577 RENAL CELL CARCINOMA (RCC) IN PATIENTS WITH END-STAGE RENAL DISEASE: DOES IT REALLY EXHIBIT FAVORABLE PROGNOSIS COMPARED TO SPORADIC RCC?

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575 NSAID AND STATIN USE AND RISK OF RENAL CELL CARCINOMA Lisly Che´ry*, Jonathan Wright, James Hotaling, Michael Davenport, Jonathan Harper, John Gore, Emily White, Seattle, WA INTRODUCTION AND OBJECTIVES: Renal Cell Carcinoma (RCC) incidence is increasing and there is little data on causative or preventative pharmacological agents. To date, some data suggests that statins may reduce RCC risk and nonsteroidal anti-inflammatory drugs (NSAIDs) may increase RCC risk but these data are primarily retrospective. In this study, we examine the relationship between use of statins and NSAIDs on the risk of RCC using a contemporary, population-based prospective cohort. METHODS: Participants in the VITAL Study – (VITamins and Lifestyle) aged 50-76 years comprised the study population. Participants enrolled and completed questionnaires in 2000-2002 on cancer risk factors including medication usage. Incident cases of RCC were identified via linkage to the cancer registry. For NSAID use, ten-year use of aspirin and other NSAIDs was categorized as none, low-use (1-3 days/week or ⬍4 years), or high-use (ⱖ4 days/week and ⱖ4 years). Participants were queried on the use of statins in the last 2 weeks. Cox regression analyses estimated the hazard ratios (HR) for RCC in both a base (age and gender adjusted) and multivariate model (base ⫹ race, smoking, alcohol use, BMI, kidney disease, hypertension, diabetes, viral hepatitis). RESULTS: A total of 249 cases of RCC were detected. Statin use was reported by 20% of participants. In the base model, statin use was associated with an increased risk of RCC (HR 1.4, 95%CI 1.0-1.8) yet failed to maintain significance in the multivariate model (HR 1.1, 0.8-1.4). A similar relationship was found for NSAID use. Compared to non-users, low (HR 1.2, 0.8-1.6) and high (HR 1.4, 1.0 –2.0) users of NSAIDs (aspirin and non-aspirin NSAIDs) had an increased risk of RCC in the base model (p-trend 0.03). However, this relationship was attenuated and non-significant (p-trend 0.35) in the multivariate model for both low (HR 1.01, 0.7-1.4) and high (1.2, 0.8-1.7) users compared to non-users. CONCLUSIONS: The results of this study do not support previous findings that statin and NSAID use are associated with the risk of RCC. The observed relationships between these commonly used medications and RCC risk do not persist after adjusting for known risk factors for RCC. Source of Funding: None

576 RENAL CELL CARCINOMA IN END-STAGE RENAL DISEASE: ACCORDING TO THE KIDNEY TRANSPLANT AND DIALYSIS Hyung Ho Lee*, Seoul, Korea, Republic of; Ho Song Yu, Gwangju, Korea, Republic of; Woo Jin Bang, Woong Kyu Han, Sung Jun Hong, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: End-stage renal disease (ESRD) patients are at a higher risk for cancer, especially renal cell carcinoma (RCC). Acquired cystic kidney disease (ACKD) and long duration of dialysis were known as risk factors for RCC in these patients. We evaluated the clinical and pathologic characteristics of renal masses and compared between the dialysis patients and kidney transplantation patients. METHODS: From January 2001 to December 2010, 78 ESRD patients were referred to urology clinic for management of renal mass which was diagnosed by abdominal ultrasound or computed tomography during dialysis or after kidney transplantation. Of them, 3 patients who could not be performed surgery were excluded. We retrospectively reviewed the medical records of 75 patients and analyzed. RESULTS: There were 52 RCC, 7 urothelial carcinoma, 2 angiomyolipoma, 1 adenoma, 1 hemangioma and no tumor in 12 patients. There were no significant differences between patients with malignant tumor and with benign tumor. Out of the 52 RCC patients,

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30 received only dialysis (Group A), and the other 22 underwent kidney transplantation after dialysis (Group B). Cell types of RCC were clear in 29 patients (55.8%) and papillary in 16 patients (30.8%). 2 patients have bilateral RCC. In group A, RCC was observed after an average of 120 months (2-251) of dialysis, and nephrectomy was then conducted. In group B, the renal replacement therapy period averaged 94 months, and the period from transplantation to RCC averaged 158 months (20-253). Group A had a higher prevalence of ACKD (83.3% vs. 27.3%, P⬍0.0001) and it had a statistically relevant effect on the occurrence of RCC by comparison to group B (P⬍0.01). The duration of ESRD was significantly shorter in group A (145.9⫾91.1 vs. 207.9⫾63.8 months, P⫽0.006) compared to group B. However, there was no statistically significant difference in the duration of dialysis. CONCLUSIONS: The most common renal mass in ESRD was RCC. Although the incidence rate of ACKD was significantly higher in the dialysis group, cancer was found even without ACKD development in some transplant recipients. Considering that the transplant recipients also underwent dialysis, an informative prospective study will to determine whether other immunosuppressive agents besides ACKD may function as a cancer risk factor. Source of Funding: None

577 RENAL CELL CARCINOMA (RCC) IN PATIENTS WITH END-STAGE RENAL DISEASE: DOES IT REALLY EXHIBIT FAVORABLE PROGNOSIS COMPARED TO SPORADIC RCC? Junpei Iizuka*, Tsunenori Kondo, Yasunobu Hashimoto, Hirohito Kobayashi, Toshio Takagi, Eri Ikezawa, Kazunari Takagi, Tokyo, Japan INTRODUCTION AND OBJECTIVES: In end-stage renal disease (ESRD) patients, it is well known that renal cell carcinoma (RCC) develop from acquired cystic disease of the kidney (ACDK) with longterm dialysis. Recently some reports showed favorable clinical features and prognosis of RCCs in ESRD patients (ESRD-RCC) compared to those in the general population (sporadic-RCC). However it is a disputable point. In this study, we assessed clinical features and oncological outcomes of ESRD-RCC compared to sporadic-RCC. METHODS: Until Jun 2011, a total of 1651 patients who underwent surgery at our institution were the subject of this study (305 ESRD-RCC and 1346 sporadic-RCC). Thus we also evaluated the oncological outcome using a stage-for-stage analysis between the two groups. Cancer-specific survival (CSS) rate was calculated using the Kaplan-Meier method. RESULTS: In ESRD-RCC, mean duration of dialysis before surgery was 170⫾95 months. There were 137 patients (45%) with dialysis for over 15 years. Compared to sporadic-RCC, ESRD-RCC was likely to occur in younger patients (55 yr vs 59 yr: p⬍0.0001), more frequently in males (81% vs 70%: p⬍0.0001), at smaller tumor size (4.0cm vs 5.2cm: p⬍0.0001) and incidentally (72% vs 68%: P⬍0.0001). Pathological characteristics of ESRD-RCC included higher proportion of papillary tumor (19% vs 4.5%: p⬍0.0001), and lower proportion of advanced tumor (stage III, IV) (26% vs 29%: p⬍0.0001). During a median follow-up period of 42 months (range: 1-363 months), 27(9%) of ESRD-RCC and 200(15%) of sporadic-RCC had died from cancer. Five-year CSS was significantly higher in patients with ESRDRCC than those with sporadic-RCC (89.0% vs 83.9%: p⫽0.009). However, in stage-for-stage analysis, 5-year CSS was very similar between the two groups in stage I (98.0% vs 98.7%: p⫽0.32), in stage II (100% vs 91.0%: p⫽0.23), in stage III (76.5% vs 77.1%: p⫽0.68) and in stage IV (0% vs 23.5%: p⫽0.63) respectively. Fifteen years or longer duration of dialysis before surgery adversely influenced the patient survival of ESRD-RCC. CONCLUSIONS: The patients with ESRD-RCC showed better clinical features and prognosis, however in the analysis of 5-year CSS by stage-for-stage, there were no statistically significant differences between the two groups in any stage. It seemed to be

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that in ESRD-RCC there were more low stage tumors compared to sporadic-RCC. So, we should not misunderstand the prognosis of ESRD-RCC especially when the patients had been under long-term dialysis therapy. Source of Funding: None

578 PREDICTIVE FACTORS FOR CHRONIC RENAL FAILURE AFTER PARTIAL NEPHRECTOMY IN SOLITARY KIDNEY: MULTICENTRIC STUDY IN 259 CASES. Gregory Verhoest*, Rennes, France; Thomas Bessede, Geraldine Pignot, Rachid Bahi, Paris, France; Jean Christophe Bernhard, Bordeaux, France; Fabien Bouliere, Paris, France; Jean De La Rosette, Alex Bex, Amsterdam, Netherlands; Jerome Rigaud, Nantes, France; Morgan Roupret, Guillaume Coffin, Paris, France; Jean Marie Ferriere, Bordeaux, France; Jean Alexandre Long, Jean Louis Descotes, Grenoble, France; Alexander Zisman, Tel Aviv, Israel; Philippe Paparel, Lyon, France; Charlotte Maurin, Eric Lechevallier, Marseille, France; Roberto Bertini, Francesco Montorsi, Milan, Italy; Laurent Salomon, Paris, France; Roy Farfara, Haifa, Israel; Bjorn Ljungberg, Umean, Sweden; Alexandro Rodriguez, Tampa, FL; Karim Bensalah, Rennes, France; Jean Jacques Patard, Paris, France INTRODUCTION AND OBJECTIVES: Multiple questions remain regarding surgical approach (laparoscopic vs open) or renal vessel clamping modalities for an optimal renal function preservation following partial nephrectomy (PN). Solitary kidney is indeed a good clinical model for analyzing functional consequences of PN. The objective of this study was to determine predictive factors for chronic renal failure following PN in the solitary kidney setting. METHODS: Epidemiological variables, pre, per and postoperative parameters were extracted from 15 international centre partial nephrectomy databases. Information such as age, gender, BMI, Charlson index, tumor characteristics (tumor size, TNM stage), surgical parameters (renal clamping, ischemic time, renal cooling, surgery duration, operative blood loss), medical and surgical postoperative complications, MDRD glomerular filtration rates (GFR) before and after the surgery were registered. Multivariate analysis was performed by using a Cox regression model analysis. RESULTS: 259 PN in solitary kidneys were analyzed. Patients were 164 (63.3%) men and 95 (36.7%) women whose median age was 62 years (29-84). Median tumor size was 3.5 cm (1-17). Median ischemic, ope´rative times and length of hospital stay were 16 min (0-160), 180 min (60-410) and 9 days (2-49). Median blood loss was 350 ml (0-4800). Temporary and permanent post-operative haemodialysis occurred in 16 (6.2%) and 8 (3.1%) patients respectively. Independent predictive factors for experiencing MDRD GFR ⬍30 ml/min at last follow up were: BMI (p⫽0.007), Baseline renal function (p⫽0.0001), operative blood loss (p⫽0.001) and post operative medical complications (p⫽0.001). Ischemic time, renal vessels clamping modalities and renal cooling had no independent impact when all pre, per and post-operative parameters were included in the multivariate model. CONCLUSIONS: Patient and renal function pre-operative characteristics as well as intra and post operative parameters are important predictive factors for chronic renal failure following partial nephrectomy in solitary kidneys. Source of Funding: None

579 CORRELATION OF R.E.N.A.L. NEPHROMETRY SCORE AND PERIOPERATIVE AND RENAL FUNCTIONAL OUTCOMES FOLLOWING ROBOT-ASSISTED PARTIAL NEPHRECTOMY Adrian Clubb, Aaron Grossman, Philip Dahm, Li-Ming Su*, Gainesville, FL INTRODUCTION AND OBJECTIVES: The R.E.N.A.L nephrometry score (NS) was developed to allow for a more objective comparison

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of technically similar cases taking into account unique morphometric characteristics of tumors on cross sectional imaging. The objective of this study was to evaluate the validity of NS in predicting perioperative and renal function outcomes following robot-assisted partial nephrectomy. METHODS: 83 consecutive robot-assisted partial nephrectomies performed by a single surgeon between May 2009 and March 2010 were reviewed. Data was maintained prospectively on all subjects including pre and post-operative creatinine, estimated glomerular filtration rate (GFR) based on MDRD, total operative time (TOT), warm ischemia time and estimated blood loss (EBL). NS data was correlated with perioperative and renal functional outcomes in three separate ways. First, total NS sum score was compared as a continuous variable to perioperative outcomes. Second, a subanalysis was made comparing low versus medium NS complexity groups. Finally, component variables of R.E.N.A.L were individually assessed to determine which variable(s) were most predictive of perioperative and renal functional outcomes. Statistical analysis was performed utilizing PASW Statistics 18 program and included one way ANOVA, t-test and linear regression. RESULTS: Mean tumor size was 2.7 cm, TOT 213 minutes, EBL of 98 mL and length of stay of 2.7 days. The mean warm ischemic time for our series was 22 minutes (14 – 45 mins) with three off-clamp cases excluded from our results. The majority of cases in our series fell into low (n⫽49, 61%) and moderate complexity groups (n⫽20 35%). No statistical significance was demonstrated for the NS sum score and change in Cr and eGFR, TOT, or EBL. NS sum score approached significance when correlated with WIT (p-value 0.051). When comparing low to medium complexity groups, significance was demonstrated for WIT ( 20.5 vs. 26 min, p ⫽ 0.02). The only parameter of R.E.N.A.L that predicted WIT was the nearness to the collecting system (N) with a p value of ⬍0.01. CONCLUSIONS: Nephrometry sum score did not correlate with most operative variables in our series, but did appear to predict those patients who were more likely to be subjected to a prolonged warm ischemia time. Total sum score and especially nearness of tumor to the collecting system were most predictive of WIT. Such information may be most useful in counseling patients with pre-existing renal insufficiency, where a prolonged WIT may be especially detrimental. Source of Funding: None

580 RADIOLOGICAL PREDICTION OF PRESERVED RENAL MASS IN PATIENTS UNDERGOING LAPAROSCOPIC PARTIAL NEPHRECTOMY: CORRELATION WITH OPERATIVE AND FUNCTIONAL OUTCOMES Scott Leslie*, Syed Rahmanuddin, Eric Yi-Hsiu Huang, Dennis J Lee, Andre Luis de Castro Abreu, Alvin Goh, Andre K Berger, Jie Cai, Monish Aron, Mihir M Desai, Vinay A Duddalwar, Inderbir S Gill, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Preserved renal mass following partial nephrectomy (PN) correlates with postoperative renal function. We assessed the accuracy of preoperative radiological prediction of preserved renal mass using a novel CT image-rendering program (3D Synapse - Fuji film©). Correlation is made with the volume of the resected specimen and post-operative renal function. METHODS: We identified 100 patients undergoing laparoscopic partial nephrectomy (LPN) for a solitary renal mass. The preoperative CT scan was assessed using advanced image-processing software to measure the volume of both kidneys, the tumor volume and to calculate the predicted volume of preserved renal mass by subtracting the predicted resection volume. The predicted resection volume included the tumor as well as a surgical margin of normal renal parenchyma (see image). The actual resected volume was calculated by measuring the volume of the specimen on the back table following excision. Predicted postoperative eGFR was calculated by multiplying the preoperative eGFR with the predicted functional remaining volume (FRV). Predicted postop eGFR ⫽ Preop eGFR ⫻ % FRV RESULTS: All patients successfully underwent zero-ischemia LPN, with or without robotic assistance. Mean age was 60.5 years. The