Page 5 - CUA 2020_Onco_Testis-Kidney-Urothelial

2020 CUA ABSTRACTS
2020 CUA ABSTRACTS

Moderated Poster Session 3: Uro-Oncology

MP-3.1 MP-3.3
PDL1 expression by tumor proportion score in immunohistochemistry Ureteric stents for malignant ureteric obstruction – assessing the
on the tumor tissue of urothelial carcinoma locally advanced or factors associated with encrustation and inadequate drainage: A
metastatic treated by immune checkpoint inhibitors cohort study
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Quang Loc Bui , Ahmed Khalil , Hong Son Trinh , Carolina Saldana , Shreyas Gandhi , Alex Koziarz , Jason Y. Lee 1
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Aurelien Gobert , Maya Nourieh , Eva Comperat , Olivier Cussenot 7 1 Department of Urology, University of Toronto, Toronto, ON, Canada; Faculty
1 Oncology Medical, Tenon Hospital, Paris, France; Oncology Service, of Medicine, University of Toronto, Toronto, ON, Canada
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Viet Duc Hospital, Hanoi, Viet Nam; Oncology Medical, Henri-Mondor Introduction: Malignant ureteric obstruction (MUO) is a challenging clini-
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Hospital, Paris, France; Oncology Medical, Pitié Salpêtrière Hospital, Paris, cal entity for urologists. Currently, no definitive guidelines exist regarding
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France; Pathology, Henri-Mondor Hospital, Paris, France; Pathology, Tenon optimal management of MUO, including the required frequency of stent
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Hospital, Paris, France; Urology, Tenon Hospital, Paris, France changes. Therefore, we evaluated the association of clinical factors at
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Introduction: The benefit of immune checkpoint inhibitors (ICIs) is modest, initial stent implantation with prognosis and stent management in patients
with a tumor response rate of 23– 29% in locally advance or metastatic with MUO.
urothelial carcinoma. The expression of PD-L1 is perhaps a predictive Methods: A single-center, retrospective cohort study was conducted among
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factor of tumor response of ICIs. all patients with MUO managed with a ureteral stent from August 2015 to
Methods: We conducted a non-interventional, retrospective, multicenter December 2019. A multivariable regression model was used to evalu-
study in three university hospitals in Paris. All patients were diagnosed with ate patient factors associated with the following primary outcomes: stent
locally advanced or metastatic urothelial carcinoma and treated by anti- encrustation requiring need for stent change, need for antegrade decom-
PD1 or anti-PDL1 for at least one cycle. We classified all patients into two pression due to inadequate drainage, and time to first stent change.
groups according to RECIST 1.1 criteria: the clinical benefit group, which Results: Fifty patients (72% female) were included with mean age of 63.9
included stable disease, partial response or complete response; and the years. Mean followup was one year. The most common indication for stent-
progression group. We collected paraffin tissue blocks of these patients. ing was acute kidney injury (46%), followed by hydronephrosis without
Then we determined the expression of PDL-1 by immunohistochemistry creatinine elevation (42%), and pain (6%). Ten patients (20%) required
using the tumor proportion score (TPS). antegrade decompression following first stent check. Median (interquartile
Results: From January 1, 2015 to June 30, 2019, 23 patients were enrolled range [IQR]) time to first stent change was 91 (84–104) days. History of
in our study. For the primary endpoint, the mean PDL1 expression did bowel resection (p=0.018) and diabetes mellitus (p<0.00001) was associ-
not differ between the clinical benefit group and the progression group ated with increased frequency of stent change when controlling for stent
(TPS 32.83%; 95% confidence interval [CI] 3.5–67.3 vs. 26.35; 95% CI location, creatinine at stent insertion, and indication. Initial ureteric obstruc-
7.8–48.0, respectively); the difference of PDL1 expression was 6.48% (95% tion at the mid-ureter was associated with fewer number of stent changes
CI -46.2–28.3). Concerning the secondary endpoint, overall survival from (p=0.035). There was no association of stent location, creatinine at stent
diagnosis did not differ significantly either in the TPS ≥50% group or in insertion, indication, history bowel resection, or diabetes mellitus with risk
the TPS <50% group (hazard ratio [HR] 0.75; 95% CI 0.19–2.99; p=0.69). for future antegrade decompression, risk for encrustation at first check, or
Patients in the clinical benefit group received ICIs earlier compared to the time to first change.
progression disease group, with a significant difference of 1.5 lines (95% Conclusions: History of bowel resection and diabetes mellitus is associated
CI 0.8–2.3). Half (50%) of the patients received the ICIs first-line and 50% with greater number of stent changes due to encrustation. Patients with
second-line, benefiting the clinical group. On average, the progression this history may require more frequent stent surveillance, as encrustation
disease group received ICIs as third-line treatment. rates may be higher.
Conclusions: Our results suggest that PDL1 expression is not a predictive References
factor of tumor response in the locally advanced or metastatic urothelial 1. O’Connor E, Nason GJ, Kiely E. Urological management of extramural
carcinoma patients treated by ICIs. malignant ureteric obstruction: A survey of Irish urologists. Curr Urol
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https://doi.org/10.1016/S0140-6736(17)33297-X
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S91
© 2020 Canadian Urological Association