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HISTOLOGICAL SUBTYPES OF LOCALIZED RENAL CELL CARCINOMA (RCC)CORRELATE WITH TUMOR SIZE: A SEER ANALYSIS
THE JOURNAL OF UROLOGY®
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
353
anemia. Multivariate analysis for variables associated with development of anemia Variable Age q 60 (Yes vs. No) Race (African-American vs. Caucasian-Other) History of Smoking (Yes vs. No)
Odds Ratio 1.62
95% Confidence Interval 1.13-2.22
2.30
1.63-3.25
P value 0.008 <0.0001
1.60
1.10-2.32
0.013
Preoperative GFR < 60 (Yes vs. No)
4.09
2.11-7.94
<0.0001
Preoperative proteinuria (Yes vs. No) Preoperative Metabolic Acidosis (Yes vs. No) RN vs. NSS
2.19
1.08-4.46
0.03
4.08
1.48-11.25
0.007
2.58
1.78-3.82
<0.0001
Source of Funding: None
989 HISTOLOGICAL SUBTYPES OF LOCALIZED RENAL CELL CARCINOMA (RCC)CORRELATE WITH TUMOR SIZE: A SEER ANALYSIS Jason Rothman*, Brian L Egleston, Yu-Ning Wong, Kevan Iffrig, Steve Lebovitch, Robert G Uzzo, Philadelphia, PA INTRODUCTION AND OBJECTIVE: Histology is an important prognostic variable when counseling patients with localized RCC. We investigated the relationship between tumor size and histology in patients with localized RCC. METHODS: Data from Surveillance, Epidemiology and End Results (SEER) were used to create a cohort of patients with localized, node negative RCC (1988-2004). Multinomial logistic models were used to predict the probability of specific histologies based on increasing primary tumor size. RESULTS: 19,932 patients in SEER with localized RCC were evaluated. 88% (17,552) patients had clear cell RCC, 4.4% (865) had papillary RCC, 1.9% (388) had chromophobe RCC. A high probability of detecting clear cell RCC was found for all tumor sizes; although localized clear cell RCCs were less commonly very large (Figure 1). Papillary RCC exhibited a u-shaped relationship between histology and tumor size such that at 10 cm the probability of papillary RCC increased with increasing tumor size (Figure 2). The probability of chromophobe RCC also increased with tumor size (Figure 3). Multinomial models predict the probability of papillary vs clear cell RCC decreases with tumor size (OR=0.95 per 1 cm increase, p<0.001) while the odds of chromophobe vs clear cell RCC increases with tumor size (OR=1.08 per 1 cm increase in size, p<0.001). CONCLUSIONS: The probability of detecting particular histologies varies with increasing primary tumor size such that localized clear cell RCCs were less often very large. Additionally, the incidence of both papillary and chromophobe histologies increased with primary tumor size. These data provide insight into the basic biology of localized RCC and have implications when counseling patients with large localized renal masses.
Source of Funding: The Fox Chase Kidney Cancer Keystone Program
990 INVESTIGATION OF PREOPERATIVE SERUM C-REACTIVE PROTEIN LEVEL ON THE PROGNOSIS FOR PATIENTS WITH LOCALIZED RENAL CELL CARCINOMA Soichi Mugiya*, Seiichiro Ozono, Masao Nagata, Tatsuya Takayama, Yutaka Kurita, Hamamatsu, Japan INTRODUCTION AND OBJECTIVE: Serum level of C-reactive protein (CRP) is frequently increased in patients with cancer, and was found to be associated with the prognosis in patients with advanced renal cell carcinoma (RCC). However, there are few studies that have examined the prognostic value of CRP in patients with localized RCC. We attempted to evaluate the importance of the preoperative serum CRP level on the prognosis for patients with localized RCC. METHODS: We studied retrospectively the records of 617 patients with RCC who underwent curative resection under classification as T1-3aN0M0. Disease-free and overall survival rates were estimated using the Kaplan-Meier method, and its associations with the CRP and other clinical and pathologic features were evaluated using Cox proportional hazard model. We also examined the predictive value of CRP as a predictor for recurrence, using receiver-operator characteristic (ROC) analysis. RESULTS: T classification included T1a in 321 patients, T1b in 172, T2 in 64, and T3a in 60. Of the 617 patients, 65 patients presented recurrence of RCC during a median follow-up of 57 months (range: 1-251). Disease-free survival rates at 5 and 10 years accounted for 88 and 81%, respectively. Patients with elevated CRP levels had significantly higher pathological T stage and histological grade. The preoperative serum CRP levels in patients with recurrence (1.956±3.570) were significantly higher than those in patients with non-recurrence (0.937±3.158) (p<0.0001). Using ROC analysis, CRP threshold value of 0.25 mg/dL gave a high sensitivity and specificity for recurrence. Analysis of disease-free and
Vol. 181, No. 4, Supplement, Monday, April 27, 2009
353
anemia. Multivariate analysis for variables associated with development of anemia Variable Age q 60 (Yes vs. No) Race (African-American vs. Caucasian-Other) History of Smoking (Yes vs. No)
Odds Ratio 1.62
95% Confidence Interval 1.13-2.22
2.30
1.63-3.25
P value 0.008 <0.0001
1.60
1.10-2.32
0.013
Preoperative GFR < 60 (Yes vs. No)
4.09
2.11-7.94
<0.0001
Preoperative proteinuria (Yes vs. No) Preoperative Metabolic Acidosis (Yes vs. No) RN vs. NSS
2.19
1.08-4.46
0.03
4.08
1.48-11.25
0.007
2.58
1.78-3.82
<0.0001
Source of Funding: None
989 HISTOLOGICAL SUBTYPES OF LOCALIZED RENAL CELL CARCINOMA (RCC)CORRELATE WITH TUMOR SIZE: A SEER ANALYSIS Jason Rothman*, Brian L Egleston, Yu-Ning Wong, Kevan Iffrig, Steve Lebovitch, Robert G Uzzo, Philadelphia, PA INTRODUCTION AND OBJECTIVE: Histology is an important prognostic variable when counseling patients with localized RCC. We investigated the relationship between tumor size and histology in patients with localized RCC. METHODS: Data from Surveillance, Epidemiology and End Results (SEER) were used to create a cohort of patients with localized, node negative RCC (1988-2004). Multinomial logistic models were used to predict the probability of specific histologies based on increasing primary tumor size. RESULTS: 19,932 patients in SEER with localized RCC were evaluated. 88% (17,552) patients had clear cell RCC, 4.4% (865) had papillary RCC, 1.9% (388) had chromophobe RCC. A high probability of detecting clear cell RCC was found for all tumor sizes; although localized clear cell RCCs were less commonly very large (Figure 1). Papillary RCC exhibited a u-shaped relationship between histology and tumor size such that at 10 cm the probability of papillary RCC increased with increasing tumor size (Figure 2). The probability of chromophobe RCC also increased with tumor size (Figure 3). Multinomial models predict the probability of papillary vs clear cell RCC decreases with tumor size (OR=0.95 per 1 cm increase, p<0.001) while the odds of chromophobe vs clear cell RCC increases with tumor size (OR=1.08 per 1 cm increase in size, p<0.001). CONCLUSIONS: The probability of detecting particular histologies varies with increasing primary tumor size such that localized clear cell RCCs were less often very large. Additionally, the incidence of both papillary and chromophobe histologies increased with primary tumor size. These data provide insight into the basic biology of localized RCC and have implications when counseling patients with large localized renal masses.
Source of Funding: The Fox Chase Kidney Cancer Keystone Program
990 INVESTIGATION OF PREOPERATIVE SERUM C-REACTIVE PROTEIN LEVEL ON THE PROGNOSIS FOR PATIENTS WITH LOCALIZED RENAL CELL CARCINOMA Soichi Mugiya*, Seiichiro Ozono, Masao Nagata, Tatsuya Takayama, Yutaka Kurita, Hamamatsu, Japan INTRODUCTION AND OBJECTIVE: Serum level of C-reactive protein (CRP) is frequently increased in patients with cancer, and was found to be associated with the prognosis in patients with advanced renal cell carcinoma (RCC). However, there are few studies that have examined the prognostic value of CRP in patients with localized RCC. We attempted to evaluate the importance of the preoperative serum CRP level on the prognosis for patients with localized RCC. METHODS: We studied retrospectively the records of 617 patients with RCC who underwent curative resection under classification as T1-3aN0M0. Disease-free and overall survival rates were estimated using the Kaplan-Meier method, and its associations with the CRP and other clinical and pathologic features were evaluated using Cox proportional hazard model. We also examined the predictive value of CRP as a predictor for recurrence, using receiver-operator characteristic (ROC) analysis. RESULTS: T classification included T1a in 321 patients, T1b in 172, T2 in 64, and T3a in 60. Of the 617 patients, 65 patients presented recurrence of RCC during a median follow-up of 57 months (range: 1-251). Disease-free survival rates at 5 and 10 years accounted for 88 and 81%, respectively. Patients with elevated CRP levels had significantly higher pathological T stage and histological grade. The preoperative serum CRP levels in patients with recurrence (1.956±3.570) were significantly higher than those in patients with non-recurrence (0.937±3.158) (p<0.0001). Using ROC analysis, CRP threshold value of 0.25 mg/dL gave a high sensitivity and specificity for recurrence. Analysis of disease-free and