Page 4 - CUA2019 Abstracts - Oncology-Kidney

Poster session 9: Kidney, Penis, and testis Cancer

Toronto, Toronto, ON, Canada; Urology, Cross Cancer Institute, University two to determine if findings of the PET-CT scan predicted the Ki-67 levels,
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of Alberta, Edmonton, AB, Canada; Urology, BC Cancer Agency Vancouver indicating tumour aggressiveness.
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Cancer Centre, Vancouver, BC, Canada; Urology, Centre Hospitalier de Results: Dual-phase PET-CT findings correlated well with tumour, node,
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l’Université de Montréal, Montréal, QC, Canada; Urology, Sunnybrook and metastases stage of the tumour. It also correlated positively with
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Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; tumour Ki-67 levels, although this association failed to reach statistical
9 Urology, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; significance. The retention index obtained from dual-time PET images
10 Medical Oncology, Tom Baker Cancer Centre, University of Calgary, were positive for clear-cell and papillary cancer, while it was negative for
Calgary, AB, Canada; Urology, Centre Hospitalier Universitaire de chromophobe tumour and benign variants, including angiomyolipoma
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Québec, Université Laval, Québec City, QC, Canada; Medical Oncology, and oncotyoma.
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Southern Alberta Institute of Urology, Alberta, AB, Canada Conclusions: Dual-phase F-FDG PET-CT may preoperatively be able to
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KCRNC predict the biology, aggressiveness, and underlying pathology of renal
Introduction: The objective of this study was to use real-world data masses and guide an appropriate management and surveillance scheme
(RWD) to evaluate and compare the outcomes of metastatic renal cell for patients with RCC.
carcinoma (mRCC) patients who underwent cytoreductive nephrectomy
(CN) with or without targeted treatment (TT) compared to patients who MP-9.12
only received TT.
Methods: The Canadian Kidney Cancer information system (CKCis) data- Perioperative chemotherapy for upper tract urothelial carcinoma:
base was used to identify patients diagnosed with mRCC after January A microsimulation Markov model 1,2 2,3
1,2
1,2
2011. Patients were stratified into four different groups: CN without TT, Diana E. Magee , Amanda Hird , Douglas C. Cheung , Beate Sander ,
1,2
2
1,2
CN followed by TT, TT followed by CN, TT alone. Kaplan-Meier curve Srikala S. Sridhar , Robert K. Nam , Girish S. Kulkarni
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was used to estimate the overall survival (OS) from diagnosis of mRCC 2 Division of Urology, University of Toronto, Toronto, ON, Canada;
to death from any cause for the following groups: 1) CN without TT; 2) Institute of Health Policy, Management and Evaluation, University
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CN before or after TT; and 3) and TT alone. A Cox proportional hazards of Toronto, Toronto, ON, Canada; Toronto Health Economics and
model was used to assess the impact of the CN while adjusting for poten- Technology Assessment Collaborative, University of Toronto, Toronto,
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tial confounding variables. ON, Canada; Department of Medical Oncology, University of Toronto,
Results: A total of 813 patients were included in the analysis; 663 (81.6%) Toronto, ON, Canada
patients underwent CN and 150 (18.5%) did not. Of the 663 patients Introduction: Upper tract urothelial carcinoma (UTUC) accounts for less
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in the CN group, 202 did not receive any TT and 461 received TT (383 than 5% of all urothelial cancers. As a result, this disease is clinically
preceded by CN and 78 followed by CN). The median time between CN understudied and there are no definitive recommendations regarding use
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to TT initiation and between TT initiation to CN was three (interquartile and timing of perioperative chemotherapy. The objective of this study was
range [IQR] 2–8] and five (IQR 3–9) months, respectively, with a median to create a decision model comparing three treatment pathways in UTUC:
TT duration of five (IQR 2–11) and seven (IQR 3–14) months, respec- nephroureterectomy (NU) alone, neoadjuvant chemotherapy (NAC), and
tively. The median OS for patients undergoing CN without TT, CN with adjuvant chemotherapy (AC).
TT, and TT alone was not reached, 37 months (95% confidence inter- Methods: A Markov microsimulation model was constructed using
val [CI] 29–43), and 13 months (95% CI 10–19), respectively. Having a TreeAge Pro to compare treatment strategies for patients with UTUC (Fig.
metastasectomy (hazard ratio [HR] 0.51; 95% CI 0.37–0.73) and clear-cell 1). Our primary outcome was quality-adjusted life expectancy (QALE).
histology (HR 0.69; 95% CI 0.54–0.87) were associated with improved Secondary outcomes included rates of adverse chemotherapy events,
survival. Compared to patients in the CN before or after TT group, CN bladder cancer diagnoses, and crude survival. Markov cycle length was
without TT patients presented an improved survival (HR 0.57; 95% CI three months to mimic the followup interval used in clinical practice for
0.41–0.80), but patients in the TT group alone presented a decreased patients with UTUC. A systematic literature review was used to generate
survival (HR 2.14; 95% CI 1.68–2.74). probabilities to populate the model. The base case was a 70-year-old
Conclusions: Our study presents the clinical impact of CN in mRCC patient with a radiographically localized upper tract tumour. Patients
patients using RWD. Further analyses will be conducted in subgroups of could have evidence of nodal disease but no distant metastasis.
patients and using matched analysis to decrease confounding by indica- Results: A total of 100 000 microsimulations were generated. NAC was
tion in this population. preferred, with an estimated QALE of 7.52 years vs. 6.80 years with
NU alone and 7.20 years with AC. Overall, 39.6% of patients in the AC
group with invasive pathology received and were able to complete che-
MP-9.11 motherapy. A total of 37.5% of patients in the NAC group experienced
Can preoperative imaging predict the biology of renal cell an adverse chemotherapy event compared to 15.1% of patients in the AC
carcinoma? A study of the relationship between dual phase group. Bladder cancer recurrence rates were 64.9%, 66.0%, and 67.1%
18F-fluorocholine positron emission tomography-computed over the patient’s lifetime in the NU, NAC, and AC groups, respectively.
tomography findings and Ki-67 levels in renal cell carcinoma Conclusions: This study provides evidence to support the increased use
Uttam Mete , Tushar Aditya Naryan , Ashwani Sood , Nandita Kakkar 4 of NAC in UTUC until robust randomized trials can be completed. While
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1 Urology, PGIMER, Chandigarh, Chandigarh, India; Urology, PGIMER, the use of NAC in this population appears favourable, the ultimate choice
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Chandigarh, Chandigarh, India; Nuclear Medicine, PGIMER, Chandigarh, rests with the clinician and should be based on patient and tumour factors.
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Chandigarh, India; Pathology, PGIMER, Chandigarh, Chandigarh, India This paper has a figure, which may be viewed online at:
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Introduction: Renal cell carcinoma (RCC) is one of the most lethal https://2019.cua.events/webapp/lecture/221
tumours of the genitourinary tract. A continuing concern has been the References
varying clinical behaviour and different rates of local and systemic recur- 1. Rouprêt M, Babjuk M, Compérat E, et al. European Association of
rence in patients with similar clinical stage, grade, and pathology. In this Urology guidelines on upper urinary tract urothelial cell carcinoma:
work, we evaluated whether a dual-phase F-flurodeoxyglucose positron 2015 update. Eur Urol 2015;68:868-79. https://doi.org/10.1016/j.
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emission tomography-computed tomography ( F-FDG PET-CT) can pro- eururo.2015.06.044
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vide a better understanding of this variability in tumour behaviour; predict 2. Leow JJ, Martin-Doyle W, Fay AP, et al. A systematic review and
aggressiveness and risk of recurrence preoperatively by correlating it with meta-analysis of adjuvant and neoadjuvant chemotherapy for upper
tumoural tissue Ki-67 levels; and help formulate an appropriate treatment tract urothelial carcinoma. Eur Urol 2014;66:529-41. https://doi.
and surveillance scheme for the patient. org/10.1016/j.eururo.2014.03.003
Methods: Twenty-three patients with a suspected RCC underwent a dual-
time F-FDG PET-CT scan and estimation of Ki-67 levels in the tumoural
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tissue by immunohistochemistry. A correlation was derived between the
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S143