Page 1 - CUA2018 Abstracts - Oncology-Other

2018 CUA AbstrACts

Podium Session 4: Other Oncology

June 26, 2018; 1105–1205

POD–4.1 cystectomy (RARC) with intracorporeal urinary diversion (ICUD) in a large
Predictors of a positive genetic test result in patients with a contemporary cystectomy series.
suspected hereditary kidney cancer syndrome: Results from a Methods: We performed a retrospective review of 837 consecutive patients
provincial medical genetics unit who underwent ORC (n=598) or RARC with ICUD (n=238) for bladder
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Andrea Kokorovic , Aidan Thomas , Meghan Ferguson , Ricardo Rendon 1 cancer between August 2009 and October 2016. Recurrences were clas-
1 Department of Urology, Dalhousie University, Halifax, NS, Canada; sified as local, distant, or secondary urothelial carcinomas. Kaplan–Meier
2 Maritime Medical Genetics Service, IWK Health Centre, Halifax, NS, method was used for recurrence–free survival (RFS) estimates. One–year
Canada recurrence patterns were assessed. Multivariate Cox regression models were
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Introduction: Current guidelines recommend genetic referral for patients used to determine the impact of surgical technique on the risk of recurrence.
with renal cell carcinoma (RCC) and high risk features: young age, bilat- Results: Patients with RARC with ICUD were more likely to have ileal con-
eral/multifocal tumours, strong family history, history of pneumothorax, duit urinary diversion (64% vs. 29%; p<0.01) and have extravesical disease
non–clear–cell histology, dermatological findings, presence of associated (38% vs. 30%; p=0.03) (Table 1; available at https://cua.guide/). There was
tumours. Data on outcomes of patients referred for genetic testing as per no difference in RFS for the entire cohort (Fig. 1; available at https://cua.
current guidelines are limited. A single–centre study found an association guide/), and also by pathological stage: organ–confined disease (pT0–pT2,
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between young age and a positive genetic test in patients evaluated for n=565), extravesical disease (pT3–pT4, n=270), and node–positive disease
hereditary RCC. The purpose of our study is to delineate risk factors associ- (pN+, n=183). On multivariate Cox regression analysis, RARC with ICUD
ated with a positive genetic test in a real–life cohort of patients referred to was not an independent predictor of recurrence after adjusting for age,
medical genetics for evaluation of hereditary RCC. sex, perioperative chemotherapy, pathological tumour and nodal stage,
Methods: A retrospective chart review of patients referred to medical genet- lymphovascular invasion, and positive surgical margins (hazard ratio [HR]
ics for genetic evaluation of a hereditary kidney cancer from 2006–2016 in 1.05; 95% confidence interval [CI] 0.75–1.48; p=0.8). There were no sig-
Nova Scotia, Canada, was performed. Univariate and multivariate analyses nificant differences in the number of local or distant recurrences within
using Fisher’s exact test were used to determine predictors of a positive one between ORC and RARC (p=0.6). Further, the patterns of local and
test result. distant recurrences were similar between ORC and RARC, in particular, with
Results: A total of 109 patients were referred, 85 evaluated, and 64 tested. respect to peritoneal carcinomatosis and extrapelvic lymph node metastasis.
Five were excluded from analysis (four non–RCC; one unavailable result). Conclusions: This large contemporary series suggests that surgical technique
Five (8.5%) had a positive test (three Birt–Hogg–Dube, one CS, one TS). is not an independent predictor of recurrence after radical cystectomy for
Mean age at time of RCC diagnosis was 54 years. Thirty–two (54%) had bladder cancer. These data show no differences in the rates or patterns of
multifocal/bilateral tumours, 26 (44%) had a positive family history, 26 local or distant recurrence between ORC and RARC with ICUD.
(44%) had non–clear–cell histology, and 10 (17%) had tumours outside
the kidney. Dermatological findings (facial fibrofolliculomas) (p=0; odds POD–4.3
ratio [OR] 42) and family history (p=0.037; OR 7.2) were the only predic- Optimizing the use of neoadjuvant chemotherapy in micropapillary
tors of a positive test. bladder cancer: Validation of proposed risk classifiers
Conclusions: We identified dermatological findings and family history as Jon Duplisea , William Tabayoyong , Neema Navai , Arlene Siefker–Radtke ,
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the only predictors of a positive genetic test in patients undergoing evalua- Charles Guo , Bogdan Czerniak , Louis Pisters , Barton Grossman , John
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tion for hereditary RCC. Our patient population represents the largest of its Papadopoulos , Ashish Kamat , Colin Dinney 1
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kind in the literature. This study suggests that current referral criteria may 1 Urology, University of Texas MD Anderson Cancer Center, Houston, TX,
be too broad for application in a real–life patient population, but further United States; Genitourinary Medical Oncology, University of Texas MD
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evaluation with prospective trials is needed. Anderson Cancer Center, Houston, TX, United States; Pathology, University
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References: of Texas MD Anderson Cancer Center, Houston, TX, United States
1. Reaume M, Graham GE, Tomiak E, et al. Canadian guideline on Introduction: Micropapillary urothelial cell cancer (MPUC) is a known
genetic screening for hereditary renal cell cancers. Can Urol Assoc J aggressive variant of bladder cancer. Neoadjuvant chemotherapy (NAC)
2013; 7: 319–23. https://doi.org/10.5489/cuaj.1496 has a proven survival benefit in muscle–invasive disease, however, its
2. Stratton K et al. Outcome of genetic evaluation of patients with kid- benefit in variant histology is less defined. Prior work by our group iden-
ney cancer referred for suspected hereditary cancer syndromes. Urol tified three distinct risk groups of surgically resectable MPUC (lower–
Oncol 2016; 34: 238e1–238e7 risk=cT1, no hydronephrosis; high–risk = ≥cT2 no hydronephrosis; high-
est–risk=hydronephrosis). Herein, we aim to confirm that NAC’s survival
POD–4.2 benefit is limited to the high–risk group.
Patterns of bladder cancer recurrence after open and robotic Methods: Clinical and pathological data were collected on all patients
radical cystectomy with MPUC histology who underwent radical cystectomy (RC) with or
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Akbar Ashrafi , Pierre–Alain Hueber , Nieroshan Rajarubendra , Giovanni without NAC at MD Anderson Cancer Center from 2003–2017. Using our
Cacciamani , Luis Medina , Matthew Winter , Andre de Castro Abreu , proposed MPUC risk stratification, patients were classified as lower–, high–,
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Siamak Daneshmand , Monish Aron , Inderbir Gill , Andre Berger , Mihir or highest–risk. Overall survival (OS) was compared based on NAC status
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Desai 1 and MPUC risk stratification.
1 Urology, University of Southern California, Los Angeles, CA, United States Results: A total of 117 patients were identified with a median age of 70 years
Introduction: The objective of this study was to compare rates and patterns (range 43–89); 83 patients were ≥T2 and 34 patients T1. Median followup
of recurrence after open radical cystectomy (ORC) vs. robot–assisted radical was 22.1 months (range 2–123). Sixty–four patients received NAC. Of the
S60 CUAJ • June 2018 • Volume 12(6Suppl2)
© 2018 Canadian Urological Association