Page 6 - CUA2018 Abstracts - Oncology-Bladder

Poster session 5: Other Oncology I

UP–5.3 76 patients were found to have a biopsy–proven Grade 3–4 RCC, and
Prospective evaluation of the surgical learning curve of radical later underwent surgery by PN or RN. Clinical, surgical, and pathologi-
cystectomy and urinary diversion for bladder cancer cal parameters were compared. Univariable and multivariable logistic
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Benjamin Beech , Lucas Dean , Niels Jacobsen , Sunita Ghosh , Nathan regression analysis (MLRA) predicting PN was performed, after adjusting
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Hoy , Jan Rudzinski , Adrian Fairey 1 for pertinent variables.
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1 Division of Urology, Department of Surgery, University of Alberta, Results: No neo– or adjuvant therapy was used. Table 1 (available at
Edmonton, AB, Canada; Urology Service, Memorial Sloan Kettering https://cua.guide/) records the preoperative clinical characteristics
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Cancer Center, New York, NY, United States; Department of Oncology, and shows a higher T3/T4 stage and Grade 4 rate among RN patients.
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University of Alberta, Edmonton, AB, Canada Postoperative data (Table 2; available at https://cua.guide/) shows higher
Introduction: Radical cystectomy (RC) and urinary diversion for bladder stage and grade, and worse outcomes for RN. When stratifying outcomes
cancer is a complex oncology procedure that may have a substantial by tumour size <7 cm, none of the PN patients died, but 2/25 (8%) of the
learning curve. We used individual patient data from surgeons at a single RN patients died of disease. Furthermore, in patients with postoperative
academic centre to examine the association between surgeon experience FG 3–4, 30% of RN compared to 12% of PN developed metastasis (p=0.1)
performing RC for bladder cancer and clinical outcomes. and 19% of RN compared to none of the PN patients died of disease
Methods: Our prospective analysis included 274 patients with cTanyN– (p=0.035). MLRA (Table 3; available at https://cua.guide/) showed that
–3M0 bladder cancer who were treated with curative intent RC by one Grade 4 compared to Grade 3 (odds ratio [OR] 0.093; 95% confidence
of two urologic oncologists at a single centre between 2007 and 2016. interval [CI] 0.01–0.871; p=0.0375), and T3/T4 compared to T1 disease
Standardized followup included renal ultrasound and function assessment (OR 0.09; 95% CI 0.0092–0.8961; p=0.04) significantly predict a lower
4–6 weeks following stent removal, as well as risk–adapted surveillance OR for undergoing PN.
with clinical assessment, blood chemistry, and computed tomography. Conclusions: Although RN patients had worse disease, sensitivity analy-
For each patient, surgeon experience was coded as the total number of ses of patients with postoperative Grade 3–4 or tumour size <7 cm, did
RC procedures performed by the surgeon prior to that patient’s operation. not show worse outcomes for PN. Despite the small, multicentre cohort
Outcomes were overall survival (OS) and benign uretero–ileal anastomotic and an inherent selection bias, PN does not appear to confer worse out-
stricture (BUIS). Multivariable survival time regression models were used comes for biopsy–proven Grade 3–4 RCC. Larger cohorts are required
to evaluate the association between surgeon experience and outcomes to demonstrate that PN should be attempted whenever feasible, even for
with adjustment for case mix. Statistical tests were two–sided (p≤0.05). high–grade RCC disease.
Results: Complete data were evaluable for 274 patients. The median
followup was 20 months (range 0–110). The predicted two–year OS and UP–5.5
freedom from BUIS rates were 70% and 95%, respectively. Multivariable Comorbidity status independently predicts overall survival after
analysis showed that surgeon experience was not significantly associated radical nephroureterectomy for upper tract urothelial carcinoma
with OS (hazard ratio [HR] 0.997; p=0.18) or BUIS (HR 1.003; p=0.60). Ryan McLarty , Niels Jacobsen , Derek Tilley , Jan Rudzinski , Benjamin
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The predicted probabilities of OS and BUIS at two years did not differ Beech , Nick Dean , Steven Tong , Dylan Hoare , Adrian Fairey 1
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for patients treated by a surgeon with 10 prior operations or with 100 1 Division of Urology, University of Alberta, Edmonton, AB, Canada;
prior operations. 2 Department of Oncology, University of Alberta, Edmonton, AB, Canada
Conclusions: This analysis of individual patient data from two urologic Introduction: Radical nephroureterectomy (RNU) ± regional lymph
oncologists showed that rates of OS and BUIS after RC for bladder cancer node dissection is a standard of care treatment for upper tract urothe-
were stable and there was no evidence of a surgical learning curve, pre- lial carcinoma (UTUC). Independent predictors of survival after RNU
sumably due to stable patient selection and surgical technique following are pathological TNM stage, lymphovascular invasion (LVI), and World
completion of fellowship training. Health Organization (WHO) grade. Comorbidity status has previously
been shown to not be an independent predictor of survival. The objective
UP–5.4 of the current study was to re–examine the association between comor-
Does partial nephrectomy for biopsy–proven Grade 3/4 renal bidity status and survival after RNU for UTUC.
cell carcinoma confer worse outcomes compared to radical Methods: A retrospective analysis of data from the University of Alberta
nephrectomy? Results from a Canadian multicentre cohort (UA) Radical Nephroureterectomy Database was performed. Between
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Hanan Goldberg , Thenappan Chandrasekar , Zachary Klaassen , April 1994 and August 2017, 255 consecutive patients underwent RNU
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Rodney Breau , Ranjeeta Mallick , Ranjena Maloni , Neil Fleshner , Girish ± regional lymph node dissection for UTUC at two academic teaching
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Kulkarni , Robert Hamilton , Alexandre Zlotta , Michael Jewett , Ricardo hospitals. Comorbidity status was obtained through a medical record
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Rendon , Simon Tanguay , Jun Kawakami , Luke Lavallee , Frédéric review and classified using the Charleson Comorbidity Scale (CCS). The
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Pouliot , Antonio Finelli 1 main outcome was overall survival (OS). The Kaplan–Meier method and
1 Surgical Oncology, Urology Division, Princess Margaret Cancer Centre, Cox proportional regression models were used to analyze survival data.
Toronto, ON, Canada; Division of Urology, The Ottawa Hospital Research Statistical tests were two–sided (p≤0.05).
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Institute, Ottawa, ON, Canada; Department of Urology, Dalhousie Results: Data were evaluable for 255 patients. The median followup dura-
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University, Halifax, NS, Canada; Division of Urology, McGill University, tion was 52.4 months. The median age was 71 years (interquartile range
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Montreal, QC, Canada; Southern Alberta Institute of Urology, University [IQR] 34–89) and 157 patients (61%) were male. Thirty–five (13%) and
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of Calgary, Calgary, AB, Canada; Department of Surgery and Cancer 220 (87%) patients had CCS <2 and CCS >2 comorbidity, respectively.
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Research Centre, Division of Urology, Université Laval, Quebec City, The five–year OS rates for patients with CCS <2 and CCS >2 comorbidity
QC, Canada were 97% and 67%, respectively (log rank p<0.001). Multivariate Cox
Study Groups: Multicenter Canadian Kidney Cancer information system regression analyses showed that increased comorbidity was independently
(CKCis). associated with worse OS (hazard ratio [HR] 5.7; 95% confidence interval
Introduction: To date, there is no evidence for the superiority of radical [CI] 2.3 to 14.1; p<0.001).
nephrectomy (RN) compared to partial nephrectomy (PN) for non–meta- Conclusions: This is the first study to show comorbidity status, as mea-
static, high–grade (3–4) renal cell carcinoma (RCC). In this study, we sured by the CCS, was independently associated with overall survival
compared results of treatment with PN or RN. after RNU for UTUC. Further prospective validation is required. This data
Methods: From 2006–2017, 2844 records of patients who had under- has implications for patient counselling and use of CCS as stratification
gone a biopsy for a suspicious renal mass from the multicentre Canadian variable in clinical trials.
Kidney Cancer information system (CKCis) were reviewed. A total of
S94 CUAJ • June 2018 • Volume 12(6Suppl2)