Page 2 - CUA 2020_Onco_Testis-Kidney-Urothelial

2020 CUA Abstracts

POD-4.2 to have UTUC. RCC prevalence was 0.98% (n=107). Similarly, RCC was
Diagnostic test performance of ultrasound and cytology in upper more prevalent in VH (1.26%, n=90) vs. NVH (0.41%, n=13) and NH
tract cancer: Results from a global, multicenter analysis (0.65%, n=4). Ultrasound (USS) performed better in detecting RCC in
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Taeweon Lee , Miles Mannas , Peter C. Black , Mark Assmus , Tim the NVH group than in the VH group (Table 1). USS was poor at detect-
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Wollin , Sinan Khadhouri , Kevin Gallagher , Kenneth MacKenzie , Taimur ing UTUC alone, however, improved in sensitivity when combined with
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Shah , Chuanyu Gao , Sacha Moore , Eleanor Zimmermann , Eric cytology. All UTUCs in the NVH group without bladder cancer were
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Edison , Matthew Jefferies , Arjun Nambiar , Matthew Nielsen , John detected using a combination of USS, cytology, and flexible cystoscopy.
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McGrath , Veeru Kasivisvananthan 15 Conclusions: UTUC and RCC are rare. USS is a good diagnostic per-
1 Department of Urologic Sciences, University of British Columbia, formance test in detecting RCC, especially in patients with NVH.
Vancouver, BC, Canada; Vancouver Prostate Centre, Vancouver General Combined non-invasive tests improve diagnostic accuracy in detecting
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Hospital, Vancouver, BC, Canada; Division of Urology, University of UTUC. These can be considered in place of CTU in selected patients
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Alberta, Edmonton, AB, Canada; Department of Urology, Aberdeen Royal in a risk-stratified model.
Infirmary, Aberdeen, United Kingdom; Department of Urology, Western
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General Hospital, Edinburgh, United Kingdom; Department of Urology, POD-4.3
Freeman Hospital, Newcastle, United Kingdom; Department of Surgery and The prognostic and predictive implications of the 12-Chemokine
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Cancer, Charing Cross Hospital, London, United Kingdom; Department Score in muscle-invasive bladder cancer
of Urology, Peterborough City Hospital, Peterborough, United Logan Zemp , Anders Berglund , Jasreman Dhillon , RyanPutney ,
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Kingdom; Department of Urology, Wrexham Maelor Hospital, Wrexham, Youngchul Kim , Rohit K. Jain , G. Daniel Grass , Jingsong Zhang , Mic
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United Kingdom; Department of Urology, Weston General Hospital, hael A. Poch , Julio Pow-Sang , Wade J. Sexton , Scott M. Gilbert , Shari
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Weston-super-Mare, United Kingdom; Department of Urology, North Pilon-Thomas , José Conejo-Garcia , Colin P.N. Dinney , James J. Mulé ,
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Middlesex Hospital, London, United Kingdom; Department of Urology, Roger Li, MD
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Morriston Hospital, Swansea, United Kingdom; University of North 1 Department of Genitourinary Oncology, H. Lee Moffitt Cancer
Carolina, Dept. of Urology, Chapel Hill, North Carolina, United States; Center, Tampa, FL, United States; Department of Biostatistics and
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14 Department of Urology, University of Exeter Medical School, Exeter, Bioinformatics, H. Lee Moffitt Cancer Center, Tampa, FL, United States;
United Kingdom; Department of Urology, University College London, 3 Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, FL,
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London, United Kingdom; The IDENTIFY Study Group United States; Department of Radiation Oncology, H. Lee Moffitt Cancer
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Introduction: Upper tract urothelial carcinoma (UTUC) and renal cell Center, Tampa, FL, United States; Department of Immunology, H. Lee
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carcinoma (RCC) are rare in patients with hematuria. There is limited data Moffitt Cancer Center, Tampa, FL, United States; Department of Urology,
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to guide the most appropriate upper tract evaluation in these patients. We MD Anderson Cancer Center, Houston, TX, United States
evaluated the diagnostic test performance of investigations for UTUC and *Contributed equally to the study
RCC in a global study of patients referred to secondary care for suspected Introduction: Adaptive anti-tumor immunity can be orchestrated by lymph
urinary tract cancer. node-like immune cell aggregates within the tumor microenvironment
Methods: The IDENTIFY group prospectively assessed 10 896 patients (27 (TME) called tertiary lymphoid structures (TLSs). TLSs are postulated to
countries). Those with previous urological malignancy were excluded. be the gateway of lymphocyte infiltration into the TME. A 12-chemokine
Diagnostic test performance (e.g., cystoscopy, imaging) was assessed (12-CK) metagene grouping (has previously been described that corre-
using the predetermined reference standard (i.e., detection of UTUC/ lates with the presence of TLSs in other solid tumor types and response
RCC with histology or accepted clinical gold standard diagnosis) with to immune checkpoint blockade (ICB). In this study, we explored the
resultant index test outcomes. Computed tomography urography (CTU) prognostic implication of the 12-CK score in bladder cancer and its cor-
was considered the reference test, thus its performance was not observed. relation with the presence of TLSs.
Equivocal outcomes were deemed positive findings, as these prompted Methods: Cystectomy specimens from 130 patients with bladder cancer
further workup. Test adequacy was determined by individual collaborators were arrayed on Affymetrix microarrays. 12-CK scores were normalized
and only those deemed adequate were included in the analysis. with >1 denoting high scores (12-CKHi). Overall survival was estimated
Results: UTUC prevalence was 1.17% (n=128). It was more prevalent using the Kaplan-Meier method. Findings were validated using 12-CK
in patients with visible hematuria (VH) (1.60%, n=114) vs. non-visible scores extracted from TCGA data. Immunohistochemistry antibody stain-
hematuria (NVH) (0.29%, n=9) and no hematuria (NH) (0.81%, n=5). ing was performed for CD4, CD8, CD20, LAMP3. A genitourinary (GU)
Among those with NVH under the age of 60 (n=1313), no one was found pathologist scored TLSs into types I-III, with type III representing fully
POD-4.2. Table 1. The diagnostic test evaluation of ultrasound (USS) and cytology in renal cell carcinoma (RCC) and upper
tract urothelial cancer (UTUC)
n Sensitivity Specificity Positive predictive value Negative predictive value
Renal cell carcinoma
USS Overall 6913 81.6% 98.0% 22.6% 99.9%
In VH 4165 82.1% 97.8% 26.0% 99.8%
In NVH 2380 87.5% 98.3% 14.6% 100%
Upper tract urothelial cancer
USS ** 50.0% 97.9% 16.9% 99.6%
Cytology ** 58.8% 89.4% 8.4% 99.2%
USS + cytology 5798 78.7% 92.3% 9.8% 99.8%
USS + cytology + Overall ** 80.0% 92.1% 10.3% 99.8%
cystoscopy* in VH 3265 79.2% 91.2% 13.0% 99.6%
in NVH 2282 100% 94.2% 3.7% 100%
*Cystoscopy findings suspicious for tumour (e.g., hematuric jet from ureteric orifice, bulge in the transmural ureter). **Final data pending distribution from the IDENTIFY study group.
S38 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)