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1256 CIGARETTE SMOKING IS ASSOCIATED WITH ADVANCED RENAL CELL CARCINOMA
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THE JOURNAL OF UROLOGY姞
strated RN (OR 2.93, p⫽0.0107), preoperative (OR 1.98, p⫽0.037) and postoperative (OR 7.89, p⬍0.001) GFR ⬍60 mL/min/1.73m2 as significantly associated with HL development after surgery. CONCLUSIONS: Patients who underwent RN had significantly higher incidence of de novo HL compared to a contemporary, wellmatched cohort that underwent NSS. In addition to RN, preoperative and postoperative eGFR⬍60 were also significantly associated with development of HL. Further investigation on effects of nephron loss on lipid metabolism is requisite. Source of Funding: None
1254 POSITIVE SURGICAL MARGINS AFTER PARTIAL NEPHRECTOMY FOR PT1 LOCALIZED RENAL CELL CARCINOMA: LOCAL RECURRENCE AND RCC-SPECIFIC SURVIVAL William Faust, M.D.*, Cambridge, MA; Patrick Kenney, Alireza Moinzadeh, John Libertino, Burlington, MA INTRODUCTION AND OBJECTIVES: In patients undergoing partial nephrectomy for localized Renal Cell Carcinoma (RCC), positive surgical margin (PSM) is thought to increase the risk of local recurrence. Fewer than 200 cases of PSM after partial nephrectomy have been described in the literature. Our objective is to describe the natural history of 26 patients with PSM following partial nephrectomy for RCC. METHODS: We identified 1044 patients who underwent partial nephrectomy at a single institution from 1988 to 2010. 50 of these patients had PSM (4.8%). Patients with familial kidney cancer, benign pathology, ⱖpT2 disease, or follow up less than 6 months were excluded (n ⫽ 24). Clinical, pathological, and follow up data were analyzed for the remaining cohort (n ⫽ 26). RCC-specific survival and local recurrence, defined as imaging with a persistent enhancing lesion in the area of resection or biopsy proven recurrence, were calculated. RESULTS: Mean age at diagnosis was 63 ⫾ 11 years. 23% of patients (6/26) had a solitary kidney. 81% (21/26) were open partial nephrectomies, the remaining 5 patients were laparoscopic. 50% (13/26) of patients had vascular clamping, with cold (n ⫽ 9) and warm (n ⫽ 4) ischemia times of 24 ⫾ 11.6 and 23 ⫾ 0.5 minutes, respectively. Mean tumor size was 3.3 ⫾ 1.4 cm. Pathology revealed 14 clear cell (54%), 9 mixed histology (35%), 2 chromophobe (7%), and 1 papillary (4%) tumor. 18 (69%) were pT1a. After surgery, patients had surveillance with contrast-enhanced CT scan or MRI every 6 months for two years, and yearly imaging thereafter. No patient had elective invasive management of the PSM. Median follow up was 31 months. Of the 26 patients in the cohort, 1 (3.8%) developed a local recurrence at 1.8 years after surgery. This recurrence was not treated invasively as the patient had synchronous distant metastases and received systemic therapy. Among all patients with PSM, 3-year RCC-specific survival was 90.9%. CONCLUSIONS: Local recurrence was rare among patients with PSM after partial nephrectomy for pT1 RCC at a median follow-up of 31 months. Routine post-operative surveillance is reasonable in patients with PSM after partial nephrectomy. Source of Funding: None
1255
Vol. 185, No. 4S, Supplement, Monday, May 16, 2011
METHODS: Patients undergoing surgery for a localized renal mass between 2000 –2008 were studied. Demographic, clinical, radiographic and pathological characteristics were compared between patients with and without a history of organ transplant. A subanalysis focused on the features of a kidney compared to another, non-renal, organ transplant. RESULTS: Of 950 patients identified, 19 were organ recipients. Transplant recipients were younger and had lower body mass indices. Most organ recipients (94.7%) were asymptomatic at presentation. Transplant recipients had higher incidence of malignant pathology (88.2 vs 78.7%), but had smaller masses, of lower stage and grade and a higher proportion of papillary histology (35.3 vs 19.8%). Papillary subtype accounted for almost one-half of the RCCs in kidney recipients compared to 20% in other organ recipients. Over a median follow up of 4 years, 1 (5.9%) local recurrence, no metastatic progressions and no RCC-related deaths occurred in the transplant cohort. CONCLUSIONS: Organ recipients typically present with incidental renal masses of smaller size. However, these are twice more likely to be malignant compared to the general population. RCC arising in transplant recipients tend to be of lower stage and grade contributing to the apparently excellent oncological outcomes of surgical treatment. Source of Funding: None
1256 CIGARETTE SMOKING IS ASSOCIATED WITH ADVANCED RENAL CELL CARCINOMA Matvey Tsivian*, Daniel Moreira, Jorge Caso, Vladimir Mouraviev, Thomas Polascik, Durham, NC INTRODUCTION AND OBJECTIVES: Cigarette smoking is a recognized risk factor for renal cell carcinoma (RCC) but little data is available on the association between smoking and RCC biology. Herein we investigated the association between cigarette smoking and RCC stage in a large contemporary multiethnic surgical cohort. METHODS: Retrospective review of demographic, clinical and pathological data of patients undergoing surgery for RCC between 2000 –2009. Advanced RCC was defined as metastatic disease, pathological stage – and/or lymph node involvement. Self-reported smoking history included smoking status, duration, intensity, cumulative exposure and cessation. Patient and tumor characteristics were compared between the groups by univariate and multivariate analyses. RESULTS: Of the 845 eligible patients, 19.4% and 29.1% were current and former smokers; 207 (24.5%) patients had advanced disease. In both univariate and multivariate analyses, smoking was consistently associated with advanced RCC and cessation reversed the risk. Current and former smokers had a 1.5 and 1.6-fold increased odds of advanced disease. Heavier smoking (longer duration and exposure) was associated with increased risk of advanced RCC. Durable cessation reduced the odds of advanced disease by approximately 9% per smoking-free decade. CONCLUSIONS: Cigarette smoking is an independent risk factor for advanced RCC. Heavier smoking increases the likelihood of advanced disease with a dose-dependent effect. Durable smoking cessation attenuated the risk of advanced disease. Given that cigarette smoking is among the few modifiable risk factors for RCC, our results reinforce the importance of smoking cessation and encourage further investigation of the association between smoking and RCC biology. Source of Funding: None
RENAL TUMORS IN SOLID ORGAN RECIPIENTS: CLINICAL AND PATHOLOGICAL FEATURES Matvey Tsivian*, Jorge Caso, Masaki Kimura, Thomas Polascik, Durham, NC INTRODUCTION AND OBJECTIVES: Solid organ recipients are several times more likely to develop renal cell carcinoma (RCC) compared to the general population, but little is known about the features of these tumors. The aim of this study is to report on the characteristics of renal tumors in solid organ recipients compared to the general population.
1257 SMALL RENAL MASSES: SHOULD CURRENT TREATMENT STRATEGY BE REAPPRAISED? Matvey Tsivian*, Michael Ferrandino, Vladimir Mouraviev, Masaki Kimura, David Albala, Thomas Polascik, Durham, NC INTRODUCTION AND OBJECTIVES: Currently, most renal masses are detected incidentally on imaging for unrelated problems
THE JOURNAL OF UROLOGY姞
strated RN (OR 2.93, p⫽0.0107), preoperative (OR 1.98, p⫽0.037) and postoperative (OR 7.89, p⬍0.001) GFR ⬍60 mL/min/1.73m2 as significantly associated with HL development after surgery. CONCLUSIONS: Patients who underwent RN had significantly higher incidence of de novo HL compared to a contemporary, wellmatched cohort that underwent NSS. In addition to RN, preoperative and postoperative eGFR⬍60 were also significantly associated with development of HL. Further investigation on effects of nephron loss on lipid metabolism is requisite. Source of Funding: None
1254 POSITIVE SURGICAL MARGINS AFTER PARTIAL NEPHRECTOMY FOR PT1 LOCALIZED RENAL CELL CARCINOMA: LOCAL RECURRENCE AND RCC-SPECIFIC SURVIVAL William Faust, M.D.*, Cambridge, MA; Patrick Kenney, Alireza Moinzadeh, John Libertino, Burlington, MA INTRODUCTION AND OBJECTIVES: In patients undergoing partial nephrectomy for localized Renal Cell Carcinoma (RCC), positive surgical margin (PSM) is thought to increase the risk of local recurrence. Fewer than 200 cases of PSM after partial nephrectomy have been described in the literature. Our objective is to describe the natural history of 26 patients with PSM following partial nephrectomy for RCC. METHODS: We identified 1044 patients who underwent partial nephrectomy at a single institution from 1988 to 2010. 50 of these patients had PSM (4.8%). Patients with familial kidney cancer, benign pathology, ⱖpT2 disease, or follow up less than 6 months were excluded (n ⫽ 24). Clinical, pathological, and follow up data were analyzed for the remaining cohort (n ⫽ 26). RCC-specific survival and local recurrence, defined as imaging with a persistent enhancing lesion in the area of resection or biopsy proven recurrence, were calculated. RESULTS: Mean age at diagnosis was 63 ⫾ 11 years. 23% of patients (6/26) had a solitary kidney. 81% (21/26) were open partial nephrectomies, the remaining 5 patients were laparoscopic. 50% (13/26) of patients had vascular clamping, with cold (n ⫽ 9) and warm (n ⫽ 4) ischemia times of 24 ⫾ 11.6 and 23 ⫾ 0.5 minutes, respectively. Mean tumor size was 3.3 ⫾ 1.4 cm. Pathology revealed 14 clear cell (54%), 9 mixed histology (35%), 2 chromophobe (7%), and 1 papillary (4%) tumor. 18 (69%) were pT1a. After surgery, patients had surveillance with contrast-enhanced CT scan or MRI every 6 months for two years, and yearly imaging thereafter. No patient had elective invasive management of the PSM. Median follow up was 31 months. Of the 26 patients in the cohort, 1 (3.8%) developed a local recurrence at 1.8 years after surgery. This recurrence was not treated invasively as the patient had synchronous distant metastases and received systemic therapy. Among all patients with PSM, 3-year RCC-specific survival was 90.9%. CONCLUSIONS: Local recurrence was rare among patients with PSM after partial nephrectomy for pT1 RCC at a median follow-up of 31 months. Routine post-operative surveillance is reasonable in patients with PSM after partial nephrectomy. Source of Funding: None
1255
Vol. 185, No. 4S, Supplement, Monday, May 16, 2011
METHODS: Patients undergoing surgery for a localized renal mass between 2000 –2008 were studied. Demographic, clinical, radiographic and pathological characteristics were compared between patients with and without a history of organ transplant. A subanalysis focused on the features of a kidney compared to another, non-renal, organ transplant. RESULTS: Of 950 patients identified, 19 were organ recipients. Transplant recipients were younger and had lower body mass indices. Most organ recipients (94.7%) were asymptomatic at presentation. Transplant recipients had higher incidence of malignant pathology (88.2 vs 78.7%), but had smaller masses, of lower stage and grade and a higher proportion of papillary histology (35.3 vs 19.8%). Papillary subtype accounted for almost one-half of the RCCs in kidney recipients compared to 20% in other organ recipients. Over a median follow up of 4 years, 1 (5.9%) local recurrence, no metastatic progressions and no RCC-related deaths occurred in the transplant cohort. CONCLUSIONS: Organ recipients typically present with incidental renal masses of smaller size. However, these are twice more likely to be malignant compared to the general population. RCC arising in transplant recipients tend to be of lower stage and grade contributing to the apparently excellent oncological outcomes of surgical treatment. Source of Funding: None
1256 CIGARETTE SMOKING IS ASSOCIATED WITH ADVANCED RENAL CELL CARCINOMA Matvey Tsivian*, Daniel Moreira, Jorge Caso, Vladimir Mouraviev, Thomas Polascik, Durham, NC INTRODUCTION AND OBJECTIVES: Cigarette smoking is a recognized risk factor for renal cell carcinoma (RCC) but little data is available on the association between smoking and RCC biology. Herein we investigated the association between cigarette smoking and RCC stage in a large contemporary multiethnic surgical cohort. METHODS: Retrospective review of demographic, clinical and pathological data of patients undergoing surgery for RCC between 2000 –2009. Advanced RCC was defined as metastatic disease, pathological stage – and/or lymph node involvement. Self-reported smoking history included smoking status, duration, intensity, cumulative exposure and cessation. Patient and tumor characteristics were compared between the groups by univariate and multivariate analyses. RESULTS: Of the 845 eligible patients, 19.4% and 29.1% were current and former smokers; 207 (24.5%) patients had advanced disease. In both univariate and multivariate analyses, smoking was consistently associated with advanced RCC and cessation reversed the risk. Current and former smokers had a 1.5 and 1.6-fold increased odds of advanced disease. Heavier smoking (longer duration and exposure) was associated with increased risk of advanced RCC. Durable cessation reduced the odds of advanced disease by approximately 9% per smoking-free decade. CONCLUSIONS: Cigarette smoking is an independent risk factor for advanced RCC. Heavier smoking increases the likelihood of advanced disease with a dose-dependent effect. Durable smoking cessation attenuated the risk of advanced disease. Given that cigarette smoking is among the few modifiable risk factors for RCC, our results reinforce the importance of smoking cessation and encourage further investigation of the association between smoking and RCC biology. Source of Funding: None
RENAL TUMORS IN SOLID ORGAN RECIPIENTS: CLINICAL AND PATHOLOGICAL FEATURES Matvey Tsivian*, Jorge Caso, Masaki Kimura, Thomas Polascik, Durham, NC INTRODUCTION AND OBJECTIVES: Solid organ recipients are several times more likely to develop renal cell carcinoma (RCC) compared to the general population, but little is known about the features of these tumors. The aim of this study is to report on the characteristics of renal tumors in solid organ recipients compared to the general population.
1257 SMALL RENAL MASSES: SHOULD CURRENT TREATMENT STRATEGY BE REAPPRAISED? Matvey Tsivian*, Michael Ferrandino, Vladimir Mouraviev, Masaki Kimura, David Albala, Thomas Polascik, Durham, NC INTRODUCTION AND OBJECTIVES: Currently, most renal masses are detected incidentally on imaging for unrelated problems