- Email: [email protected]
MP78-11 DO SARCOMATOID AND RHABDOID DIFFERENTIATION HAVE SIMILAR PROGNOSTIC EFFECTS FOR PATIENTS WITH GRADE 4 RENAL CELL CARCINOMA?
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
e1029
CONCLUSIONS: Our results suggest that polymorphisms in VEGF and VEGFR2 are associated with sorafenib clinical outcomes, and polymorphisms in VEGF and ABCB1 are associated with sorafenibrelated toxicities. Larger studies are warranted to validate our findings.
Source of Funding: National Natural Science Foundation of China (81171963, 81201571 and 81372757)
MP78-11 DO SARCOMATOID AND RHABDOID DIFFERENTIATION HAVE SIMILAR PROGNOSTIC EFFECTS FOR PATIENTS WITH GRADE 4 RENAL CELL CARCINOMA? Onder Kara*, Homayoun Zargar, Matthew Maurice, Hiury Andrade, Oktay Akca, Peter Caputo, Daniel Ramirez, Ercan Malkoc, Brian Rini, Jihad Kaouk, Cleveland, OH INTRODUCTION AND OBJECTIVES: The presence of sarcomatoid or rhabdoid elements within RCC has been reported to be associated with clinically poor outcomes. We aim to examine the impact of rhabdoid and sarcomatoid differentiation on cancer-specific survival (CSS) in patients with grade 4 renal cell carcinoma (RCC) undergoing extirpative surgery. METHODS: We retrospectively analyzed our IRB-approved database of 1176 consecutive patients who underwent radical or partial nephrectomy for RCC between 2005 and 2013. We identified patients with Fuhrman grade IV RCC. The study cohort was divided into four groups: Grade IV without differentiation, Grade IV with rhabdoid features, Grade IV with sarcomatoid features, and Grade IV sarcomatoid
e1030
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
and rhabdoid (mixed) features. The primary outcome was CSS, which was plotted by the Kaplan-Meier method and analyzed using the logrank test and Cox proportional hazards modeling. RESULTS: Of 264 patients with grade IV RCC, 159 (60.2%) had tumor differentiation, including 45 (28.3%) with rhabdoid only, 87 (54.7%) with sarcomatoid only, and 27 (16.9%) with both rhabdoid and sarcomatoid features (Table 1). Median CSS for the Grade IV group without tumor differentiation was 3.3 years (3.2-4.5) vs. 3.8 years (0.7-6.9) for the Grade IV-rhabdoid group (p¼0.55). Median CSS for the Grade IV-sarcomatoid group and for the Grade IV-mixed group was 1.1 years (0.7-1.4) and 0.9 years (0.6-1.2), respectively, vs. 3.8 years (0.7-6.9) for the Grade IV-rhabdoid group (p¼0.01 and p<0.01, respectively)(Figure 1). On multivariable analysis, there was a significant association between sarcomatoid differentiation and RCC death (HR 1.94; 95% CI 1.4-2.69; p<0.01); however, rhabdoid differentiation was no longer significant (HR 1.16; 95% CI 0.731.61; p¼0.45). CONCLUSIONS: Grade IV RCC with sarcomatoid differentiation is associated with worse CSS than grade IV RCC alone. Alternatively, rhabdoid differentiation does not appear to confer additional mortality risk for patients with grade 4 RCC.
Source of Funding: none
MP78-12 UTILITY OF CAD DERIVED PEAK ENHANCEMENT IN DISCRIMINATING CLEAR CELL RENAL CELL CARCINOMA FUHRMAN GRADES I-IV AT FOUR-PHASE MDCT Heidi Coy*, Jonathan Young, Michael Douek, Pechin Lo, Matthew Brown, James Sayre, Steven Raman, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Up to 70% of renal masses are found incidentally at imaging. Lesion characterization is typically assessed on biopsy and nephrectomy. A non-invasive method to assess tumor histology and grade at CT would be of great clinical value, especially in characterization of clear cell renal cell carcinoma (ccRCC) as this is the most common subtype and has the highest metastatic potential. In addition, patients with different Fuhrman tumor grades have a different prognosis and therapeutic pathway. The purpose of our study was to assess if peak enhancement derived from a CAD algorithm discriminates among Fuhrman Grades I-IV in ccRCC on four-phase CT. METHODS: With IRB approval for this HIPAA-compliant retrospective study, our pathology and imaging databases were queried to obtain a cohort of ccRCC with preoperative multiphasic multidetector CT imaged with a four-phase renal mass protocol (unenhanced, corticomedullary (C), nephrographic (N), and excretory (E)). A whole lesion 3D contour was obtained in all phases with proprietary software. The CAD algorithm determined a 0.5cm diameter region of peak enhancement 300HU within the 3D lesion contour. All contours were confirmed by a radiologist. T-tests were used to compare peak multiphasic enhancement among Fuhrman grades I-IV. P values less than 0.05 were considered to be significant. ROC curves and AUCs were used to evaluate the utility of CAD derived peak HU. RESULTS: 107 patients with 111 unique ccRCC lesions (16(14%) Fuhrman grade I, 64(58%) Fuhrman grade II, 23(21%) Fuhrman Grade III, 8(7%) Fuhrman grade IV) were analyzed. In the C phase we discriminated grade I from II (151 HU vs. 180 HU, p¼0.0273), grade I from grade IV (151 HU vs. 201 HU, p¼0.0038, AUC¼0.852), and grade III from grade IV (172 HU vs. 201 HU, p¼0.0371). In the N phase, we discriminated grade 1 from grade IV (135 HU vs 157 HU, p¼0.0411. AUC¼0.742) grade II from grade III (151 HU vs. 129 HU, p¼0.0068), and grade III from grade IV (129 HU vs. 157 HU, p¼0.0101). CONCLUSIONS: CAD derived peak lesion attenuation has highest diagnostic performance in discriminating low grade from high grade ccRCC lesions in the corticomedullary phase. Discrimination of Fuhrman grades at imaging with an objective and reproducible measure of peak lesion attenuation from a CAD algorithm can aid the clinician in stratifying patients to the appropriate therapeutic pathway, and assist in
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
e1029
CONCLUSIONS: Our results suggest that polymorphisms in VEGF and VEGFR2 are associated with sorafenib clinical outcomes, and polymorphisms in VEGF and ABCB1 are associated with sorafenibrelated toxicities. Larger studies are warranted to validate our findings.
Source of Funding: National Natural Science Foundation of China (81171963, 81201571 and 81372757)
MP78-11 DO SARCOMATOID AND RHABDOID DIFFERENTIATION HAVE SIMILAR PROGNOSTIC EFFECTS FOR PATIENTS WITH GRADE 4 RENAL CELL CARCINOMA? Onder Kara*, Homayoun Zargar, Matthew Maurice, Hiury Andrade, Oktay Akca, Peter Caputo, Daniel Ramirez, Ercan Malkoc, Brian Rini, Jihad Kaouk, Cleveland, OH INTRODUCTION AND OBJECTIVES: The presence of sarcomatoid or rhabdoid elements within RCC has been reported to be associated with clinically poor outcomes. We aim to examine the impact of rhabdoid and sarcomatoid differentiation on cancer-specific survival (CSS) in patients with grade 4 renal cell carcinoma (RCC) undergoing extirpative surgery. METHODS: We retrospectively analyzed our IRB-approved database of 1176 consecutive patients who underwent radical or partial nephrectomy for RCC between 2005 and 2013. We identified patients with Fuhrman grade IV RCC. The study cohort was divided into four groups: Grade IV without differentiation, Grade IV with rhabdoid features, Grade IV with sarcomatoid features, and Grade IV sarcomatoid
e1030
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
and rhabdoid (mixed) features. The primary outcome was CSS, which was plotted by the Kaplan-Meier method and analyzed using the logrank test and Cox proportional hazards modeling. RESULTS: Of 264 patients with grade IV RCC, 159 (60.2%) had tumor differentiation, including 45 (28.3%) with rhabdoid only, 87 (54.7%) with sarcomatoid only, and 27 (16.9%) with both rhabdoid and sarcomatoid features (Table 1). Median CSS for the Grade IV group without tumor differentiation was 3.3 years (3.2-4.5) vs. 3.8 years (0.7-6.9) for the Grade IV-rhabdoid group (p¼0.55). Median CSS for the Grade IV-sarcomatoid group and for the Grade IV-mixed group was 1.1 years (0.7-1.4) and 0.9 years (0.6-1.2), respectively, vs. 3.8 years (0.7-6.9) for the Grade IV-rhabdoid group (p¼0.01 and p<0.01, respectively)(Figure 1). On multivariable analysis, there was a significant association between sarcomatoid differentiation and RCC death (HR 1.94; 95% CI 1.4-2.69; p<0.01); however, rhabdoid differentiation was no longer significant (HR 1.16; 95% CI 0.731.61; p¼0.45). CONCLUSIONS: Grade IV RCC with sarcomatoid differentiation is associated with worse CSS than grade IV RCC alone. Alternatively, rhabdoid differentiation does not appear to confer additional mortality risk for patients with grade 4 RCC.
Source of Funding: none
MP78-12 UTILITY OF CAD DERIVED PEAK ENHANCEMENT IN DISCRIMINATING CLEAR CELL RENAL CELL CARCINOMA FUHRMAN GRADES I-IV AT FOUR-PHASE MDCT Heidi Coy*, Jonathan Young, Michael Douek, Pechin Lo, Matthew Brown, James Sayre, Steven Raman, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Up to 70% of renal masses are found incidentally at imaging. Lesion characterization is typically assessed on biopsy and nephrectomy. A non-invasive method to assess tumor histology and grade at CT would be of great clinical value, especially in characterization of clear cell renal cell carcinoma (ccRCC) as this is the most common subtype and has the highest metastatic potential. In addition, patients with different Fuhrman tumor grades have a different prognosis and therapeutic pathway. The purpose of our study was to assess if peak enhancement derived from a CAD algorithm discriminates among Fuhrman Grades I-IV in ccRCC on four-phase CT. METHODS: With IRB approval for this HIPAA-compliant retrospective study, our pathology and imaging databases were queried to obtain a cohort of ccRCC with preoperative multiphasic multidetector CT imaged with a four-phase renal mass protocol (unenhanced, corticomedullary (C), nephrographic (N), and excretory (E)). A whole lesion 3D contour was obtained in all phases with proprietary software. The CAD algorithm determined a 0.5cm diameter region of peak enhancement 300HU within the 3D lesion contour. All contours were confirmed by a radiologist. T-tests were used to compare peak multiphasic enhancement among Fuhrman grades I-IV. P values less than 0.05 were considered to be significant. ROC curves and AUCs were used to evaluate the utility of CAD derived peak HU. RESULTS: 107 patients with 111 unique ccRCC lesions (16(14%) Fuhrman grade I, 64(58%) Fuhrman grade II, 23(21%) Fuhrman Grade III, 8(7%) Fuhrman grade IV) were analyzed. In the C phase we discriminated grade I from II (151 HU vs. 180 HU, p¼0.0273), grade I from grade IV (151 HU vs. 201 HU, p¼0.0038, AUC¼0.852), and grade III from grade IV (172 HU vs. 201 HU, p¼0.0371). In the N phase, we discriminated grade 1 from grade IV (135 HU vs 157 HU, p¼0.0411. AUC¼0.742) grade II from grade III (151 HU vs. 129 HU, p¼0.0068), and grade III from grade IV (129 HU vs. 157 HU, p¼0.0101). CONCLUSIONS: CAD derived peak lesion attenuation has highest diagnostic performance in discriminating low grade from high grade ccRCC lesions in the corticomedullary phase. Discrimination of Fuhrman grades at imaging with an objective and reproducible measure of peak lesion attenuation from a CAD algorithm can aid the clinician in stratifying patients to the appropriate therapeutic pathway, and assist in