, ECOG performance status, histology and nodal status. Matched pairs were then retained only if patients who did not undergo metastasectomy were comparably alive at the time of metastasectomy in matched surgical patients to reduce the bias in survival outcomes. Overall survival (OS) from nephrectomy was studied using univariable and multivariable proportional hazards regression. RESULTS: Median OS was 8.3 months (95%CI 6.5-10.5 months) and 18.5 months (95%CI 11.5-42.9 months) for patients with synchronous and asynchronous metastases, respectively. OS for patients undergoing metastasectomy for synchronous metastasis was comparable to non-surgical patients (8.4 and 8.0 months, respectively, p¼0.35). Similarly, within the asynchronous cohort, median OS was 36.2 months (95%CI 7.6-Not Reached) in the metastasectomy group and 13.7 months (95%CI 8.8-41.6) in the nonmetastasectomy group (p¼0.29). On multivariable analysis, positive lymph node (LN) at nephrectomy was associated with increased risk of death in both synchronous and asynchronous patients groups; (HR¼2.1 [95%CI 1.1-4.0] p¼0.03) and (HR¼3.3 [95%CI 1.2-9.2] p¼0.02), respectively CONCLUSIONS: Metastasectomy in patients with synchronous or asynchronous metastases after nephrectomy does not appear to confer significant survival benefit in patients with sRCC, particularly in patients with pathological LN positive disease at nephrectomy
Source of Funding: None
PD48-07 COMPARISON OF PERCUTANEOUS RADIOFREQUENCY ABLATION AND PARTIAL NEPHRECTOMY FOR TREATING T1A RCC IN SOLITARY KIDNEY PATIENTS Stephanie Boret*, Hedrik Dendooven, Maarten Albseren, Hein Van Poppel, Ben Van Cleynenbreugel, Liesbeth Dewever, Steven Joniau, Wouter Everaerts, Leuven, Belgium INTRODUCTION AND OBJECTIVES: Partial nephrectomy (PN) is currently considered the standard treatment option for patients with cT1a RCC. Percutaneous radiofrequency ablation (RFA) is a minimally invasive treatment with minimal morbidity and maximal preservation of renal function, albeit with higher rates of local recurrence, making it an interesting alternative for patients who are poor candidates for surgery or with metachronous tumours. Our aim is to compare the outcomes of percutaneous CT-guided radiofrequency ablation (RFA) versus partial nephrectomy (PN) for patients with T1a RCC lesions in a solitary kidney.