Page 6 - CUA2019 Abstracts - Oncology-Kidney

Poster session 9: Kidney, Penis, and testis Cancer

(hazard ratio [HR] 3.1), SSM at multiple sites (HR 3.9), extra-RP disease III and IV cysts have traditionally been managed with surgical exci-
(HR 3.9), and incomplete resection of SSM (HR 3.6) predicted mortality. sion. There is growing evidence suggesting that many of these cysts
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On multivariable analysis, only extra-RP disease (HR 4.8) was indepen- behave in an indolent fashion. Therefore, active surveillance (AS) has
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dently associated with inferior OS (five-year OS 82% vs. 52%; p=0.017). been proposed as a possible treatment alternative. The objectives of
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Conclusions: SSM is an important potential complication of LR GCT and this study were to characterize the use of AS in the management of
seems to be associated with the lack of resection of RP metastases. Early complex renal cysts in Canada and to identify the perceived barriers to
identification and complete resection prior to SSM arising in extra-RP its greater adoption.
sites are critical to optimizing outcomes. Methods: A web-based survey was sent to all practicing urologists (n=583)
of the Canadian Urological Association (CUA) in October 2018. The
UP-9.3 survey examined the physician’s management of complex renal cysts
and perceived barriers to adoption of AS. Chi-squared tests were used to
Development and validation of a risk score based on patient assess for differences between respondents.
characteristics to predict major complications after partial Results: The response rate was 24.7%. Of eligible respondents, 13.7%
nephrectomy never or rarely offer AS (<5% of cases), while 33.1% offer AS in >50%
Melissa J. Huynh , Ye Wang , Ross E. Krasnow , Benjamin I. Chung, Steven of patients with a Bosniak III cysts in whom surgical extirpation is con-
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L. Chang 1,5 sidered a viable treatment option. In contrast, for Bosniak IV cyst, 60.1%
1 Urology, Brigham and Women’s Hospital, Boston, MA, United States;
2 Center for Surgery and Public Health, Brigham and Women’s Hospital,, of urologists never or rarely offer AS, while only 10.1% offer it >50%
of cases. A greater proportion of academic urologists compared to non-
Boston, MA, United States; Urology, MedStar Washington Hospital academic urologists viewed AS as a viable treatment option for patients
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Center, Washington, DC, United States; Urology, Stanford University, with a Bosniak III (p=0.03) or IV (p=0.002) cysts. The most commonly
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Stanford, CA, United States; Dana-Farber Cancer Institute, Boston, MA, reported barriers to greater adoption of AS were: concerns regarding the
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United States safety and/or benefits of AS, the lack of data to support AS in patients
Introduction: Partial nephrectomy has become the gold standard in the treat- with Bosniak III–IV cyst and the lack of specific triggers for intervention
ment of clinical T1a renal masses. While tumour characteristics have been for patient managed by AS.
shown to correlate with complication rates in some studies, fewer studies Conclusions: Although AS is reported by the CUA guidelines as a possible
have focused on the impact of patient comorbidities. We, therefore, sought treatment option for complex cysts, most urologists are still reluctant to
to develop and validate a risk score to predict the probability of major com- offer this option to their patients, mostly due to the lack of data support-
plications following partial nephrectomy based on patient characteristics. ing its role. Thus, future studies are required to better define the role of
Methods: The Premier Healthcare Database (Premier Inc., Charlotte, NC, AS in patients with Bosniak III or IV cysts.
U.S.) was used to identify patients who had undergone elective partial References
nephrectomies. Through review of available ICD9 codes, we identified 1. Schoots IG, Zaccai K, Hunink MG, et al. Bosniak classification
comorbidities and major surgical complications (Clavien grade 3–5). We for complex renal cysts re-evaluated: A systematic review. J Urol
used half of the set as the training cohort to develop our risk score and 2017;198:12-21. https://doi.org/10.1016/j.juro.2016.09.160
the other half as a validation cohort. Covariates with a p<0.20 in the uni- 2. Bhatt JR, Jewett M, Richard PO, et al. Multilocular cystic renal cell
variate analysis were included as candidate variables in the multivariable carcinoma: Results of a long-term, large population-level study:
logistic regression to identify predictors of major complications. Pathologic T-staging makes no difference to favourable outcomes
Results: From 2003–2015, 25 451 partial nephrectomies were per- and should be reclassified. J Urol 2016;196:1350-5. https://doi.
formed. The overall rate of major complications for the whole cohort was org/10.1016/j.juro.2016.05.118
4.9%. The final risk score consisted of 10 predictors (Table 1) and stratifies 3. Chandrasekar T, Ahmad AE, Fadaak K, et al. Natural history of com-
patients into low-, intermediate-, high-, and very high-risk categories. In plex renal cysts: Clinical evidence supporting active surveillance. J
the training cohort, the area under the receiver-operator characteristic Urol 2018:199:633-40. https://doi.org/10.1016/j.juro.2017.09.078
curve (AUC) was 0.75 (95% confidence interval [CI] 0.73–0.78) for major 4. Pruthi DK, Liu Q, Kirkpatrick IDC, et al. Long-term surveillance of
complications, while the AUC for the validation cohort was 0.73 (95% complex cystic renal masses and heterogeneity of Bosniak 3 lesions.
CI 0.70–0.75) (Fig. 1). The predicted probabilities of major complication J Urol 2018;200:1192-9. https://doi.org/10.1016/j.juro.2018.07.063
in patients in the low-risk (≤10 points), intermediate-risk (11–20 points), 5. Richard PO, Violette PD, Jewett MAS, et al. CUA guideline on the
high-risk (21–30 points), and very high-risk (>30 points) categories were management of cystic renal lesions. Can Urol Assoc J 2017;11:E66-
3% (95% CI 2.6–3.2), 8% (95% CI 7.2–9.2), 24% (95% CI 20.5–27.8), 73. https://doi.org/10.5489/cuaj.4484
and 41% (95% CI 34.5–47.8), respectively.
Conclusions: We developed and validated a risk score to predict the
risk of complications following partial nephrectomy based on patient UP-9.5
characteristics. Calculation of a risk score can enhance the informed The evaluation of non-neoplastic kidney tissue at time of
consent process for those planning to undergo partial nephrectomy for nephrectomy to predict postoperative renal function
the management of a renal mass. Mohammad Mohaghegh , Yong Jia , Ian Gibson , Rahul Bansal , Thomas
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This paper has figures, which may be viewed online at: McGregor , Deepak Pruthi , Darrel E. Drachenberg , Corey J. Knickle ,
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https://2019.cua.events/webapp/lecture/223 Jasmir G. Nayak 1
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1 Surgery, University of Manitoba, Winnipeg, MB, Canada; Pathology,
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UP-9.4 University of Manitoba, Winnipeg, MB, Canada; Urology, Queen’s
University, Kingston, ON, Canada; Urology, University of Texas Health
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Management of complex cysts in Canada: Results of a survey study Sciences Center, San Antonio, TX, United States
Patrick Richard , Amélie Tétu , Luke T. Lavallée , Philippe Violette , Anil Introduction: Impaired renal function is a potentially serious and mor-
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Kapoor , Wassim Kassouf , Antonio Finelli 6 bid complication from renal surgery. Currently, we are limited in our
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1 Division of Urology, Centre Hospitalier Universitaire de Sherbrooke, ability to predict postoperative renal function and rely on serological
Sherbrooke, QC, Canada; Division of Urology, The Ottawa Hospital, investigations to monitor for this occurrence. The histological evaluation
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Ottawa, ON, Canada; Division of Urology, Woodstock General Hospital, of non-neoplastic kidney (NNK) tissue at the time of renal surgery may
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Woodstock, ON, Canada; Division of Urology, St. Joseph Healthare offer unique insight into the postoperative renal function.
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Centre, Hamilton, ON, Canada; Division of Urology, McGill University Methods: This study was performed as a combined prospective patho-
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Health Network, Montréal, QC, Canada; Division of Surgical Oncology, logical review and retrospective clinical chart review. A blinded expert
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Princess Margaret Cancer Centre, Toronto, ON, Canada pathologist assessed NNK tissues for four histological elements to report
Introduction: Given their high-risk of malignancy (>50% risk), Bosniak scores on glomerular sclerosis, tubulointerstitial changes, arterioscle-
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S145