Page 8 - CUA2019 Abstracts - Oncology-Kidney

Poster session 9: Kidney, Penis, and testis Cancer

UP-9.10 partial nephrectomies and 101 (46%) were on-clamp. In the clampless
Disparities associated with disease presentation and poor survival group, mean preoperative eGFR was 84. Mean discharge eGFR was 82,
among Asian patients with upper tract urothelial carcinoma while six-month and one-year eGFR were 75 and 76, respectively. Mean
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Dixon Woon , Jaime O. Herrera-Cáceres , Zachary Klaassen , Hanan EBL in the clampless group was 450 mL, while mean operative time was
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Goldberg , Thenappan Chandrasekar , Guan Hee Tan , Khaled Ajib , 92 minutes. In the on-clamp group, mean pre-operative eGFR was 81,
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Greg Nason , Omar Alhunaidi , Girish S. Kulkarni , Neil E. Fleshner 1 while discharge eGFR was 69. Mean six-month and one-year eGFR were
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1 Surgical Oncology, University Health Network, Toronto, ON, Canada both 72. Additionally, mean clamp time was 12.62 minutes. Mean EBL
Introduction: In most cancers, minority populations, such as African for the on-clamp group was 556 mL, while mean operative time was
Americans and Hispanics, have shown poorer outcomes than Caucasians. 121 minutes.
To our knowledge, most epidemiological data on upper tract urothelial Conclusions: This preliminary data suggests that in the early postoperative
cancer (UTUC) has mainly focused on African Americans and Caucasians, timeframe, renal function in patients receiving clampless partial nephrec-
and thus neglected the Asian populations, which represent >5% of the tomy demonstrate consistently better eGFR compared to the on-clamp
U.S. population and are rapidly increasing. Our study aimed to evalu- group, even with short mean clamp times. However, this difference nar-
ate potential differences in disease stage at diagnosis, surgical manage- rows with time. Long-term data and further study are needed to gain
ment for localized disease, and survival outcomes for Asian patients with an understanding of how intraoperative ischemia can affect renal func-
UTUC. tion and whether zero-ischemia procedures translate to better long-term
Methods: Patients diagnosed with UTUC from 1988–2014 were identi- renal function.
fied in the Surveillance, Epidemiology, and End Results (SEER) database.
Demographic and socioeconomic variables, such as marital and insurance UP-9.12
status, were analyzed. Multivariable logistic regression was used to assess Immunological impact of the surgical resection of renal tumours:
predictors of metastatic disease at diagnosis. Fine and Gray competing Implications for cytoreduction in the immune checkpoint
risks analyses were used to identify predictors of cancer-specific mortality inhibitor era
(CSM) and Cox proportional hazard models was performed to evaluate Bimal Bhindi , Paras Shah , Christine Lohse , Ross Mason , Henan
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overall survival (OS). Zhang , Lance Pagliaro , Brian Costello , R. Houston Thompson , Stephen
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Results: A total of 12 124 patients with UTUC were identified. Of these, Boorjian , John Cheville , Haidong Dong , Bradley Leibovich
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10 638 (87.7%) were Caucasians, 793 (6.5%) Asian, 578 (4.8%) African 1 Surgery, Section of Urology, University of Calgary, Calgary, AB, Canada;
American, and 115 (1%) patients of other races; 1193 (9.8%) patients 2 Urology, Mayo Clinic, Rochester, MN, United States; Urology, Dalhousie
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had metastasis at diagnosis. Rates of Caucasian and Asian patients who University, Halifax, NS, Canada
presented with metastatic disease at diagnosis were 9.5% and 12.6%, Introduction: Immune checkpoint inhibitors are increasingly being used
respectively. Compared to Caucasian patients, Asians were 38% (odds for renal cell carcinoma (RCC). The role of nephrectomy in conjunction
ratio [OR] 1.38; 95% confidence interval [CI] 1.1–1.7) more likely to with these agents remains unclear and the mechanisms of the potential
present with metastatic disease and were 27% more likely to die of UTUC benefit of cytoreduction require further exploration. We sought to evalu-
(hazard ratio [HR] 1.27; 95% CI 1.1–1.5). There were no differences in ate whether surgical resection of renal tumours influences anti-tumour
surgical management or OS between Caucasians and Asians. immune markers.
Conclusions: Asian patients with UTUC are more likely to present Methods: We prospectively enrolled 28 patients undergoing partial
with metastatic disease at diagnosis and have worse CSM compared to (10), radical (13), or cytoreductive nephrectomy (5) for a unilateral pri-
Caucasian patients. Further research should be conducted to evaluate the mary renal tumour from 2016–2018. Immunosuppressed patients were
underlying reason for these findings in order to improve the outcomes excluded. Blood was drawn preoperatively, on postoperative day one
for Asian patients with UTUC. (POD1), and at three months (3MO). Peripheral blood mononuclear cells
This paper has a figure, which may be viewed online at: (PBMCs) were isolated and flow cytometry was used to assess the percent
https://2019.cua.events/webapp/lecture/231 of PMBCs that were CD11a+CD8+ (to identify tumour-reactive cytotoxic
T-lymphocytes; CTLs) and the percent of CTLs that were Bim+ (down-
UP-9.11 stream pro-apoptotic mediator of PD-1 pathway), CX3CR1+GZMB+ (to
Clampless vs. on-clamp partial nephrectomy: Comparing identify effector memory T-cells), and Ki67+ (marker of proliferation).
perioperative renal outcomes Changes in immune markers preoperatively to POD1 and 3MO were
Akshay Sathya , Michael K. Organ , David Harvey , Paul H. Johnston , compared using Wilcoxon signed rank tests. Comparisons between
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Robert Wilson , Christopher French 2 aggressive (pT3-4, N1, M1, or aggressive histology [high-grade, coagula-
1 Faculty of Medicine, Memorial University of Newfoundland, St. John’s, tive necrosis, sarcomatoid differentiation, or specific RCC-variant histolo-
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NL, Canada; Division of Urology, Memorial University of Newfoundland, gies]) vs. indolent tumours were made using a Wilcoxon rank sum test.
St. John’s, NL, Canada Results: Nineteen, six, and three patients had clear-cell RCC, non-clear
Introduction: Clampless partial nephrectomy, while technically challeng- cell RCC, and oncocytoma, respectively. At 3MO, there was a significant
ing, is a method of minimizing long-term risks associated with renal isch- rise in the percent of CTLs among PMBCs (median change +1.6; p=0.008).
emia during partial nephrectomies. The aim of this study was to examine On POD1, there was a significant rise in the percent of CTLs that were
outcomes in one centre by comparing clampless and on-clamp partial proliferating (median change +0.7; p=0.016) and a significant decrease
nephrectomies, focusing largely on short-term renal outcomes. by 3MO vs. preoperatively (median change -0.9; p<0.001). There was
Methods: A retrospective analysis of 219 partial nephrectomy cases per- a non-significant decline by 3MO in the percent of Bim+ CTLs (median
formed by six urologists in St. John’s, Newfoundland from 2012–2017 was change -1.8; p=0.14). At 3MO, the percent of effector memory CTLs was
completed. Primary outcomes were preoperative estimated glomerular increased among patients treated for aggressive tumours but not indolent
filtration rate (eGFR), discharge eGFR, six-month eGFR, and one-year tumours (median change +2.7 vs. -0.4; p=0.048).
eGFR. Secondary parameters were estimated blood loss (EBL), margin Conclusions: These findings suggest potential beneficial effects on the
status, and clamp time. Patient and tumour characteristics were collected anti-tumour immune response with surgical resection of the primary renal
including RENAL nephrometry scores. tumour. These data have important implications in an era when immune
Results: Of the 219 patients, 54 (24.6%) were laparoscopically performed checkpoint inhibitors are being used in the metastatic setting and are
and 165 (75.4%) were open; 117 (54%) of the 219 cases were clampless being evaluated in the adjuvant setting.
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S147