Page 4 - CUA2018 Abstracts - Oncology-Testis

Poster session 12: Other Oncology III

2. Higginson IJ, Evans CJ. What is the evidence that palliative care teams Centre, University of Calgary, Calgary, AB, Canada; Centre Hospitalier
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improve outcomes for cancer patients and their families? The Cancer de l’Université de Montréal, Montreal, QC, Canada; Juravinski Cancer
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J 2010;16:423–5. https://doi.org/10.1097/PPO.0b013e3181f684e5 Centre, McMaster University, Hamilton, ON, Canada
3. Ferrell BR, Temel JS, Temin S, et al. Integration of palliative care into Introduction: Over 25% of patients are diagnosed with metastasis at the
standard oncology care: ASCO clinical practice guideline update time of renal cell carcinoma (RCC) diagnosis and 35% will eventually
summary. J Clin Onc;13:119–22. progress to the metastatic stage. Surgical resection of metastasis can be
integrated in the management of mRCC, as it can contribute to delay
MP–12.7 disease progression and improve survival. With the availability of a pan–
Canadian database, this study assessed the impact of metastasectomy in
Surveillance post–radio frequency ablation for small renal mRCC patients using real–world Canadian data.
masses: Recurrence and followup Methods: The Canadian Kidney Cancer information system (CKCis) data-
Cameron Lam , Michael Nixon , Nathan Wong , Edward Matsumoto , base was used to select patients who were diagnosed with mRCC between
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Anil Kapoor 1 January 2011 and December 2016. Patients diagnosed with mRCC and
1 Department of Surgery, Division of Urology, McMaster University, with pathological confirmation of RCC were included in the analysis.
Hamilton, ON, Canada; Michael G. DeGroote School of Medicine, The date of first diagnosis of metastasis was considered as the index date.
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McMaster University, Hamilton, ON, Canada Patients were stratified depending on whether they had a metastasectomy
Introduction: Small renal masses (SRMs), enhancing tumours <4 cm in (complete or incomplete) and no metastasectomy, and then matched to
diameter, are suspicious for renal cell carcinoma (RCC). The incidence minimize selection bias. Each patient having received metastasectomy
of SRMs has risen with the increased quality and frequency of imaging. was matched with up to 10 patients with no metastasectomy by age (over
Partial nephrectomy is widely accepted as a nephron–sparing approach in 65 year old), clear–cell RCC histology, pStage, and time to metastasis
the management of clinically localized RCC, with a greater than 90% dis- greater than one year. Overall survival (OS) was calculated from diag-
ease–specific survival for stage T1a. Radio frequency ablation (RFA) has nosis of metastatic disease to death from any cause. A Cox proportional
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been emerging as an alternative management strategy, although overall hazards model was used to identify the impact of the metastasectomy
survival, recurrence rates, and followup strategy after RFA has not yet been while adjusting for potential confounding variables.
clearly established. In this study, we aimed to evaluate the time to recur- Results: A total of 252 patients had complete (173 patients) and incom-
rence and recurrence rates of SRMs treated with RFA at our institution. plete (79 patients) metastasectomy, while 1000 mRCC patients did not
Methods: A retrospective review between October 2011 and April 2017 undergo a metastasectomy. Median time of followup since the date of
identified 84 patients with a single SRM treated with RFA at Hamilton mRCC diagnosis was 26 months (interquartile range [IQR] 14–43). At 12
Health Sciences and St. Joseph’s Healthcare Hamilton. Patients with famil- months, 97.9%, 86.7%, and 75.3 % of patients were alive in the com-
ial syndromes and distant metastases were excluded. Repeat RFAs of the plete metastasectomy, incomplete metastasectomy, and no metastasec-
ipsilateral kidney for incomplete ablation were not considered a new tomy groups, respectively (p<0.001). Over 64% of patients who did not
procedure. The primary variable measured was time from initial ablation undergo a metastasectomy were treated with targeted therapy, compared
to recurrence. A Cox proportional hazard regression model was used with 70.8% and 41.0% in the incomplete metastasectomy and complete
to identify possible prognostic variables defined a priori, including age, metastasectomy groups, respectively. Having clear–cell histology, being
gender, and mass size, as well as RENAL nephrometry and PADUA scores. aged over 65 year at diagnosis of metastasis, and having bone, liver, or
Results: The overall average age of our patients was 68.6±10.6 years, with brain metastasis were all associated with increased risk of mortality. When
71% being male. Average tumour size was 2.42±0.81 cm. There was a patients were matched, having had a metastasectomy was still a predictor
total of 4/84 total recurrences (4.8%) post–RFA. Those without recurrence of survival (hazard ratio 0.45; p<0.001).
had median followup of 41 months. Those with recurrences had median Conclusions: Our study revealed the positive effect of metastasectomy
time to recurrence of 17 and no recurrence beyond 30 months. Five of performed in mRCC with an improved OS compared to patients with no
84 patients had residual disease (6%) and were identified within the first metastasectomy. Clear–cell histology, metachronous presentation, time
eight months post–RFA. The only prognostic variable identified as a pre- to metastasis greater than one year, and younger age at presentation are
dictor of residual disease was tumour size (hazard ratio 2.402; p=0.047). all favourable factors of survival.
Conclusions: This study shows the risk of recurrence following RFA for
SRMs is 4.8%. Most recurrences were a result of residual tumour at the
ablation site identified within the first nine months post–RFA. No recur- MP–12.9
rences were identified beyond 30 months. Tumour size alone, without Predictors of pathologically node–positive disease in patients
need for complex scoring systems, may serve as a predictor of incomplete undergoing retroperitoneal lymph node dissection for renal
ablation following RFA. cell carcinoma: Results from the Canadian Kidney Cancer
Reference: information system
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Mallick , Ricardo Rendon 1
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MP–12.8 1 2 Department of Urology, Dalhousie University, Halifax, NS, Canada;
Division of Urology, University of Ottawa, Ottawa, ON, Canada;
Outcomes of metastasectomy in metastatic renal cell carcinoma 3 Department of Surgery (Urology) and Surgical Oncology, University
patients: The Canadian Kidney Cancer information system Health Network and Princess Margaret Cancer Centre, University of
experience Toronto, Toronto, ON, Canada; Division of Urology, McGill University,
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Sara Nazha , Alice Dragomir , Antonio Finelli , Aaron Hansen , Lori Wood , Montreal, QC, Canada; Division of Urology, McMaster University,
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Ricardo Rendon , Alan So , Christian Kollmannsberger , Frédéric Pouliot , Hamilton, ON, Canada; Division of Urology, University of Calgary,
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Naveen Basappa , Daniel Heng , Denis Soulières , Anil Kapoor , Simon Calgary, AB, Canada; Division of Urology, University of Alberta,
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Tanguay 1 Edmonton, AB, Canada; Department of Urologic Sciences, University
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1 McGill University Health Centre, McGill University, Montreal, QC, of British Colombia, Vancouver, BC, Canada; Division of Urology,
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Canada; Princess Margaret Cancer Centre, University of Toronto, Toronto, University of Manitoba, Winnipeg, MB, Canada; Division of Urology,
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ON, Canada; Queen Elizabeth II Health Sciences Centre, Halifax, NS, Université de Montréal, Montreal, QC, Canada; Division of Urology,
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Canada; BC Cancer Agency Vancouver Cancer Centre, BC Cancer Université Laval, Quebec, QC, Canada; Ottawa Hospital Research
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Agency, Vancouver , BC, Canada; Centre Hospitalier Universitaire de Institute, Ottawa, ON, Canada
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Québec, Université de Laval, Quebec, QC, Canada; Cross Cancer Introduction: A randomized trial demonstrated that patients with clini-
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Institute, University of Alberta, Edmonton, AB, Canada; Tom Baker Cancer cally low–risk renal cell carcinoma (RCC) do not benefit from retroperi-
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CUAJ • June 2018 • Volume 12(6Suppl2) S133