Page 2 - CUA2018 Abstracts - Oncology-Testis

2018 CUA AbstrACts

Poster Session 12: Other Oncology III

June 26, 2018; 0800–0930

MP–12.1 regression was used to generate odds ratios (OR) for predictors of 30–day
Development of a patient decision aid for complex, localized Grade III–V Clavien–Dindo (CD) complications, and linear regression was
renal masses used to assess predictors of increasing length of stay (LOS). Multivariable
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Kristen McAlpine , Rodney Breau , Dawn Stacey , Christopher Knee , competing risks and Cox proportional hazards models were used to assess
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Luke Lavallee 1,2 disease–specific (DSS) and overall survival (OS), respectively.
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1 Division of Urology, University of Ottawa, Ottawa, ON, Canada; The Results: The median age was 70 years (interquartile range [IQR] 78–60),
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Ottawa Hospital Research Institute, Ottawa, ON, Canada VAT 165 cm (IQR 223–114), SAT 233 cm (IQR 316–182), LOS 9 days (IQR
Introduction: Patient decision aids are structured clinical tools that facili- 12–7), and age–adjusted Charlson Comorbidity Index (CCI) score was 6
tate shared decision–making. Decision aids present therapeutic options, (IQR 8–5). Most patients (76%) were male, 59% were smokers, there were
including their risks and benefits, in an evidence–based fashion and help 32 (16%) 30–day Grade III–V complications, 71% had ≥pT2 disease, and
patients communicate their values. In urology, one of the most challenging 40% received chemotherapy. Over a median followup of 37 months (IQR
decisions is between an open partial nephrectomy and a laparoscopic radi- 54–27) for alive patients, there were 43 (21%) bladder cancer and 65 (32%)
cal nephrectomy to remove a complex renal mass. We sought to develop all–cause deaths. Adjusting for CCI and smoking status, SAT predicted
and evaluate a patient decision aid for this population. Grade III–V 30–day complications (OR 1.004; 95% confidence intervcal
Methods: The International Patient Decision Aids Standards (IPDAS) and [CI] 1.001–1.008). VAT predicted increasing LOS (ß–coef 0.0233; 95% CI
the Ottawa Decision Support Framework were used to guide the systematic 0.0002–0.0463) when adjusted for CCI and gender. Neither VAT nor SAT
development of the decision aid. A comprehensive review of the literature predicted DSS or OS.
was performed to identify evidence on options for management of com- Conclusions: We demonstrated that higher VAT predicted longer postopera-
plex, localized renal masses (cT1b–T2). The content of the decision aid tive LOS, and SAT predicted worse complications (CD III–V) 30 days after
was agreed upon by content and methodological experts using an iterative RC. There was no difference in DSS or OS between groups. VAT and SAT
feedback process. A mixed methods survey was created to assess the deci- may help improve preoperative risk assessment for patients undergoing RC.
sion aid. Patients and urologists were recruited to evaluate the decision aid.
Results: A structured patient decision aid presented evidence on options, MP–12.3
including probabilities of benefits and risks. Open partial nephrectomy, The association of chronic kidney disease with tumour recurrence
laparoscopic radical nephrectomy, and observation were the defined man- and mortality following radical cystectomy for urothelial carcinoma
agement options. Included outcomes were: bleeding, urine leak, length of Ross Mason , Bimal Bhindi , Igor Frank , Prabin Thapa , Matthew Tollefson ,
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stay, renal failure, and survival. Simple language and pictures were used Houston Thompson , Jeffrey Karnes , Stephen Boorjian 1
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to present data at a level suitable for a wide range of patients. A validated 1 Urology, Mayo Clnic, Rochester, MN, United States; Health Sciences
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screening tool (SURE test) was included to assess patients’ decisional con- Research, Mayo Clinic, Rochester, MN, United States
flict. Knowledge questions were included to verify patients’ understanding. Introduction: Chronic kidney disease (CKD) has been identified as a poten-
The decision aid met all IPDAS criteria to be defined as a decision aid, five tial risk factor for disease recurrence and mortality in a variety of malignan-
of six certification criteria, and 17 of 23 quality criteria. cies. We, therefore, evaluated the association between preoperative CKD
Conclusions: A patient decision aid was created to facilitate shared–deci- and outcomes following radical cystectomy (RC) for urothelial carcinoma
sion making for patients with complex renal masses. The effectiveness of (UC).
our decision aid is currently being evaluated prospectively. Methods: We identified 1234 patients who underwent RC without neoad-
juvant chemotherapy at Mayo Clinic for UC and who had a preoperative
MP–12.2 serum creatinine measurement available (1980–2016). Patients were strati-
Predicting perioperative complications in patients receiving fied according to the presence or absence of preoperative CKD (defined as
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radical cystectomy using preoperative computed tomography– estimated glomerular filtration rate <60 ml/min/1.73m ). The associations
measured adipose tissue indices between CKD and non–urothelial cancer recurrence (CR), cancer–specific
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Michael Kim , Jaimin Bhatt , Zachary Klaassen , Bimal Bhindi , Thomas mortality (CSM), and all–cause mortality (ACM) were examined using mul-
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Hermanns , Patrick Richard , John Kachura , Robert Hamilton , Neil tivariable competing risk analysis.
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Fleshner , Antonio Finelli , Michael Jewett , Alexandre Zlotta , Girish Results: A total of 550 (44.6%) patients were classified with preoperative
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Kulkarni 1 CKD. Patients with CKD were older (median 72.7 years vs. 67.4 years;
1 Surgical Oncology, University Health Network, Toronto, ON, Canada; p<0.001), more likely to be female (23.5% vs. 17.1%; p=0.006), and had
2 Joint Department of Medical Imaging, University Health Network, Toronto, a higher pT stage (pT3/4 in 40.2% vs. 29.4%; p<0.001). Median followup
ON, Canada after RC was 10.7 years (interquartile range [IQR] 6.4, 18.7), during which
Introduction: Obesity is a global epidemic, but the link between obesity time 488 patients experienced recurrence and 988 patients died. In mul-
and bladder cancer outcomes remains controversial. Recent studies have tivariable competing risk analysis, we found that preoperative CKD was
suggested body mass index (BMI) may not be the best measure of obesity. not independently associated with either CR (hazard ratio [HR] 1.06; 95%
In this study, visceral adipose tissue (VAT) and subcutaneous adipose tissue confidence interval [CI] 0.88–1.14; p=0.53) or CSM (HR 1.05; 95% CI
(SAT) levels were measured with computed tomography (CT) scans prior 0.86–1.30). However, patients with CKD had a significantly increased risk
to radical cystectomy (RC). The hypothesis was that patients with higher of ACM after RC compared to patients without CKD (HR 1.18; 95% CI
adipose levels would have poorer perioperative and survival outcomes. 1.03–1.33; p=0.02). Similar results were noted when analyzing estimated
Methods: A total of 202 patients undergoing RC were included in this glomerular filtration rate as a continuous variable and when categorizing
single–centre, retrospective study (2000–2012). Multivariable logistic patients according to CKD stage.
CUAJ • June 2018 • Volume 12(6Suppl2) S131
© 2018 Canadian Urological Association