Page 11 - CUA2019 Abstracts - Oncology-Kidney

2019 CUA Abstracts

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Natural history of renal angiomyolipoma favours surveillance Post-nephrectomy upstaging of cT1a to pT3a renal tumour: Is renal
as an initial approach tumour biopsy a predisposing factor?
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Jake Morris , Gregory J. Nason , Jaimin Bhatt , Patrick Richard , Lisa Charles Asselin , Rodney H. Breau , Ranjeeta Mallick , Anil Kapoor ,
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Martin , Michael A. Jewett , Kartik Jhaveri , Alexandre Zlotta , Robert Antonio Finelli , Ricardo A. Rendon , Simon Tanguay , Frédéric Pouliot ,
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Hamilton , Antonio Finelli 1 Adrian Fairey , Luke T. Lavallée , Franck Bladou , Jun Kawakami , Alan
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1 Division of Urology, Department of Surgery, Princess Margaret Cancer I. So , Patrick Richard 1
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Centre, University of Toronto, Toronto, ON, Canada; Department of 1 Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke,
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Urology, University Hospital Ayr, Scotland, United Kingdom; Division QC, Canada; Urology, Ottawa Hospital, Ottawa, ON, Canada; Urology,
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of Urology, Departments of Surgery, Centre Hospitalier Universitaire de Ottawa Hospital Research Institute, Ottawa, ON, Canada; Urology, St.
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Sherbrooke and Centre de Recherche du CHUS, Sherbrooke, QC, Canada; Joseph Healthcare, Hamilton, ON, Canada; Urology, Juravinski Hospital,
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4 Division of Abdominal Imaging, Joint Department of Medical Imaging, Hamilton, ON, Canada; Urology, University Health Network, Toronto,
University Health Network, University of Toronto, Toronto, ON, Canada ON, Canada; Urology, Capital Health - QEII, Halifax, NS, Canada;
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Introduction: Traditionally, renal angiomyolipoma (AML) >4 cm were 8 Urology, McGill University Health Centre, Montréal, QC, Canada;
treated (with embolization, radiofrequency ablation, surgery) due to the 9 Urology, Centre Hospitalier Universitaire de Québec, Québec City,
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risk of hemorrhage. The aim of this study was to delineate the natural QC, Canada; Urology, Alta Health Services, Edmonton, AB, Canada;
history of AMLs, including growth rates and need for intervention. 11 Urology, Jewish General Hospital, Montréal, QC, Canada; Urology,
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Methods: A retrospective review and update were performed of a previ- Alberta Health Service, Calgary, AB, Canada; Urology, British Columbia
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ously reported AML series from a radiology database that identified all Cancer Care, Vancouver, BC, Canada
renal AML lesions between 2002 and 2013 at the Princess Margaret Introduction: Many small renal masses (SRM) are unlikely to metastasize
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Cancer Centre, which have now been followed until 2018. We defined and should be managed with surveillance. Renal tumour biopsies (RTB)
lesion size by maximum axial diameter and categorized lesion size at have been proposed as a tool to decrease overtreatment of SRMs. 1,2 A
baseline as ≤4 or >4 cm. The primary endpoint was the growth rate of potential concern of RTB is tumour seeding along the biopsy tract. The
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untreated AMLs. We used a linear mixed-effects model to evaluate the objective of this study was to evaluate whether preoperative RTB increases
association between baseline lesion size and growth rate. the risk of tumour upstaging to pT3a among patients with a SRM who
Results: A total of 458 patients with 593 AMLs were identified during underwent a radical or partial nephrectomy.
the study period, with a median followup of 65.2 months; 534 (90.1%) Methods: The Canadian Kidney Cancer information system (CKCIS), a
lesions were ≤4 cm at diagnosis. Thirty-two (7%) patients required inter- multi-institutional, prospectively maintained database, was used to iden-
ventions; 43 interventions were required on 34 (5.7%) AMLs. The initial tify patients with a SRM (cT1a) who underwent either a partial or radical
indications for intervention included 22 for growth, six due to a bleed, nephrectomy between January 1, 2011 and September 31, 2018. Rates of
two for patient anxiety, and two for pain. The median size at interven- upstaging to pT3a were compared between subjects that had a preopera-
tion was 4.9 cm (range 1.1–29 cm). The average number of scans per tive RTB and the ones that did not. A multivariable analysis was used to
lesion (prior to treatment) was 4.5 (range 1–23). Most (94%) lesions grew evaluate factors associated with upstaging.
slowly (growth rate of <0.25 cm per year) during the period of observa- Results: The cohort consisted of 1794 patients, of which 424 (24%) had a
tion. The linear mixed-effects model showed that the growth rate (slope) preoperative RTB. There was no difference in the rate of tumour upstaging
of log-transformed maximal axial diameter was not significantly different to pT3a between patients that had a RTB and those that did not (6.8%
between lesions ≤4 cm (0.02 log cm per year) and those >4 cm (0.01 log vs. 6.4%; p=0.8). On multivariable analysis, RTB was not associated
cm per year) (p=0.23). with pathological upstaging (odds ratio [OR] 0.76; confidence interval
Conclusions: This large, single-institution, updated series on renal AMLs [CI] 0.41–1.41; p=0.4). Year of surgery (OR 1.3; CI 1.07–1.58; p=0.008),
demonstrates early intervention is not required regardless of the tradi- nuclear grade >2 at surgery (OR 3.23; CI 1.54–6.74; p=0.002) and
tional 4 cm cutoff. The vast majority of AMLs are indolent lesions that tumours larger than 2 cm (OR 1.89; CI 1.47–1.98; p=0.006) were all
are predominantly asymptomatic and slow-growing. Followup should be associated with higher rate of upstage.
no more frequent than annually. Conclusions: In a large cohort of patients, RTB was not associated with
Reference increased risk of tumour upstaging. Hence, tumour tract seeding, although
1. Bhatt JR, Richard PO, Kim NS, et al. Natural history of renal angio- possible, should not be a clinical deterrent to using RTBs as a triage tool
myolipoma (AML): Most patients with large AMLs >4 cm can be to decrease overtreatment of SRMs.
offered active surveillance as an initial management strategy. Eur References
Urol 2016;70:85-90. https://doi.org/10.1016/j.eururo.2016.01.048 1. Marconi L, Dabestani S, Lam TB et al. Systematic review and
meta-analysis of diagnostic accuracy of percutaneous renal tumour
biopsy. Eur Urol 2016;69:660-73. https://doi.org/10.1016/j.
eururo.2015.07.072
2. Richard PO, Jewett MAS, Tanguay S, et al. Safety, reliability, and
accuracy of small renal tumour biopsies: Results from a multi-insti-
tution registry. BJU Int 2017;119:543-9. https://doi.org/10.1111/
bju.13630
3. Richard PO, Martin L, Lavallée LT, et al. Identifying the use and
barriers to the adoption of renal tumour biopsy in the management
of small renal masses. Can Urol Assoc J 2018;12:260-6. https://doi.
org/10.5489/cuaj.5065
4. Salmasi A, Faiena I, Lenis AT, et al. Association between renal
mass biopsy and upstaging to perinephric fat involvement in a
contemporary cohort of patients with clinical T1a renal cell car-
cinoma. Urol Oncol 2018;36:527e13-9. https://doi.org/10.1016/j.
urolonc.2018.08.009
S156 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)