Page 3 - CUA2019 Abstracts - Oncology-Kidney

2019 CUA Abstracts

ond digit=0 and Canadian urban boundary files). Trends in the data over MP-9.9
time were analyzed. The most contemporary data from CKCis (2016/2017) Prognostic impact of paraneoplastic syndromes on patients with
was compared to the 2016/2017 Canadian Cancer Society (CCS) statistics non-metastatic renal cell carcinoma undergoing surgery: Results
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to help determine generalizability of the data. from Canadian Kidney Cancer
Results: The CKCis cohort includes 10 294 patients: 66% male (vs. 64% Ryan Sun , Anil Kapoor , Antonio Finelli , Frédéric Pouliot , Ricardo A.
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CCS, 2017), median age 62 years (vs. 64 years Amercian Cancer Society, Rendon , Alan I. So , Adrian Fairey , Simon Tanguay , Luke T. Lavallée ,
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2017), 23% de novo metastatic disease, and 71.4% clear-cell pathology Rodney H. Breau , Jean-Baptiste Lattouf , Jun Kawakami , Lori A. Wood ,
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(vs. 69.5% NS data, 2010). More detailed data are presented by province Daniel Heng , Naveen Basappa , Georg Bjarnason , Ranjeeta Mallick ,
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in Table 1. The CKCis cohort in 2016/2017 includes 2065 patients, which Rahul Bansal 1
represents 18% and 14%, respectively, of the total number of patients 1 Urology, University of Manitoba, Winnipeg, MB, Canada; Urology, St.
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diagnosed with RCC in Canada. This proportion of patients captured Joseph’s Hospital, Hamilton, ON, Canada; Urology, University Health
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per province did vary from 10–43%. Rural patients make up 16% of Network, Toronto, ON, Canada; Urology, CHUQ, Québec City, QC,
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patients (18.9% Statistics Canada, 2011). Canadian heat maps detailing Canada; Urology, Dalhousie University, Halifax, NS, Canada; Urology,
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patient location will be presented. University of British Columbia, Vancouver, BC, Canada; Urology,
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Conclusions: CKCis currently contains prospective data on >10 000 University of Alberta, Edmonton, AB, Canada; Urology, McGill University,
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Canadian RCC patients over seven years, making it an invaluable resource Montréal, QC, Canada; Urology, University of Ottawa, Ottawa, ON,
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for RCC research. The baseline demographic and geographic data do Canada; Urology, CHUM, Montréal, QC, Canada; Urology, Alberta
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appear to include a broad cross-section of patients and are generaliz- Health Services, Calgary, AB, Canada; Medical Oncology, University of
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able to the Canadian RCC population. Moving forward, CKCis should Calgary, Calgary, AB, Canada; Urology, Sunnybrook Hospital, Toronto,
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maximize the overall patient capture rate in all participating provinces. ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada
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This paper has a figure, which may be viewed online at: Introduction: The impact of paraneoplastic syndromes (PNS) on survival
https://2019.cua.events/webapp/lecture/207 in patients with renal cell carcinoma (RCC) is uncertain. This study was
References conducted to analyze the association of PNS with recurrence-free sur-
1. Canadian Cancer Society (CCS). vival (RFS) and overall survival (OS) in patients with non-metastatic RCC
2. American Cancer Society. undergoing nephrectomy.
3. Himmelman J, Merrimen J, Matheson K, et al. Accuracy of kidney Methods: From the Canadian Kidney Cancer information system (CKCis)
cancer diagnosis and histological subtype within Canadian can- database, a prospective cohort of patients who underwent nephrectomy
cer registry data. Can Urol Assoc J 2017;11:E326-9. https://doi. for non-metastatic RCC from 2011–2018 was identified. Patients with PNS
org/10.5489/cuaj.4269 were identified and compared to patients without PNS. PNS identified
were one or more of anemia, polycythemia, hypercalcemia, and weight
MP-9.8 loss. Association of PNS with RFS and OS was examined. Univariate and
Long-term outcomes after radical or partial nephrectomy for multivariate analyses were performed.
T1a kidney cancer: A population-based study Results: Of 2724 patients, 1004 (36.9%) had evidence of one or more
Madhur Nayan , Olli Saarela , Keith Lawson , Lisa Martin , Maria PNS. Mean age was 60.6 years (standard deviation [SD] 11.6) and 1769
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Komisarenko , Antonio Finelli 1 (64.9%) were males. Median Charlson comorbidity index (CCI) score
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1 Division of Urology, Departments of Surgery and Surgical Oncology, was 3 (interquartile range [IQR] 1–4). There was no significant differ-
University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public ence between groups with regards to gender, race, or family history of
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Health, Toronto, ON, Canada kidney cancer. In the group with PNS, patients were of advanced age,
Introduction: Nephrectomy is primary treatment for localized renal cell had higher CCI score, and advanced clinical tumour stage as compared
carcinoma (RCC). However, there remains uncertainty whether type of to patients without PNS. The five-year projected OS in patients without
nephrectomy, partial (PN) or radical (RN), is associated with survival and PNS was 87.8% (95% confidence interval [CI] 84.2–90.6) as compared to
risk of developing significant chronic kidney disease (CKD). Therefore, the 80.3% (95% CI 75.5–84.3) in patients with PNS (p<0.0001). On univari-
objective of this study was to compare outcomes in patients undergoing ate analysis, presence of PNS adversely affected RFS (hazard ratio [HR]
PN or RN for T1a RCC. 1.68; 95% CI 1.47–1.92; p<0.0001) and OS (HR 1.90; 95% CI 1.38–2.63;
Methods: We performed a population-based study of patients in Ontario p<0.0001) (Table 1). On multivariate analysis, PNS did not predict RFS or
undergoing a single PN or RN for T1a RCC between 1995 and 2014. The OS when adjusted for age, CCI score, tumour size, grade, pathological
primary outcome was overall survival (OS). Secondary outcomes were stage, and tumour margin (Table 2).
cancer-specific survival (CSS), diagnosis of CKD, and development of Conclusions: In non-metastatic RCC patients undergoing surgery from
end-stage renal disease (ESRD), defined as receipt of chronic dialysis or CKCis database, the presence of PNS (one or more of anemia, polycy-
renal transplant. We used multivariable Cox proportional hazard models themia, hypercalcemia, and weight loss) is associated with advanced
to evaluate the association between PN or RN and these outcomes. age, higher CCI score, and advanced tumour stage but not with poor
Results: A total of 5670 patients met inclusion criteria, of which 2503 RFS or OS.
(44.1%) underwent PN. PN patients were more likely to be male, younger, This paper has figures, which may be viewed online at:
have lower Charlson scores, smaller tumour sizes, and have surgery in https://2019.cua.events/webapp/lecture/215
more recent years. With a median followup of 6.4 years (interquartile
range [IQR] 3.9–10.7), 1187 patients died. Multivariable Cox proportional MP-9.10
hazard models found that PN was associated with significantly improved Outcomes of cytoreductive nephrectomy (CN) in metastatic
OS (hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.63–0.84), renal cell carcinoma (mRCC) patients using real-world data from
CSS (HR 0.44; 95% CI 0.30–0.65), and a reduced risk of CKD (HR 0.18; Canadian hospital centres
95% CI 0.12–0.28). Fifteen patients developed ERSD; univariate analysis Alice Dragomir , Sara Nazha , Simon Tanguay , Anil Kapoor , Sebastien
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found no significant association with type of surgery (HR 0.25; 95% CI Hotte , Ricardo A. Rendon , Antonio Finelli , Aaron Hansen , Naveen
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0.06–1.12). Basappa , Adrian Fairey , Christian Kollmannsberger , Alan I. So , Jean-
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Conclusions: Our population-based study comparing PN vs. RN for T1a Baptiste Lattouf , Georg Bjarnason , Daniel Heng , Neil M. Reaume ,
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RCC found that PN was associated with significantly improved OS, CSS, Rodney H. Breau , Frédéric Pouliot , Bimal Bhindi , Lori A. Wood 3
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and CKD-free survival. Importantly, ESRD occurred infrequently regardless 1 Urology, McGill University Health Centre, Montréal, QC, Canada;
of type of surgery. PN should be the preferred approach for T1a RCC. 2 Urology, Juravinski Cancer Centre, McMaster University, Hamilton, ON,
Canada; Urology, Queen Elizabeth II Health Sciences Centre, Halifax,
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NS, Canada; Urology, Princess Margaret Cancer Centre, University of
S142 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)