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IMPACT OF FAMILY HISTORY ON OUTCOME IN RENAL CELL CARCINOMA
172
THE JOURNAL OF UROLOGY®
Vol. 179, No. 4, Supplement, Sunday, May 18, 2008
489
491
THE INCIDENCE OF LARGE (>4 CM) BENIGN RENAL MASSES Orit Raz*, Sonia Mendlovic, Yaniv Shilo, Dan Leibovici, Judith 6DQGEDQN$ULH/LQGQHU$PQRQ=LVPDQ=UL¿Q,VUDHO INTRODUCTION AND OBJECTIVE: It is customary to think WKDWWKHVL]HRIUHQDOPDVVHVFRUUHODWHVZLWKDQLQFUHDVHGULVNRIEHLQJ PDOLJQDQW,QWKLVVWXG\ZHDQDO\]HGWKHUDWHRIEHQLJQUHQDOPDVVHV DQGWKHLUVL]HGLVWULEXWLRQ METHODS: 366 patients underwent partial (110) or radical (256) nephrectomy with the indication of a suspicious solid renal mass. Cases with TCC were excluded, as well as cases with no details of the OHVLRQ¶VVL]H Q RESULTS: In 50 cases the renal mass was benign (13.6%). 7KHGLVWULEXWLRQRIWKHEHQLJQOHVLRQVE\VL]HDQGVXUJLFDODSSURDFKLV shown in the table. Of the renal masses that were selected for nephron sparing surgery approximately 20% were benign and 10% among those who underwent radical nephrectomy (p<0.05). There was no VLJQL¿FDQWGLIIHUHQFHLQWKHUDWHRIEHQLJQOHVLRQVEHWZHHQPDVVHV cm in diameter and those larger then 4 cm, regardless of the surgical approach (for both p<0.05).
EFFICACY OF 3-DIMENSIONAL COMPUTED TOMOGRAPHY IN THE DIFFERENTIAL DIAGNOSIS OF CYSTIC RENAL MASS Jeong Kyoon Bang*, Gyeong Eun Min, Cheryn Song, Bumsik Hong, Jun Hyuk Hong, Choung-Soo Kim, Hanjong Ahn. Seoul, Republic of Korea. INTRODUCTION AND OBJECTIVE: We evaluated the usefulness of 3-dimensional computed tomography (3D CT) in the differential diagnosis of cystic renal mass. METHODS: Between March 1997 and June 2007, total 104 patients with Bosniak class II (29, 27.8%), III (38, 36.5%), IV (37, 35.7%) cystic renal masses managed surgically were reviewed. From WKHSUHRSHUDWLYH'&7VFDQVHQKDQFHPHQWGLIIHUHQFHVLQ+RXQV¿HOG units (HU) between precontrast phase (PCP) and corticomedullary phase (CMP) were measured at the (highest enhancement area) to correlate ZLWKWKHSDWKRORJLFDO¿QGLQJV RESULTS: Renal cell carcinoma (RCC) was diagnosed in 56 (53.8%) patients, most commonly of the clear cell histology (21, 37.5%). According to the Bosniak class, 3 (11.5%) from class II/IIf, 21 (55.2%) from class III, 32 (86.4%) from class IV were diagnosed of RCC. Between RCC and benign cysts, mean HU measured from the PCP and CMP was 31.77, 117.89 in RCC and 34.25, 69.82 in benign cysts. Using the difference in the HU between the PCP and CMP, the area under the receiver-operating characteristics (ROC) curve was 0.939 with the VHQVLWLYLW\DQGWKHVSHFL¿FLW\DW DQGZKHQWKHGLIIHUHQFH was over 45HU. Moreover, for the masses that continue to enhance into the early excretory phase (EEP), enhancement HU could be measured at the EEP and the difference from the PCP over 50HU demonstrated KLJKHVWVHQVLWLYLW\DQGVSHFL¿FLW\ DQGUHVSHFWLYHO\ ZLWK the area under the ROC curve of 0.938. CONCLUSIONS: Enhancement differences measured from 3D CT between precontrast and maximal enhancement phases (>45HU in PCP/CMP or >50HU in PCP/EEP) are reliable and useful in the differential diagnosis and decision-making for surgical treatment of cystic renal mass.
6L]H 4 cm 4 < x 7cm >7 cm Total
Partial Radical nephrectomy nephrectomy Benign / Total Benign / Total 12/102 (11.7%) 20/86 (22.4%) 7/91 (7.6%) 5/22 (22.7%) 5/63 (7.9%) 1/2 24/256 26/110
Total 32/188 (17%) 12/113 (10.6%) 6/65 (9.2%) 50/366
CONCLUSIONS: Large renal masses are not necessarily malignant. Large benign renal masses are not uncommon (10-20%). This data, justify reconsideration the role of preoperative biopsy of renal mass, since according to our data, if pre-operative tissue diagnosis existed it was possible to save 12 renal units (15.5%) as well to prevent warm renal ischemia in additional 18 cases (20%) that underwent partial nephrectomy, for lesions > 4cm in diameter.
Source of Funding: None
Source of Funding: None
490 IMPACT OF FAMILY HISTORY ON OUTCOME IN RENAL CELL CARCINOMA Shawn M McGee*, Stephen A Boorjian, Christine M Lohse, Bradley C Leibovich, Michael L Blute. Rochester, MN. INTRODUCTION AND OBJECTIVE: While an increased incidence of renal cell carcinoma (RCC) has been reported in people with a family history of RCC, treatment results for patients with a family history RI5&&KDYHQRWEHHQZHOOGH¿QHG:HLQYHVWLJDWHGWKHLPSDFWRIIDPLO\ history on pathological and clinical outcomes following nephrectomy. METHODS: We studied 2,677 patients treated surgically for 5&&EHWZHHQ DQG$WRWDORISDWLHQWV ZHUHLGHQWL¿HG ZLWKDIDPLO\KLVWRU\RI5&&GH¿QHGDVKDYLQJD¿UVWGHJUHHUHODWLYH with RCC but excluding patients with an established RCC syndrome. Demographics and postoperative outcomes were compared to 2,635 patients treated for sporadic RCC. RESULTS: Patients with a family history of RCC were VLJQL¿FDQWO\PRUHOLNHO\WRKDYHELODWHUDOV\QFKURQRXVWXPRUV vs. 2.2%, p=0.003), although age, symptoms at presentation, tumor VWDJHDQGQXFOHDUJUDGHGLGQRWGLIIHUVLJQL¿FDQWO\EHWZHHQWKHJURXSV )DPLO\KLVWRU\RI5&&ZDVQRWVLJQL¿FDQWO\DVVRFLDWHGZLWKGHDWKIURP 5&&RQXQLYDULDWHDQDO\VLV 55 S VHH)LJXUH ZKLOHWKH \HDUFDQFHUVSHFL¿FVXUYLYDOZDVVLPLODUIRUSWVZLWKDQGZLWKRXWD)+ of RCC (76% vs. 71%). CONCLUSIONS: Patients with a family history of RCC have pathological and clinical outcomes similar to pts with sporadic RCC. The increased incidence of bilateral tumors seen in these pts argues for a nephron-sparing approach when possible. Source of Funding: None
Penis/Testis/Urethra: Benign and Malignant Disease (I) Moderated Poster Session 16 Sunday, May 18, 2008
3:30 - 5:30 pm
492 INCREASED RISK OF SECONDARY MALIGNANCY IN PATIENTS ON ACTIVE SURVEILLANCE FOR NSGCT Karim Chamie*, Eric A Kurzrock, Victor Romero, Ralph W deVere White. Sacramento, CA. INTRODUCTION AND OBJECTIVE: Radiation exposure from imaging is associated with an increased risk of secondary malignancy. Active surveillance for clinical stage 1 non-seminomatous germ cell tumors (NSGCT) is now a standard of care. The patients on active surveillance undergo frequent CT imaging. Our goal was to determine whether NSGCT patients on active surveillance are at increased risk of developing secondary malignancies. 0(7+2'6 :HXWLOL]HGWKH6((5GDWDRIWKH1&,WRLGHQWLI\ patients between the years 1973 and 1997 who were diagnosed with NSGCT and were treated with either RPLND or followed with DFWLYH VXUYHLOODQFH 7KH GDWD ZDV DQDO\]HG IRU DJH UDFH KLVWRU\ RI radiotherapy, previous malignancy, development of a new malignancy, and cause of death. Exclusion criteria included radiotherapy treatment, >T3 disease, nodal or distant metastasis, previous malignancy, and development of a new a malignancy within 1 year of initial diagnosis of testicular cancer. 5(68/76 $IWHUDSSOLFDWLRQRIH[FOXVLRQFULWHULDZHLGHQWL¿HG 1729 patients who were on active surveillance and 1605 who underwent RPLND. The median follow-up of the entire cohort (3334 patients) was 13.9 years. The median follow-up of those who developed a secondary malignancy (172 patients) was 16.4 years. Patients on active surveillance had a higher incidence of secondary malignancy than those who
THE JOURNAL OF UROLOGY®
Vol. 179, No. 4, Supplement, Sunday, May 18, 2008
489
491
THE INCIDENCE OF LARGE (>4 CM) BENIGN RENAL MASSES Orit Raz*, Sonia Mendlovic, Yaniv Shilo, Dan Leibovici, Judith 6DQGEDQN$ULH/LQGQHU$PQRQ=LVPDQ=UL¿Q,VUDHO INTRODUCTION AND OBJECTIVE: It is customary to think WKDWWKHVL]HRIUHQDOPDVVHVFRUUHODWHVZLWKDQLQFUHDVHGULVNRIEHLQJ PDOLJQDQW,QWKLVVWXG\ZHDQDO\]HGWKHUDWHRIEHQLJQUHQDOPDVVHV DQGWKHLUVL]HGLVWULEXWLRQ METHODS: 366 patients underwent partial (110) or radical (256) nephrectomy with the indication of a suspicious solid renal mass. Cases with TCC were excluded, as well as cases with no details of the OHVLRQ¶VVL]H Q RESULTS: In 50 cases the renal mass was benign (13.6%). 7KHGLVWULEXWLRQRIWKHEHQLJQOHVLRQVE\VL]HDQGVXUJLFDODSSURDFKLV shown in the table. Of the renal masses that were selected for nephron sparing surgery approximately 20% were benign and 10% among those who underwent radical nephrectomy (p<0.05). There was no VLJQL¿FDQWGLIIHUHQFHLQWKHUDWHRIEHQLJQOHVLRQVEHWZHHQPDVVHV cm in diameter and those larger then 4 cm, regardless of the surgical approach (for both p<0.05).
EFFICACY OF 3-DIMENSIONAL COMPUTED TOMOGRAPHY IN THE DIFFERENTIAL DIAGNOSIS OF CYSTIC RENAL MASS Jeong Kyoon Bang*, Gyeong Eun Min, Cheryn Song, Bumsik Hong, Jun Hyuk Hong, Choung-Soo Kim, Hanjong Ahn. Seoul, Republic of Korea. INTRODUCTION AND OBJECTIVE: We evaluated the usefulness of 3-dimensional computed tomography (3D CT) in the differential diagnosis of cystic renal mass. METHODS: Between March 1997 and June 2007, total 104 patients with Bosniak class II (29, 27.8%), III (38, 36.5%), IV (37, 35.7%) cystic renal masses managed surgically were reviewed. From WKHSUHRSHUDWLYH'&7VFDQVHQKDQFHPHQWGLIIHUHQFHVLQ+RXQV¿HOG units (HU) between precontrast phase (PCP) and corticomedullary phase (CMP) were measured at the (highest enhancement area) to correlate ZLWKWKHSDWKRORJLFDO¿QGLQJV RESULTS: Renal cell carcinoma (RCC) was diagnosed in 56 (53.8%) patients, most commonly of the clear cell histology (21, 37.5%). According to the Bosniak class, 3 (11.5%) from class II/IIf, 21 (55.2%) from class III, 32 (86.4%) from class IV were diagnosed of RCC. Between RCC and benign cysts, mean HU measured from the PCP and CMP was 31.77, 117.89 in RCC and 34.25, 69.82 in benign cysts. Using the difference in the HU between the PCP and CMP, the area under the receiver-operating characteristics (ROC) curve was 0.939 with the VHQVLWLYLW\DQGWKHVSHFL¿FLW\DW DQGZKHQWKHGLIIHUHQFH was over 45HU. Moreover, for the masses that continue to enhance into the early excretory phase (EEP), enhancement HU could be measured at the EEP and the difference from the PCP over 50HU demonstrated KLJKHVWVHQVLWLYLW\DQGVSHFL¿FLW\ DQGUHVSHFWLYHO\ ZLWK the area under the ROC curve of 0.938. CONCLUSIONS: Enhancement differences measured from 3D CT between precontrast and maximal enhancement phases (>45HU in PCP/CMP or >50HU in PCP/EEP) are reliable and useful in the differential diagnosis and decision-making for surgical treatment of cystic renal mass.
6L]H 4 cm 4 < x 7cm >7 cm Total
Partial Radical nephrectomy nephrectomy Benign / Total Benign / Total 12/102 (11.7%) 20/86 (22.4%) 7/91 (7.6%) 5/22 (22.7%) 5/63 (7.9%) 1/2 24/256 26/110
Total 32/188 (17%) 12/113 (10.6%) 6/65 (9.2%) 50/366
CONCLUSIONS: Large renal masses are not necessarily malignant. Large benign renal masses are not uncommon (10-20%). This data, justify reconsideration the role of preoperative biopsy of renal mass, since according to our data, if pre-operative tissue diagnosis existed it was possible to save 12 renal units (15.5%) as well to prevent warm renal ischemia in additional 18 cases (20%) that underwent partial nephrectomy, for lesions > 4cm in diameter.
Source of Funding: None
Source of Funding: None
490 IMPACT OF FAMILY HISTORY ON OUTCOME IN RENAL CELL CARCINOMA Shawn M McGee*, Stephen A Boorjian, Christine M Lohse, Bradley C Leibovich, Michael L Blute. Rochester, MN. INTRODUCTION AND OBJECTIVE: While an increased incidence of renal cell carcinoma (RCC) has been reported in people with a family history of RCC, treatment results for patients with a family history RI5&&KDYHQRWEHHQZHOOGH¿QHG:HLQYHVWLJDWHGWKHLPSDFWRIIDPLO\ history on pathological and clinical outcomes following nephrectomy. METHODS: We studied 2,677 patients treated surgically for 5&&EHWZHHQ DQG$WRWDORISDWLHQWV ZHUHLGHQWL¿HG ZLWKDIDPLO\KLVWRU\RI5&&GH¿QHGDVKDYLQJD¿UVWGHJUHHUHODWLYH with RCC but excluding patients with an established RCC syndrome. Demographics and postoperative outcomes were compared to 2,635 patients treated for sporadic RCC. RESULTS: Patients with a family history of RCC were VLJQL¿FDQWO\PRUHOLNHO\WRKDYHELODWHUDOV\QFKURQRXVWXPRUV vs. 2.2%, p=0.003), although age, symptoms at presentation, tumor VWDJHDQGQXFOHDUJUDGHGLGQRWGLIIHUVLJQL¿FDQWO\EHWZHHQWKHJURXSV )DPLO\KLVWRU\RI5&&ZDVQRWVLJQL¿FDQWO\DVVRFLDWHGZLWKGHDWKIURP 5&&RQXQLYDULDWHDQDO\VLV 55 S VHH)LJXUH ZKLOHWKH \HDUFDQFHUVSHFL¿FVXUYLYDOZDVVLPLODUIRUSWVZLWKDQGZLWKRXWD)+ of RCC (76% vs. 71%). CONCLUSIONS: Patients with a family history of RCC have pathological and clinical outcomes similar to pts with sporadic RCC. The increased incidence of bilateral tumors seen in these pts argues for a nephron-sparing approach when possible. Source of Funding: None
Penis/Testis/Urethra: Benign and Malignant Disease (I) Moderated Poster Session 16 Sunday, May 18, 2008
3:30 - 5:30 pm
492 INCREASED RISK OF SECONDARY MALIGNANCY IN PATIENTS ON ACTIVE SURVEILLANCE FOR NSGCT Karim Chamie*, Eric A Kurzrock, Victor Romero, Ralph W deVere White. Sacramento, CA. INTRODUCTION AND OBJECTIVE: Radiation exposure from imaging is associated with an increased risk of secondary malignancy. Active surveillance for clinical stage 1 non-seminomatous germ cell tumors (NSGCT) is now a standard of care. The patients on active surveillance undergo frequent CT imaging. Our goal was to determine whether NSGCT patients on active surveillance are at increased risk of developing secondary malignancies. 0(7+2'6 :HXWLOL]HGWKH6((5GDWDRIWKH1&,WRLGHQWLI\ patients between the years 1973 and 1997 who were diagnosed with NSGCT and were treated with either RPLND or followed with DFWLYH VXUYHLOODQFH 7KH GDWD ZDV DQDO\]HG IRU DJH UDFH KLVWRU\ RI radiotherapy, previous malignancy, development of a new malignancy, and cause of death. Exclusion criteria included radiotherapy treatment, >T3 disease, nodal or distant metastasis, previous malignancy, and development of a new a malignancy within 1 year of initial diagnosis of testicular cancer. 5(68/76 $IWHUDSSOLFDWLRQRIH[FOXVLRQFULWHULDZHLGHQWL¿HG 1729 patients who were on active surveillance and 1605 who underwent RPLND. The median follow-up of the entire cohort (3334 patients) was 13.9 years. The median follow-up of those who developed a secondary malignancy (172 patients) was 16.4 years. Patients on active surveillance had a higher incidence of secondary malignancy than those who