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MP55-09 OPEN PARTIAL NEPHRECTOMY VS. ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR CYSTIC RENAL MASSES: IMPACT OF PEROPERATIVE CYSTIC SPILLAGE AND ONCOLOGICAL RESULTS.
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Sunday, May 14, 2017
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Source of Funding: none
MP55-08 DIAGNOSIS, MANAGEMENT, AND CLINICAL OUTCOMES OF CYSTIC RENAL CELL CARCINOMA €tker, Mahyar Kashan*, Mazyar Ghanaat, Maria Becerra, Andreas M. Ho Michael Chiok, Brandon Manley, Nicole Benfante, Manhattan, NY; Jozefina Casuscelli, Munich, Germany; Shawn Mendonca, Satish Tickoo, Oguz Akin, Paul Russo, Jonathan Coleman, A Ari Hakimi, Manhattan, NY INTRODUCTION AND OBJECTIVES: Complex cystic masses pose a clinical challenge given lack of certainty for malignant potential. Cystic changes are common in renal cell carcinoma (RCC); however, there is limited data on cystic RCC (cRCC) specifically. The Bosniak classification system is used to categorize these lesions and help predict risk of malignancy. Current literature suggests that cRCC has a more favorable and benign course, but with no consensus on proper diagnosis and intervention. We aim to better categorize cRCC and the natural history of this disease. METHODS: We identified all patients with pathologically confirmed cRCC, multilocular cRCC, or RCC with cystic features between Jan 2000 - Dec 2015 from our institutional database. Patients with follow-up of <1 year, previous history of RCC, familial syndromes, multifocal tumors, and lesions with >50% solid component on imaging were excluded from our analysis. Available imaging was re-reviewed by a single expert radiologist (AH). Radiological, clinical, and pathological characteristics were recorded. RESULTS: Of 128 patients identified for analysis, 76 (59.4%) were male and 52 (40.6%) were female. Median age at surgery was 54.4 years (17.3-78.4). Twenty (15.6%) patients had a family history of RCC. The majority of lesions were found incidentally on imaging (89.1%). Fourteen (10.9%) patients had local symptoms, with flank pain (8.6%) being the most common. Partial nephrectomy was performed on 116 (90.6%) patients and radical nephrectomy on 12 (9.4%); open technique was used in >80% of cases. Pathologic and imaging characteristics are shown in Table 1. On median follow-up of 66.1 months, there were no tumor recurrences or metastatic disease. A total of 5 (3.9%) patients died from other conditions. CONCLUSIONS: Diagnosis of cRCC should include cystic lesions with <50% solid component on imaging. Our data shows that cRCC includes a wide variety of tumors, most commonly with clear cell features. Most of these lesions are discovered incidentally on imaging as Bosniak grades 3 or 4 and are surgically resected. These patients uniformly do well with minimal risk of recurrence or metastasis on follow-up, thus, nephron sparing surgery is recommended. Given the indolent nature cRCC, enrollment of these patients into active surveillance protocols should be considered.
Source of Funding: Funded in part by the Sidney Kimmel Center for Prostate and Urologic Cancers and the National Cancer Institute Training Grant T32 CA082088 (BM, GM)
MP55-09 OPEN PARTIAL NEPHRECTOMY VS. ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR CYSTIC RENAL MASSES: IMPACT OF PEROPERATIVE CYSTIC SPILLAGE AND ONCOLOGICAL RESULTS. Benjamin PRADERE*, Tours, France; Benoit PEYRONNET, Rennes, France; Quentin Manach, Paris, France; Zineddine Khene, Rennes, rome Rizk, Lille, France; France; Gauthier Delporte, Je Jean Baptiste Beauval, Toulouse, France; Thomas Seisen, Paris, ans, France; Morgan Moulin, Dijon, France; Nicolas Brichart, Orle France; Axel Bex, Amsterdam, Netherlands; Morgan Roupret, Paris, re, Tours, France; Karim BENSALAH, Rennes, France; Franck Bruye France INTRODUCTION AND OBJECTIVES: It is recommended to remove suspect cystic renal tumours when they are classified as Bosniak 3. These masses are fragile and may rupture during dissection or tumour excision. The impact of this intraoperative spillage on oncological outcomes remains uncertain. The objective of this study was to assess incidence of intraoperative cystic rupture according to surgical approach and its impact on oncological outcomes. METHODS: Between 2005 and 2015, patients who had a partial nephrectomy (PN) in height European centres have been retrospectively analysed. We specifically sought if there was a cystic spillage during the procedure. Oncological outcomes included overall survival (OS), disease specific survival (DSS) and recurrence-free survival (RFS). We performed a sub-group analysis on surgical approach (open partial nephrectomy (OPN) vs. robot-assisted partial nephrectomy (RAPN)) and on the existence of intraoperative cystic spillage (ICS) to determine their impact on oncological outcomes. Kaplan-Meier curves of RFS were produced. A multivariate analysis with logistic regression model was used to assess predictors of intraoperative cystic spillage. RESULTS: Overall, 268 patients were included. Malignancy of cystic renal masses was found in 75% of cases. Among them, 84.5% were Bosniak IV, 68% were Bosniak III and 62.5% were Bosniak IIF on preoperative CT-scan. With a mean follow-up of 32 months, OS was 95.1%, only 2% had a local recurrence, metastatic progression was found in 2% of cases and there was no specific-disease death. We reported intraoperative cystic spillage (ICS) in 18.7% (n¼50) of cases (20% during RAPN vs. 18% during OPN). Among them, 77.5% were
THE JOURNAL OF UROLOGYâ
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confirmed to be malignant after pathological analysis. In the ICS subgroup, with a median follow-up of 38 months, no local recurrence or metastatic progression was reported. Analyses of RFS did not found any difference among subgroups: ICS vs. no ICS (P¼0.23) (Figure 1), OPN vs. RAPN (P¼0.91) (Figure 2). No predictive factor of ICS was found. CONCLUSIONS: Intraoperative cystic spillage is rather common regardless the surgical approach, and it does not seem to impact mid-term oncological outcomes.
Vol. 197, No. 4S, Supplement, Sunday, May 14, 2017
expression with oncologic outcomes in patients with localized clear cell renal cell carcinoma (ccRCC) managed by surgery. METHODS: A retrospective analysis of 207 and 231 patients with localized ccRCC undergoing RN or NSS at two academic medical centers respectively between 2005 and 2009 was performed. The first cohort with 207 patients was treated as training set and the other as validation set. Tissue microarrays (TMAs) were created in triplicate from formalin-fixed, paraffin embedded specimens. Immunohistochemistry with a commercially available monoclonal B4GALT7 antibody was performed with the intensity (0 to 3) and percentage (0 of 100) of staining recorded. The association of B4GALT7 expression with standard pathologic features and prognosis were evaluated. RESULTS: B4GALT7 expression was significantly associated with tumor T stage (P<0.001 and P<0.001, respectively), Fuhrman grade (P<0.001 and P<0.001, respectively) and necrosis (P¼0.021 and P¼0.002, respectively) in both training and validation sets. Moreover, high B4GALT7 expression indicated poor overall survival (OS) (P<0.001 and P<0.001, respectively) in the two sets. The incorporation of B4GALT7 into T stage and Fuhrman grade would help to refine individual risk stratification. Furthermore, B4GALT7 expression was identified as an independent adverse prognostic factor for survival. CONCLUSIONS: Increased B4GALT7 expression is a potential independent adverse prognostic factor for overall survival in patients with localized ccRCC. Inhibiting B4GALT7 pathway might be a promising target of postoperative adjuvant therapy for these ccRCC patients. Source of Funding: none
MP55-11 PROGNOSTIC VALUE OF VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF), VEGF RECEPTOR 2, PLATELET-DERIVED GROWTH FACTOR-? (PDGF-b), AND PDGF-b RECEPTOR EXPRESSION IN PAPILLARY RENAL CELL CARCINOMA Myong Kim*, Jong Keun Kim, Seoul, Korea, Republic of; Myungchan Park, Sang Hyun Park, Busan, Korea, Republic of; In Gab Jeong, Cheryn Song, Jun Hyuk Hong, Choung-Soo Kim, Tai Young Ahn, Hanjong Ahn, Seoul, Korea, Republic of
Source of Funding: none
MP55-10 INCREASED B4GALT7 EXPRESSION IS ASSOCIATED WITH ADVERSE ONCOLOGIC OUTCOME IN LOCALIZED CLEAR CELL RENAL CELL CARCINOMA Huyang Xie*, Zewei Wang, Qiang Fu, Jiejie Xu, Dingwei Ye, Shanghai, China, People’s Republic of INTRODUCTION AND OBJECTIVES: B4GALT7 is one of seven beta-1,4-galactosyltransferase (beta4GalT) genes, which encode type II membrane-bound glycoproteins that appear to have exclusive specificity for the donor substrate UDP-galactose. According to previous studies aberrant B4GALT7 expression has distinct functions in different tumors. Here, we evaluate the association of B4GALT7
INTRODUCTION AND OBJECTIVES: We evaluated the prognostic value of the expression of vascular endothelial growth factor (VEGF), VEGF receptor 2 (VEGFR2), platelet-derived growth factor-b (PDGF-b), and its receptors (PDGFR-b) for papillary renal cell carcinoma (pRCC). METHODS: A total of 145 patients, who were confirmed to have pRCC, were analyzed. Expression levels of molecular markers were assessed by immunohistochemical staining. RESULTS: The median follow-up period for all subjects was 52.0 (interquartile range, 34.5-90.5) months. Among the cohort of 145 patients, high VEGF expression was observed in 100 (69.0%) patients, whereas high expression of VEGFR2, PDGF-b, and PDGFR-b was observed in 64 (44.1%), 42 (29.0%), and 30 (20.7%) patients, respectively. Only individuals with high VEGFR2 expression exhibited improved 10-year recurrence-free survival (85.3 vs. 58.1%; p¼0.005) and cancer-specific survival (86.4 vs. 70.1%; p¼0.014) rates compared to individuals who exhibited low expression. Multivariate analysis revealed that high VEGFR2 expression was an independent prognostic factor for recurrence (HR, 0.326; p¼0.006) and cancer-specific mortality (HR, 0.334; p¼0.046). During follow-up, 17 patients received targeted drug therapy. Patients with high VEGFR2 expression showed a better initial response (PR, 40%; SD, 20%; PD, 40%) than patients with low expression did (PR, 0%; SD, 58.3%; PD, 41.7%; p¼0.052). CONCLUSIONS: pRCC with high VEGFR2 expression correlates with a better initial response to targeted drug therapy and a better prognostic outcome. Source of Funding: None
Vol. 197, No. 4S, Supplement, Sunday, May 14, 2017
e733
Source of Funding: none
MP55-08 DIAGNOSIS, MANAGEMENT, AND CLINICAL OUTCOMES OF CYSTIC RENAL CELL CARCINOMA €tker, Mahyar Kashan*, Mazyar Ghanaat, Maria Becerra, Andreas M. Ho Michael Chiok, Brandon Manley, Nicole Benfante, Manhattan, NY; Jozefina Casuscelli, Munich, Germany; Shawn Mendonca, Satish Tickoo, Oguz Akin, Paul Russo, Jonathan Coleman, A Ari Hakimi, Manhattan, NY INTRODUCTION AND OBJECTIVES: Complex cystic masses pose a clinical challenge given lack of certainty for malignant potential. Cystic changes are common in renal cell carcinoma (RCC); however, there is limited data on cystic RCC (cRCC) specifically. The Bosniak classification system is used to categorize these lesions and help predict risk of malignancy. Current literature suggests that cRCC has a more favorable and benign course, but with no consensus on proper diagnosis and intervention. We aim to better categorize cRCC and the natural history of this disease. METHODS: We identified all patients with pathologically confirmed cRCC, multilocular cRCC, or RCC with cystic features between Jan 2000 - Dec 2015 from our institutional database. Patients with follow-up of <1 year, previous history of RCC, familial syndromes, multifocal tumors, and lesions with >50% solid component on imaging were excluded from our analysis. Available imaging was re-reviewed by a single expert radiologist (AH). Radiological, clinical, and pathological characteristics were recorded. RESULTS: Of 128 patients identified for analysis, 76 (59.4%) were male and 52 (40.6%) were female. Median age at surgery was 54.4 years (17.3-78.4). Twenty (15.6%) patients had a family history of RCC. The majority of lesions were found incidentally on imaging (89.1%). Fourteen (10.9%) patients had local symptoms, with flank pain (8.6%) being the most common. Partial nephrectomy was performed on 116 (90.6%) patients and radical nephrectomy on 12 (9.4%); open technique was used in >80% of cases. Pathologic and imaging characteristics are shown in Table 1. On median follow-up of 66.1 months, there were no tumor recurrences or metastatic disease. A total of 5 (3.9%) patients died from other conditions. CONCLUSIONS: Diagnosis of cRCC should include cystic lesions with <50% solid component on imaging. Our data shows that cRCC includes a wide variety of tumors, most commonly with clear cell features. Most of these lesions are discovered incidentally on imaging as Bosniak grades 3 or 4 and are surgically resected. These patients uniformly do well with minimal risk of recurrence or metastasis on follow-up, thus, nephron sparing surgery is recommended. Given the indolent nature cRCC, enrollment of these patients into active surveillance protocols should be considered.
Source of Funding: Funded in part by the Sidney Kimmel Center for Prostate and Urologic Cancers and the National Cancer Institute Training Grant T32 CA082088 (BM, GM)
MP55-09 OPEN PARTIAL NEPHRECTOMY VS. ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR CYSTIC RENAL MASSES: IMPACT OF PEROPERATIVE CYSTIC SPILLAGE AND ONCOLOGICAL RESULTS. Benjamin PRADERE*, Tours, France; Benoit PEYRONNET, Rennes, France; Quentin Manach, Paris, France; Zineddine Khene, Rennes, rome Rizk, Lille, France; France; Gauthier Delporte, Je Jean Baptiste Beauval, Toulouse, France; Thomas Seisen, Paris, ans, France; Morgan Moulin, Dijon, France; Nicolas Brichart, Orle France; Axel Bex, Amsterdam, Netherlands; Morgan Roupret, Paris, re, Tours, France; Karim BENSALAH, Rennes, France; Franck Bruye France INTRODUCTION AND OBJECTIVES: It is recommended to remove suspect cystic renal tumours when they are classified as Bosniak 3. These masses are fragile and may rupture during dissection or tumour excision. The impact of this intraoperative spillage on oncological outcomes remains uncertain. The objective of this study was to assess incidence of intraoperative cystic rupture according to surgical approach and its impact on oncological outcomes. METHODS: Between 2005 and 2015, patients who had a partial nephrectomy (PN) in height European centres have been retrospectively analysed. We specifically sought if there was a cystic spillage during the procedure. Oncological outcomes included overall survival (OS), disease specific survival (DSS) and recurrence-free survival (RFS). We performed a sub-group analysis on surgical approach (open partial nephrectomy (OPN) vs. robot-assisted partial nephrectomy (RAPN)) and on the existence of intraoperative cystic spillage (ICS) to determine their impact on oncological outcomes. Kaplan-Meier curves of RFS were produced. A multivariate analysis with logistic regression model was used to assess predictors of intraoperative cystic spillage. RESULTS: Overall, 268 patients were included. Malignancy of cystic renal masses was found in 75% of cases. Among them, 84.5% were Bosniak IV, 68% were Bosniak III and 62.5% were Bosniak IIF on preoperative CT-scan. With a mean follow-up of 32 months, OS was 95.1%, only 2% had a local recurrence, metastatic progression was found in 2% of cases and there was no specific-disease death. We reported intraoperative cystic spillage (ICS) in 18.7% (n¼50) of cases (20% during RAPN vs. 18% during OPN). Among them, 77.5% were
THE JOURNAL OF UROLOGYâ
e734
confirmed to be malignant after pathological analysis. In the ICS subgroup, with a median follow-up of 38 months, no local recurrence or metastatic progression was reported. Analyses of RFS did not found any difference among subgroups: ICS vs. no ICS (P¼0.23) (Figure 1), OPN vs. RAPN (P¼0.91) (Figure 2). No predictive factor of ICS was found. CONCLUSIONS: Intraoperative cystic spillage is rather common regardless the surgical approach, and it does not seem to impact mid-term oncological outcomes.
Vol. 197, No. 4S, Supplement, Sunday, May 14, 2017
expression with oncologic outcomes in patients with localized clear cell renal cell carcinoma (ccRCC) managed by surgery. METHODS: A retrospective analysis of 207 and 231 patients with localized ccRCC undergoing RN or NSS at two academic medical centers respectively between 2005 and 2009 was performed. The first cohort with 207 patients was treated as training set and the other as validation set. Tissue microarrays (TMAs) were created in triplicate from formalin-fixed, paraffin embedded specimens. Immunohistochemistry with a commercially available monoclonal B4GALT7 antibody was performed with the intensity (0 to 3) and percentage (0 of 100) of staining recorded. The association of B4GALT7 expression with standard pathologic features and prognosis were evaluated. RESULTS: B4GALT7 expression was significantly associated with tumor T stage (P<0.001 and P<0.001, respectively), Fuhrman grade (P<0.001 and P<0.001, respectively) and necrosis (P¼0.021 and P¼0.002, respectively) in both training and validation sets. Moreover, high B4GALT7 expression indicated poor overall survival (OS) (P<0.001 and P<0.001, respectively) in the two sets. The incorporation of B4GALT7 into T stage and Fuhrman grade would help to refine individual risk stratification. Furthermore, B4GALT7 expression was identified as an independent adverse prognostic factor for survival. CONCLUSIONS: Increased B4GALT7 expression is a potential independent adverse prognostic factor for overall survival in patients with localized ccRCC. Inhibiting B4GALT7 pathway might be a promising target of postoperative adjuvant therapy for these ccRCC patients. Source of Funding: none
MP55-11 PROGNOSTIC VALUE OF VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF), VEGF RECEPTOR 2, PLATELET-DERIVED GROWTH FACTOR-? (PDGF-b), AND PDGF-b RECEPTOR EXPRESSION IN PAPILLARY RENAL CELL CARCINOMA Myong Kim*, Jong Keun Kim, Seoul, Korea, Republic of; Myungchan Park, Sang Hyun Park, Busan, Korea, Republic of; In Gab Jeong, Cheryn Song, Jun Hyuk Hong, Choung-Soo Kim, Tai Young Ahn, Hanjong Ahn, Seoul, Korea, Republic of
Source of Funding: none
MP55-10 INCREASED B4GALT7 EXPRESSION IS ASSOCIATED WITH ADVERSE ONCOLOGIC OUTCOME IN LOCALIZED CLEAR CELL RENAL CELL CARCINOMA Huyang Xie*, Zewei Wang, Qiang Fu, Jiejie Xu, Dingwei Ye, Shanghai, China, People’s Republic of INTRODUCTION AND OBJECTIVES: B4GALT7 is one of seven beta-1,4-galactosyltransferase (beta4GalT) genes, which encode type II membrane-bound glycoproteins that appear to have exclusive specificity for the donor substrate UDP-galactose. According to previous studies aberrant B4GALT7 expression has distinct functions in different tumors. Here, we evaluate the association of B4GALT7
INTRODUCTION AND OBJECTIVES: We evaluated the prognostic value of the expression of vascular endothelial growth factor (VEGF), VEGF receptor 2 (VEGFR2), platelet-derived growth factor-b (PDGF-b), and its receptors (PDGFR-b) for papillary renal cell carcinoma (pRCC). METHODS: A total of 145 patients, who were confirmed to have pRCC, were analyzed. Expression levels of molecular markers were assessed by immunohistochemical staining. RESULTS: The median follow-up period for all subjects was 52.0 (interquartile range, 34.5-90.5) months. Among the cohort of 145 patients, high VEGF expression was observed in 100 (69.0%) patients, whereas high expression of VEGFR2, PDGF-b, and PDGFR-b was observed in 64 (44.1%), 42 (29.0%), and 30 (20.7%) patients, respectively. Only individuals with high VEGFR2 expression exhibited improved 10-year recurrence-free survival (85.3 vs. 58.1%; p¼0.005) and cancer-specific survival (86.4 vs. 70.1%; p¼0.014) rates compared to individuals who exhibited low expression. Multivariate analysis revealed that high VEGFR2 expression was an independent prognostic factor for recurrence (HR, 0.326; p¼0.006) and cancer-specific mortality (HR, 0.334; p¼0.046). During follow-up, 17 patients received targeted drug therapy. Patients with high VEGFR2 expression showed a better initial response (PR, 40%; SD, 20%; PD, 40%) than patients with low expression did (PR, 0%; SD, 58.3%; PD, 41.7%; p¼0.052). CONCLUSIONS: pRCC with high VEGFR2 expression correlates with a better initial response to targeted drug therapy and a better prognostic outcome. Source of Funding: None