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503 OBESITY PREDICTS IMPROVED SURVIVAL IN PATIENTS WITH CLEAR CELL KIDNEY CANCER
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Vol. 183, No. 4, Supplement, Sunday, May 30, 2010
surplus medication. Of those with leftover medication, 89% kept the medication at home, while 6% threw it in the trash, 2% flushed it down the toilet, and ⬍1% returned it to the pharmacy. There was statistically significant variability in the prescribing practices of individual physicians for surgeries of the same category. The mean and median number of tablets used in each category were: cysto/endo (14.1,14), minor open (10.8,10), major lap (14.9,14.5), major open (15.9, 14). The proportion of patients using their entire prescription in each category was 38%, 33%, 33%, and 19% respectively. CONCLUSIONS: Prescription narcotic abuse is a grave social problem. Prescription opioids can serve as gateway drugs leading to addiction and use of illicit drugs such as heroin, especially in adolescents. Our study shows that over-prescribing prescription narcotics is common and retained surplus medication presents a readily available source of opioid diversion. At this point, it appears no entity on either the prescribing or dispensing ends of opioid delivery is fulfilling the responsibility to accurately educate patients on proper surplus medication disposal. As over 40% of narcotics are unused and 2/3 of patients are left with surplus medication, urologists should consider decreasing the quantity of narcotics prescribed for a given procedure. Source of Funding: None
Kidney Cancer: Evaluation and Staging I Moderated Poster 14 Sunday, May 30, 2010
3:30 PM-5:30 PM
501 POSTOPERATIVE BETTER THAN PREOPERATIVE C-REACTIVE PROTEIN AT PREDICTING OUTCOME FOLLOWING POTENTIALLY CURATIVE NEPHRECTOMY FOR RENAL CELL CARCINOMA Viraj Master*, Timothy Johnson, Ammara Abbasi, Ashli Owen-Smith, Andrew Young, Omer Kucuk, Wayne Harris, Adeboye Osunkoye, Kenneth Ogan, John Pattaras, Peter Nieh, Fray Marshall, Atlanta, GA INTRODUCTION AND OBJECTIVES: Preoperative C-Reactive Protein (CRP) predicts metastasis and mortality in localized renal cell carcinoma (RCC). However, CRP’s predictive potential following resection of localized RCC remains unclear. Therefore, we assessed absolute postoperative CRP’s ability to predict metastases and mortality as a continuous variable. METHODS: Patients with clinically localized (T1-T3N0M0) clear cell RCC were followed for one-year postoperatively. Metastases were identified radiologically and mortality by death certificate. Univariate and multivariate binary logistic regression analyses examined one-year relapse-free survival (RFS) and overall survival (OS) across patient and disease characteristics. RESULTS: Of the 110 patients in this study, 16.4% developed metastases and 6.4% died. Mean (SD) postoperative CRP for patients who did and did not develop metastases were 69.06 (73.55) mg/L and 5.27 (7.80), respectively. Mean (SD) postoperative CRP for patients who did and did not die were 89.31 (69.51) mg/L and 10.88 (30.32), respectively. In multivariate analysis, T-Stage (OR: 12.452, 95% CI: 2.889-53.660) and postoperative CRP ((B: 0.080, SE: 0.025; p⬍0.001) were significant predictors of RFS. T-Stage (OR: 11.715; 95% CI: 1.102-124.519) and postoperative CRP (B: 0.017; SE: 0.007; p⬍0.001) were also significant predictors of OS. After adjusting for postoperative CRP, preoperative CRP was not predictive of these outcomes. CONCLUSIONS: Postoperative, not preoperative CRP is the better predictor of metastasis and mortality following nephrectomy for localized RCC. Clinicians should consider absolute postoperative CRP
to identify high-risk patients for closer surveillance or additional therapy. Predictive algorithms should consider incorporating postoperative CRP as a continuous variable to maximize predictive ability. Source of Funding: None
502 INDEPENDENT VALIDATION OF THE 2009 AMERICAN JOINT COMMITTEE ON CANCER TNM CLASSIFICATION FOR RENAL CELL CARCINOMA USING A LARGE, SINGLE INSTITUTION COHORT. Angela Alt*, Michael Blute, Igor Frank, John Cheville, Allmer Cristine, Rochester, MN INTRODUCTION AND OBJECTIVES: The TNM classification for renal cell carcinoma (RCC) was updated by the American Joint Committee on Cancer in 2009. In the current study we evaluated the 2009 classification and compared its predictive ability to the 2002 classification. METHODS: We studied 3,996 patients treated with radical nephrectomy or nephron sparing surgery for unilateral or bilateral synchronous RCC between 1976 and 2006. Cancer specific survival (CSS) was estimated using the Kaplan-Meier method. The predictive abilities of the 2002 and 2009 classifications were compared using concordance indexes. RESULTS: There were 1165 deaths from RCC at a median of 1.9 years. Median follow up for patients alive at last follow up was 7.4 years. Estimated 10 year CSS rates by the 2009 primary tumor classification were 96%, 80%, 66%, 55%, 36%, 26%, 25%, and 12% for 2009 pT1a, pT1b, pT2a, pT2b, pT3a, pT3b, pT3c, and pT4 patients, respectively (p⬍0.001). The concordance indexes for the 2002 and 2009 TNM classifications were 0.848 and 0.850, respectively. CONCLUSIONS: Our data suggest that the 2009 classification with pT2 lesions divided into pT2a and pT2b, ipsilateral adrenal involvement reclassified as pT4, renal vein involvement reclassified as pT3a, and nodal involvement simplified to N0 versus N1 resulted in a modest improvement in predictive ability compared to the 2002 classification. Source of Funding: None
503 OBESITY PREDICTS IMPROVED SURVIVAL IN PATIENTS WITH CLEAR CELL KIDNEY CANCER Sandra Waalkes*, Axel S. Merseburger, Mario W. Kramer, Thomas R. W. Herrmann, Gerd Wegener, Hannover, Germany; Axel Hegele, Rainer Hofmann, Marburg, Germany; Markus A. Kuczyk, Hannover, Germany; Andres J. Schrader, Marburg, Germany INTRODUCTION AND OBJECTIVES: Obesity increases the risk of developing renal cell carcinoma (RCC); however, it remains unclear whether obesity is associated with RCC aggressiveness and survival. We assessed whether different body mass index (BMI) levels at the time of surgery had an effect on long-term prognosis of RCC patients. METHODS: We evaluated 1553 patients with complete information about their BMI, who had undergone surgery for renal cell cancer at the University hospitals in Hannover and Marburg between 1990 and 2005. The mean follow-up was 5.3 years. RESULTS: Underweight, normal weight, pre-obesity, and obesity were diagnosed in 14 (0.9%), 530 (34.1%), 687 (44.2%), and 322 (20.8%) RCC patients, respectively. Overweight (BMI ⬎25) and obesity were significantly associated with younger age (p⫽0.021, KruskalWallis) and metastatic disease (p⫽0.007, chi-square), but not with tumor stage, grade or gender. Both uni- and multivariate analyses showed that obese patients had a significantly lower risk of death; the median 5-year overall survival rate was 58.5%, 68.3% and 80.9% for patients with a BMI below 25, 25-35 and over 35 (p⬍0.0001, Long Rank). Interestingly, subgroup analysis revealed that the positive association between overweight and survival was even more pronounced
Vol. 183, No. 4, Supplement, Sunday, May 30, 2010
in organ-confined disease (p⬍0.0001, cox regression); a correlation in advanced disease could not be confirmed in multivariate analyses (p⫽0.21). CONCLUSIONS: We were able to identify overweight as an independent prognostic marker of improved survival in patients with organ-confined RCC. Basic research is required to resolve the dilemma of why, if a higher BMI predisposes to RCC, it concurrently prolongs survival after patients have undergone (partial) nephrectomy. Source of Funding: None
504 A COMPARISON BETWEEN FINE NEEDLE ASPIRATION AND CORE NEEDLE BIOPSY IN RENAL MASS BIOPSY REGARDING SPECIMEN QUALITY AND PREDICTION ACCURACY FOR PATHOLOGICAL ANALYSIS Friedrich-Carl von Rundstedt*, Ahmed Mohamed, Stephan Sto¨rkel, Stephan Roth, Wuppertal, Germany INTRODUCTION AND OBJECTIVES: Renal mass biopsy has recently been suggested to be reevaluated for urological practice as it appears to be a valuable aid in clinical decision making. We analyzed the role of renal mass biopsy regarding technique, accuracy and specimen quality in an ex-vivo model. METHODS: We obtained biopsies in 100 patients in an “exvivo“ setting. The surgeon performed two core biopsies and two fine needle aspirations for every tumor after laparoscopic or open nephrectomy. All biopsies and nephrectomy specimens were analyzed by a single pathologist. Biopsy specimens and final histopathology were then matched comparing histological subtype and grading. RESULTS: Mean tumor size was 5.91 cm (SD 2.8). In 86% of the patients the tumors were classified T1-T3. In 87 patients the biopsy needle contained tumor tissue. In 13 cases all four biopsies contained only renal or perirenal tissue having missed the mass on biopsy. The biopsy diagnosis predicted the final histological diagnosis with a positive predictive value of 100% (sensitivity 87.9%, specificity 100%). Pathological analysis of the biopsy identified renal clear cell carcinoma in 53 patients, papillary renal cell carcinoma in 13 patients, chromophobe renal cell carcinoma in 5 patients, transitional cell carcinoma in 6 patients and oncytomas in 5 patients. Other cases contained a liposarcoma (n⫽1), a metastasis of a colorectal carcinoma (n⫽1), a squamous cell carcinoma (n⫽1), a benign pseudocyst (n⫽1) and a renal adenoma (n⫽1). All tumor diagnoses were unanimous and in 85,7% (Kappa ⫽ 0.78) even the grading of the biopsy correlated with the grading of the final tumor analysis. There was no significant difference between the reults obtained by fine needle aspiration or core biopsy regarding cylinder length (mean length 0.98 cm ⫹0.5 vs. 1.04 cm ⫹0.49) or tissue quality. CONCLUSIONS: Provided that the needle hits the renal mass, pathological analysis is able to differentiate safely between benign and malignant lesions. The positive predictive value (PPV) with regard to the prediction of the tumor type was 100% independent of the technique by which the tissue was obtained. With regards to the grading the biopsy histopathology and the final histopathology showed a substantial agreement of 85.7% (Kappa ⫽ 0.78). Renal mass biopsy seems to be an additional diagnostic tool that can help to clarify the therapeutic approach including active surveillance strategies in the future. Source of Funding: None
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505 CLINICO-PATHOLOGICAL AND OUTCOME FEATURES OF RENAL CELL CARCINOMAS IN PATIENTS WITH END STAGE RENAL DISEASE. Yann Neuzillet*, Suresnes, France; Laurent Salomon, Laurence Bastien, Creteil, France; Jacques Petit, Fabien Saint, Xavier Tillou, Amiens, France; Nathalie Rioux-Leclercq, Romain Mathieu, Rennes, France; Franck Bruyere, Jean-Michel Boutin, Nicolas Brichart, Tours, France; Je´roˆme Rigaud, Georges Karam, Julien Branchereau, Nantes, France; Jean-Marie Ferriere, Herve´ Wallerand, Se´bastien Barbet, Hicham Elkentaoui, Bordeaux, France; Jacques Hubert, Benoit Feuillu, Pierre-Etienne Theveniaud, Nancy, France; Arnauld Villers, Laurent Zini, Lille, France; Aure´lien Descazeaux, Limoges, France; Morgan Roupret, Benoit Barrou, Karim Fehri, Paris, France; Thierry Lebret, Suresnes, France; Jacques Tostain, Jean-Etienne Terrier, Saint-Etienne, France; Philippe Paparel, Lionel Badet, Laura Poissonnier, Lyon, France; Jean-Alexandre Long, Nicolas Terrier, Grenoble, France; Franc¸ois Kleinclauss, Lucille Martin, Besanc¸on, France; Christian Pfister, Fabrice Dugardin, Ismae¨l Galliot, Rouen, France; Fre´de´ric Staerman, Marie-Dominique Azemar, Reims, France; Jacques Irani, Baptiste Tisserand, Poitiers, France; Arnaud Mejean, Marc-Olivier Timsit, Paris, France; Michel Soulie, Federico Sallusto, Pascal Rischmann, Toulouse, France; Laurent Guy, Clermont-Ferrand, France; Antoine Valeri, Charles Deruelle, Brest, France; Marc Gigante, Nice, France; Abdel-Rahme`ne Azzouzi, Denis Chautard, Pierre Bigot, Angers, France; Bernard Escudier, Villejuif, France; Jean-Michel Correas, Paris, France; Herve´ Lang, Strasbourg, France; Herve´ Baumert, Paris, France; Jean-Jacques Patard, Rennes, France INTRODUCTION AND OBJECTIVES: To analyze epidemiologic, pathological and outcome features of renal cell carcinomas (RCC) arising in native kidneys of patients with End Stage Renal Disease (ESRD). METHODS: 24 French university departments of urology and kidney transplantation participated in this national retrospective survey for identifying RCCs arising in the context of ESRD. Information regarding age, sex, symptoms at diagnosis, duration of exposition to ESRD, mode and duration of dialysis, renal transplantation, tumour staging and grading, histological subtype and outcome were recorded in a unique database. Qualitative and quantitative variables were compared by using chi-square and Student statistical analyses. RESULTS: 303 RCC cases diagnosed between 1985 and 2009 were identified in 206 men (76.3%) and 64 women (23.7%). Mean age at diagnosis was 54.96 ⫾ 12.78 years. Mean tumour size was 3.7 ⫾ 2.7 cm. Organ confined (T1-2 stages) and low grade (G1-2) tumours accounted for 272 (90%) and 206 (68%) cases, respectively. Only five patients (2%) had nodal or distant metastases at presentation. RCC was identified 120 ⫾ 84 months after chronic renal failure diagnosis in 90 (29.7%) patients who were under dialysis while 213 cases occurred in renal transplant patients, on average 91 ⫾ 82 months after transplantation. Incidental tumours and those associated with acquired cystic kidney disease (ACKD) accounted for 263 (87%) and 175 cases (58%), respectively. Tumours were cystic in 60 cases (20%). Thirty tumours (10%) were bilateral while sixty seven (22%) were multifocal. Histological subtypes included clear cell, papillary, chromophobe and other carcinomas in 177 (59%), 113 (37%), 10 (3%) and 1 (1%) cases, respectively. After a mean follow-up of 37.1 months, 264 patients (86.8%) were alive without evidence of disease, 8 (2.6%) had progressive disease, 13 (4.3%) had died of RCC, and 19 (6 3%) had died of other causes. Five years progression-free and specific survival rates were 79.1% and 87.2%, respectively. CONCLUSIONS: Most RCCs arising in patients with ESRD are small, low stage, low grade, incidental tumours with favourable outcome. Younger age at presentation, frequent bilaterality and/or multifocality, association with ACKD, less propensity to be of clear cell histology suggest that different molecular pathways are involved in this
THE JOURNAL OF UROLOGY姞
Vol. 183, No. 4, Supplement, Sunday, May 30, 2010
surplus medication. Of those with leftover medication, 89% kept the medication at home, while 6% threw it in the trash, 2% flushed it down the toilet, and ⬍1% returned it to the pharmacy. There was statistically significant variability in the prescribing practices of individual physicians for surgeries of the same category. The mean and median number of tablets used in each category were: cysto/endo (14.1,14), minor open (10.8,10), major lap (14.9,14.5), major open (15.9, 14). The proportion of patients using their entire prescription in each category was 38%, 33%, 33%, and 19% respectively. CONCLUSIONS: Prescription narcotic abuse is a grave social problem. Prescription opioids can serve as gateway drugs leading to addiction and use of illicit drugs such as heroin, especially in adolescents. Our study shows that over-prescribing prescription narcotics is common and retained surplus medication presents a readily available source of opioid diversion. At this point, it appears no entity on either the prescribing or dispensing ends of opioid delivery is fulfilling the responsibility to accurately educate patients on proper surplus medication disposal. As over 40% of narcotics are unused and 2/3 of patients are left with surplus medication, urologists should consider decreasing the quantity of narcotics prescribed for a given procedure. Source of Funding: None
Kidney Cancer: Evaluation and Staging I Moderated Poster 14 Sunday, May 30, 2010
3:30 PM-5:30 PM
501 POSTOPERATIVE BETTER THAN PREOPERATIVE C-REACTIVE PROTEIN AT PREDICTING OUTCOME FOLLOWING POTENTIALLY CURATIVE NEPHRECTOMY FOR RENAL CELL CARCINOMA Viraj Master*, Timothy Johnson, Ammara Abbasi, Ashli Owen-Smith, Andrew Young, Omer Kucuk, Wayne Harris, Adeboye Osunkoye, Kenneth Ogan, John Pattaras, Peter Nieh, Fray Marshall, Atlanta, GA INTRODUCTION AND OBJECTIVES: Preoperative C-Reactive Protein (CRP) predicts metastasis and mortality in localized renal cell carcinoma (RCC). However, CRP’s predictive potential following resection of localized RCC remains unclear. Therefore, we assessed absolute postoperative CRP’s ability to predict metastases and mortality as a continuous variable. METHODS: Patients with clinically localized (T1-T3N0M0) clear cell RCC were followed for one-year postoperatively. Metastases were identified radiologically and mortality by death certificate. Univariate and multivariate binary logistic regression analyses examined one-year relapse-free survival (RFS) and overall survival (OS) across patient and disease characteristics. RESULTS: Of the 110 patients in this study, 16.4% developed metastases and 6.4% died. Mean (SD) postoperative CRP for patients who did and did not develop metastases were 69.06 (73.55) mg/L and 5.27 (7.80), respectively. Mean (SD) postoperative CRP for patients who did and did not die were 89.31 (69.51) mg/L and 10.88 (30.32), respectively. In multivariate analysis, T-Stage (OR: 12.452, 95% CI: 2.889-53.660) and postoperative CRP ((B: 0.080, SE: 0.025; p⬍0.001) were significant predictors of RFS. T-Stage (OR: 11.715; 95% CI: 1.102-124.519) and postoperative CRP (B: 0.017; SE: 0.007; p⬍0.001) were also significant predictors of OS. After adjusting for postoperative CRP, preoperative CRP was not predictive of these outcomes. CONCLUSIONS: Postoperative, not preoperative CRP is the better predictor of metastasis and mortality following nephrectomy for localized RCC. Clinicians should consider absolute postoperative CRP
to identify high-risk patients for closer surveillance or additional therapy. Predictive algorithms should consider incorporating postoperative CRP as a continuous variable to maximize predictive ability. Source of Funding: None
502 INDEPENDENT VALIDATION OF THE 2009 AMERICAN JOINT COMMITTEE ON CANCER TNM CLASSIFICATION FOR RENAL CELL CARCINOMA USING A LARGE, SINGLE INSTITUTION COHORT. Angela Alt*, Michael Blute, Igor Frank, John Cheville, Allmer Cristine, Rochester, MN INTRODUCTION AND OBJECTIVES: The TNM classification for renal cell carcinoma (RCC) was updated by the American Joint Committee on Cancer in 2009. In the current study we evaluated the 2009 classification and compared its predictive ability to the 2002 classification. METHODS: We studied 3,996 patients treated with radical nephrectomy or nephron sparing surgery for unilateral or bilateral synchronous RCC between 1976 and 2006. Cancer specific survival (CSS) was estimated using the Kaplan-Meier method. The predictive abilities of the 2002 and 2009 classifications were compared using concordance indexes. RESULTS: There were 1165 deaths from RCC at a median of 1.9 years. Median follow up for patients alive at last follow up was 7.4 years. Estimated 10 year CSS rates by the 2009 primary tumor classification were 96%, 80%, 66%, 55%, 36%, 26%, 25%, and 12% for 2009 pT1a, pT1b, pT2a, pT2b, pT3a, pT3b, pT3c, and pT4 patients, respectively (p⬍0.001). The concordance indexes for the 2002 and 2009 TNM classifications were 0.848 and 0.850, respectively. CONCLUSIONS: Our data suggest that the 2009 classification with pT2 lesions divided into pT2a and pT2b, ipsilateral adrenal involvement reclassified as pT4, renal vein involvement reclassified as pT3a, and nodal involvement simplified to N0 versus N1 resulted in a modest improvement in predictive ability compared to the 2002 classification. Source of Funding: None
503 OBESITY PREDICTS IMPROVED SURVIVAL IN PATIENTS WITH CLEAR CELL KIDNEY CANCER Sandra Waalkes*, Axel S. Merseburger, Mario W. Kramer, Thomas R. W. Herrmann, Gerd Wegener, Hannover, Germany; Axel Hegele, Rainer Hofmann, Marburg, Germany; Markus A. Kuczyk, Hannover, Germany; Andres J. Schrader, Marburg, Germany INTRODUCTION AND OBJECTIVES: Obesity increases the risk of developing renal cell carcinoma (RCC); however, it remains unclear whether obesity is associated with RCC aggressiveness and survival. We assessed whether different body mass index (BMI) levels at the time of surgery had an effect on long-term prognosis of RCC patients. METHODS: We evaluated 1553 patients with complete information about their BMI, who had undergone surgery for renal cell cancer at the University hospitals in Hannover and Marburg between 1990 and 2005. The mean follow-up was 5.3 years. RESULTS: Underweight, normal weight, pre-obesity, and obesity were diagnosed in 14 (0.9%), 530 (34.1%), 687 (44.2%), and 322 (20.8%) RCC patients, respectively. Overweight (BMI ⬎25) and obesity were significantly associated with younger age (p⫽0.021, KruskalWallis) and metastatic disease (p⫽0.007, chi-square), but not with tumor stage, grade or gender. Both uni- and multivariate analyses showed that obese patients had a significantly lower risk of death; the median 5-year overall survival rate was 58.5%, 68.3% and 80.9% for patients with a BMI below 25, 25-35 and over 35 (p⬍0.0001, Long Rank). Interestingly, subgroup analysis revealed that the positive association between overweight and survival was even more pronounced
Vol. 183, No. 4, Supplement, Sunday, May 30, 2010
in organ-confined disease (p⬍0.0001, cox regression); a correlation in advanced disease could not be confirmed in multivariate analyses (p⫽0.21). CONCLUSIONS: We were able to identify overweight as an independent prognostic marker of improved survival in patients with organ-confined RCC. Basic research is required to resolve the dilemma of why, if a higher BMI predisposes to RCC, it concurrently prolongs survival after patients have undergone (partial) nephrectomy. Source of Funding: None
504 A COMPARISON BETWEEN FINE NEEDLE ASPIRATION AND CORE NEEDLE BIOPSY IN RENAL MASS BIOPSY REGARDING SPECIMEN QUALITY AND PREDICTION ACCURACY FOR PATHOLOGICAL ANALYSIS Friedrich-Carl von Rundstedt*, Ahmed Mohamed, Stephan Sto¨rkel, Stephan Roth, Wuppertal, Germany INTRODUCTION AND OBJECTIVES: Renal mass biopsy has recently been suggested to be reevaluated for urological practice as it appears to be a valuable aid in clinical decision making. We analyzed the role of renal mass biopsy regarding technique, accuracy and specimen quality in an ex-vivo model. METHODS: We obtained biopsies in 100 patients in an “exvivo“ setting. The surgeon performed two core biopsies and two fine needle aspirations for every tumor after laparoscopic or open nephrectomy. All biopsies and nephrectomy specimens were analyzed by a single pathologist. Biopsy specimens and final histopathology were then matched comparing histological subtype and grading. RESULTS: Mean tumor size was 5.91 cm (SD 2.8). In 86% of the patients the tumors were classified T1-T3. In 87 patients the biopsy needle contained tumor tissue. In 13 cases all four biopsies contained only renal or perirenal tissue having missed the mass on biopsy. The biopsy diagnosis predicted the final histological diagnosis with a positive predictive value of 100% (sensitivity 87.9%, specificity 100%). Pathological analysis of the biopsy identified renal clear cell carcinoma in 53 patients, papillary renal cell carcinoma in 13 patients, chromophobe renal cell carcinoma in 5 patients, transitional cell carcinoma in 6 patients and oncytomas in 5 patients. Other cases contained a liposarcoma (n⫽1), a metastasis of a colorectal carcinoma (n⫽1), a squamous cell carcinoma (n⫽1), a benign pseudocyst (n⫽1) and a renal adenoma (n⫽1). All tumor diagnoses were unanimous and in 85,7% (Kappa ⫽ 0.78) even the grading of the biopsy correlated with the grading of the final tumor analysis. There was no significant difference between the reults obtained by fine needle aspiration or core biopsy regarding cylinder length (mean length 0.98 cm ⫹0.5 vs. 1.04 cm ⫹0.49) or tissue quality. CONCLUSIONS: Provided that the needle hits the renal mass, pathological analysis is able to differentiate safely between benign and malignant lesions. The positive predictive value (PPV) with regard to the prediction of the tumor type was 100% independent of the technique by which the tissue was obtained. With regards to the grading the biopsy histopathology and the final histopathology showed a substantial agreement of 85.7% (Kappa ⫽ 0.78). Renal mass biopsy seems to be an additional diagnostic tool that can help to clarify the therapeutic approach including active surveillance strategies in the future. Source of Funding: None
THE JOURNAL OF UROLOGY姞
e199
505 CLINICO-PATHOLOGICAL AND OUTCOME FEATURES OF RENAL CELL CARCINOMAS IN PATIENTS WITH END STAGE RENAL DISEASE. Yann Neuzillet*, Suresnes, France; Laurent Salomon, Laurence Bastien, Creteil, France; Jacques Petit, Fabien Saint, Xavier Tillou, Amiens, France; Nathalie Rioux-Leclercq, Romain Mathieu, Rennes, France; Franck Bruyere, Jean-Michel Boutin, Nicolas Brichart, Tours, France; Je´roˆme Rigaud, Georges Karam, Julien Branchereau, Nantes, France; Jean-Marie Ferriere, Herve´ Wallerand, Se´bastien Barbet, Hicham Elkentaoui, Bordeaux, France; Jacques Hubert, Benoit Feuillu, Pierre-Etienne Theveniaud, Nancy, France; Arnauld Villers, Laurent Zini, Lille, France; Aure´lien Descazeaux, Limoges, France; Morgan Roupret, Benoit Barrou, Karim Fehri, Paris, France; Thierry Lebret, Suresnes, France; Jacques Tostain, Jean-Etienne Terrier, Saint-Etienne, France; Philippe Paparel, Lionel Badet, Laura Poissonnier, Lyon, France; Jean-Alexandre Long, Nicolas Terrier, Grenoble, France; Franc¸ois Kleinclauss, Lucille Martin, Besanc¸on, France; Christian Pfister, Fabrice Dugardin, Ismae¨l Galliot, Rouen, France; Fre´de´ric Staerman, Marie-Dominique Azemar, Reims, France; Jacques Irani, Baptiste Tisserand, Poitiers, France; Arnaud Mejean, Marc-Olivier Timsit, Paris, France; Michel Soulie, Federico Sallusto, Pascal Rischmann, Toulouse, France; Laurent Guy, Clermont-Ferrand, France; Antoine Valeri, Charles Deruelle, Brest, France; Marc Gigante, Nice, France; Abdel-Rahme`ne Azzouzi, Denis Chautard, Pierre Bigot, Angers, France; Bernard Escudier, Villejuif, France; Jean-Michel Correas, Paris, France; Herve´ Lang, Strasbourg, France; Herve´ Baumert, Paris, France; Jean-Jacques Patard, Rennes, France INTRODUCTION AND OBJECTIVES: To analyze epidemiologic, pathological and outcome features of renal cell carcinomas (RCC) arising in native kidneys of patients with End Stage Renal Disease (ESRD). METHODS: 24 French university departments of urology and kidney transplantation participated in this national retrospective survey for identifying RCCs arising in the context of ESRD. Information regarding age, sex, symptoms at diagnosis, duration of exposition to ESRD, mode and duration of dialysis, renal transplantation, tumour staging and grading, histological subtype and outcome were recorded in a unique database. Qualitative and quantitative variables were compared by using chi-square and Student statistical analyses. RESULTS: 303 RCC cases diagnosed between 1985 and 2009 were identified in 206 men (76.3%) and 64 women (23.7%). Mean age at diagnosis was 54.96 ⫾ 12.78 years. Mean tumour size was 3.7 ⫾ 2.7 cm. Organ confined (T1-2 stages) and low grade (G1-2) tumours accounted for 272 (90%) and 206 (68%) cases, respectively. Only five patients (2%) had nodal or distant metastases at presentation. RCC was identified 120 ⫾ 84 months after chronic renal failure diagnosis in 90 (29.7%) patients who were under dialysis while 213 cases occurred in renal transplant patients, on average 91 ⫾ 82 months after transplantation. Incidental tumours and those associated with acquired cystic kidney disease (ACKD) accounted for 263 (87%) and 175 cases (58%), respectively. Tumours were cystic in 60 cases (20%). Thirty tumours (10%) were bilateral while sixty seven (22%) were multifocal. Histological subtypes included clear cell, papillary, chromophobe and other carcinomas in 177 (59%), 113 (37%), 10 (3%) and 1 (1%) cases, respectively. After a mean follow-up of 37.1 months, 264 patients (86.8%) were alive without evidence of disease, 8 (2.6%) had progressive disease, 13 (4.3%) had died of RCC, and 19 (6 3%) had died of other causes. Five years progression-free and specific survival rates were 79.1% and 87.2%, respectively. CONCLUSIONS: Most RCCs arising in patients with ESRD are small, low stage, low grade, incidental tumours with favourable outcome. Younger age at presentation, frequent bilaterality and/or multifocality, association with ACKD, less propensity to be of clear cell histology suggest that different molecular pathways are involved in this