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MP16-03 UTILITY OF INFLAMMATORY MARKERS IN PROGNOSIS FOR PATIENTS WITH RENAL CELL CARCINOMA AND VENA CAVA TUMOR THROMBUS
THE JOURNAL OF UROLOGYâ
e180
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
determine effective dosage and prevent manifestation of severe AEs in patients with mRCC. Further evaluation of ABCB1 genotypes and sunitinib dosage is warranted.
Source of Funding: none
MP16-03
Source of Funding: None
UTILITY OF INFLAMMATORY MARKERS IN PROGNOSIS FOR PATIENTS WITH RENAL CELL CARCINOMA AND VENA CAVA TUMOR THROMBUS Adam Lorentz*, Atlanta, GA; Manik Gupta, Detroit, MI; Matthew Broggi, Augusta, GA; Andrew Leung, Dattatraya Patil, Viraj Master, Atlanta, GA INTRODUCTION AND OBJECTIVES: Nephrectomy and inferior vena cava (IVC) thrombectomy for renal cell carcinoma (RCC) with IVC involvement is associated with significant morbidity and mortality, making accurate prognosis valuable. Systemic inflammatory markers have shown to be prognostic in malignancy. We assess preoperative Creactive protein (CRP), albumin, and the modified Glasgow Prognostic Score (mGPS), which combines both assays, for prognostic utility in RCC with IVC thrombus. METHODS: From 2006-2016, one surgeon performed 149 cases of radical nephrectomy and IVC tumor thrombectomy. Only those with clear cell RCC and available laboratory data were included. Patients were assigned an mGPS score 0-2 based on preoperative lab values (0¼CRP 10 mg/L, 1¼CRP > 10 mg/L, and 2¼CRP > 10 mg/L and albumin < 3.5 g/dL). Other factors included in the analysis were age, gender, race, body mass index, 2009 AJCC pathologic T and M stages, necrosis, and nuclear grade. Also examined were well-established prognostic scoring systems, the University of California Los Angeles Integrated Staging System and the Mayo Clinic Stage, Size, Grade, and Necrosis scoring system. Log-rank and multivariable regression analysis examined overall survival (OS). RESULTS: Of 117 clear cell RCC patients with IVC thrombus, the mortality rate was 38.4% over a median follow-up period of 12.6 months (interquartile range 4.8-32.4 months). Patients with albumin < 3.5 g/dL represented 62.7% of the population and those with CRP > 10 mg/L represented 67.7%. Those with mGPS scores 0, 1, and 2 represented 32.3%, 14.4%, and 53.54%, respectively. CRP > 10 mg/L (HR 4.94, 95% 1.7-14.2, p<0.001), albumin < 3.5 g/dL (HR 2.16, 95% 1.14.3, p¼0.024), and mGPS¼2 (HR 5.56, 95% 1.9-16.1, p¼0.002) correlated with OS. After adjusting for other factors, only mGPS¼2 (HR 4.25, 95% 1.4-13.3; p¼0.01) was an independent predictor of OS. A secondary analysis of only non-metastatic patients maintained significance. CONCLUSIONS: For patients with RCC and IVC involvement, elevated CRP and low albumin correlate with OS. Combining albumin with CRP in the modified Glasgow Prognostic Score independently predicts OS. The mGPS could serve as a useful clinical adjunct with regard to follow-up counseling and clinical trial design.
MP16-04 MEAN HOUNSFIELD UNITS ON UNENHANCED CT PREDICTS RESPONSE TO EVEROLIMUS IN TUBEROUS SCLEROSIS COMPLEX ASSOCIATED ANGIOMYOLIPOMAS Yi Cai*, Hanzhong Li, BEIJING, China, People’s Republic of; Yushi Zhang, Beijing, China, People’s Republic of INTRODUCTION AND OBJECTIVES: Everolimus, a mammalian target of rapamycin (mTOR) inhibitor, has been used for tuberous sclerosis complex associated angiomyolipoma (TSC-AML). However, we lack tools to accurately predict response in individual patients. METHODS: In this single-center phase 2 nonrandomized open label trial, eighteen patients with forty-three measurable AMLs associated tuberous sclerosis complex were treated with oral everolimus (10mg/d). AML volume and computed tomography (CT) parameters were measured at baseline, 12, 24, 48 and 96 weeks. Receiver operating characteristic curve (ROC) method was used to calculate the sensitivity, specificity and diagnostic accuracy. All analyses used a significance level of 0.05 and were generated in SPSS19.0 software. RESULTS: Target AML response, volume reductions over 50% relative to baseline defined by RECIST criteria, were 65.85%(27/ 41), 67.50%(27/40) and 68.42%(26/38) at weeks 12, 24 and 48, respectively. Mean HU on unenhanced CT and the longest diameter (DL) at baseline significantly correlated with percentage change of target AML at different indicated time. The AUC for mean hounsfield units (HU) on unenhanced CT were 0.99, 1.00 and 0.94 at weeks 12, 24 and 48, respectively, while the AUC for DL of 0.71, 0.78 and 0.91 at weeks 12, 24 and 48, respectively. Representative scans from two different status of mean HU target AML treated with everolimus are shown in Figure 1. A threshold of -24.50 HU for predicting AML response showed 92.86% sensitivity and 96.30% specificity at 12 weeks (likelihood ratio¼25.07), 100.0% sensitivity and 96.30% specificity at 24 weeks (likelihood ratio¼27.00), while 91.67% sensitivity and 96.15% specificity at 48 weeks (likelihood ratio¼23.83), respectively (Figure 2). CONCLUSIONS: Mean HU on unenhanced CT of target AML at baseline predicts response to everolimus and it may be useful to select treatment.
e180
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
determine effective dosage and prevent manifestation of severe AEs in patients with mRCC. Further evaluation of ABCB1 genotypes and sunitinib dosage is warranted.
Source of Funding: none
MP16-03
Source of Funding: None
UTILITY OF INFLAMMATORY MARKERS IN PROGNOSIS FOR PATIENTS WITH RENAL CELL CARCINOMA AND VENA CAVA TUMOR THROMBUS Adam Lorentz*, Atlanta, GA; Manik Gupta, Detroit, MI; Matthew Broggi, Augusta, GA; Andrew Leung, Dattatraya Patil, Viraj Master, Atlanta, GA INTRODUCTION AND OBJECTIVES: Nephrectomy and inferior vena cava (IVC) thrombectomy for renal cell carcinoma (RCC) with IVC involvement is associated with significant morbidity and mortality, making accurate prognosis valuable. Systemic inflammatory markers have shown to be prognostic in malignancy. We assess preoperative Creactive protein (CRP), albumin, and the modified Glasgow Prognostic Score (mGPS), which combines both assays, for prognostic utility in RCC with IVC thrombus. METHODS: From 2006-2016, one surgeon performed 149 cases of radical nephrectomy and IVC tumor thrombectomy. Only those with clear cell RCC and available laboratory data were included. Patients were assigned an mGPS score 0-2 based on preoperative lab values (0¼CRP 10 mg/L, 1¼CRP > 10 mg/L, and 2¼CRP > 10 mg/L and albumin < 3.5 g/dL). Other factors included in the analysis were age, gender, race, body mass index, 2009 AJCC pathologic T and M stages, necrosis, and nuclear grade. Also examined were well-established prognostic scoring systems, the University of California Los Angeles Integrated Staging System and the Mayo Clinic Stage, Size, Grade, and Necrosis scoring system. Log-rank and multivariable regression analysis examined overall survival (OS). RESULTS: Of 117 clear cell RCC patients with IVC thrombus, the mortality rate was 38.4% over a median follow-up period of 12.6 months (interquartile range 4.8-32.4 months). Patients with albumin < 3.5 g/dL represented 62.7% of the population and those with CRP > 10 mg/L represented 67.7%. Those with mGPS scores 0, 1, and 2 represented 32.3%, 14.4%, and 53.54%, respectively. CRP > 10 mg/L (HR 4.94, 95% 1.7-14.2, p<0.001), albumin < 3.5 g/dL (HR 2.16, 95% 1.14.3, p¼0.024), and mGPS¼2 (HR 5.56, 95% 1.9-16.1, p¼0.002) correlated with OS. After adjusting for other factors, only mGPS¼2 (HR 4.25, 95% 1.4-13.3; p¼0.01) was an independent predictor of OS. A secondary analysis of only non-metastatic patients maintained significance. CONCLUSIONS: For patients with RCC and IVC involvement, elevated CRP and low albumin correlate with OS. Combining albumin with CRP in the modified Glasgow Prognostic Score independently predicts OS. The mGPS could serve as a useful clinical adjunct with regard to follow-up counseling and clinical trial design.
MP16-04 MEAN HOUNSFIELD UNITS ON UNENHANCED CT PREDICTS RESPONSE TO EVEROLIMUS IN TUBEROUS SCLEROSIS COMPLEX ASSOCIATED ANGIOMYOLIPOMAS Yi Cai*, Hanzhong Li, BEIJING, China, People’s Republic of; Yushi Zhang, Beijing, China, People’s Republic of INTRODUCTION AND OBJECTIVES: Everolimus, a mammalian target of rapamycin (mTOR) inhibitor, has been used for tuberous sclerosis complex associated angiomyolipoma (TSC-AML). However, we lack tools to accurately predict response in individual patients. METHODS: In this single-center phase 2 nonrandomized open label trial, eighteen patients with forty-three measurable AMLs associated tuberous sclerosis complex were treated with oral everolimus (10mg/d). AML volume and computed tomography (CT) parameters were measured at baseline, 12, 24, 48 and 96 weeks. Receiver operating characteristic curve (ROC) method was used to calculate the sensitivity, specificity and diagnostic accuracy. All analyses used a significance level of 0.05 and were generated in SPSS19.0 software. RESULTS: Target AML response, volume reductions over 50% relative to baseline defined by RECIST criteria, were 65.85%(27/ 41), 67.50%(27/40) and 68.42%(26/38) at weeks 12, 24 and 48, respectively. Mean HU on unenhanced CT and the longest diameter (DL) at baseline significantly correlated with percentage change of target AML at different indicated time. The AUC for mean hounsfield units (HU) on unenhanced CT were 0.99, 1.00 and 0.94 at weeks 12, 24 and 48, respectively, while the AUC for DL of 0.71, 0.78 and 0.91 at weeks 12, 24 and 48, respectively. Representative scans from two different status of mean HU target AML treated with everolimus are shown in Figure 1. A threshold of -24.50 HU for predicting AML response showed 92.86% sensitivity and 96.30% specificity at 12 weeks (likelihood ratio¼25.07), 100.0% sensitivity and 96.30% specificity at 24 weeks (likelihood ratio¼27.00), while 91.67% sensitivity and 96.15% specificity at 48 weeks (likelihood ratio¼23.83), respectively (Figure 2). CONCLUSIONS: Mean HU on unenhanced CT of target AML at baseline predicts response to everolimus and it may be useful to select treatment.