MP10-19 MANAGEMENT OF CHRONIC PAIN AND OVERALL MORTALITY IN METASTATIC RENAL CELL CARCINOMA: A MULTICENTER INVESTIGATION FROM A LARGE GLOBAL HEALTH RESEARCH NETWORK (TriNetX)

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) I (MP10)1 May 2024MP10-19 MANAGEMENT OF CHRONIC PAIN AND OVERALL MORTALITY IN METASTATIC RENAL CELL CARCINOMA: A MULTICENTER INVESTIGATION FROM A LARGE GLOBAL HEALTH RESEARCH NETWORK (TriNetX) Brian H. Im, Aaron Hochberg, Joon Yau Leong, Costas Lallas, Mihir Shah, Patrick Gomella, J. Ryan Mark, Joseph Izes, Kayvan Zarrabi, and Adam Metwalli Brian H. ImBrian H. Im , Aaron HochbergAaron Hochberg , Joon Yau LeongJoon Yau Leong , Costas LallasCostas Lallas , Mihir ShahMihir Shah , Patrick GomellaPatrick Gomella , J. Ryan MarkJ. Ryan Mark , Joseph IzesJoseph Izes , Kayvan ZarrabiKayvan Zarrabi , and Adam MetwalliAdam Metwalli View All Author Informationhttps://doi.org/10.1097/01.JU.0001008588.39303.c9.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Metastatic bone lesions (BM) are the second most common site of metastasis for renal cell carcinoma (RCC), and is indicative of aggressive disease with poor prognosis. We aim to evaluate both the overall mortality and mortality without BM in RCC patients. We also aim to elucidate the effects of bone-remodeling therapy on mortality rates and opioid usage patterns in patients with BM. We hypothesize that overall mortality and chronic pain diagnoses are higher in those with BM compared to those without. METHODS: The TriNetX database was queried for all adult patients with a diagnosis of RCC, using the ICD-10 codes C64.1 and C64.2. Subsequently, patients with BM were queried through the ICD-10 codes C79.51, of which those with a subsequent chronic pain diagnosis were found under the following ICD-10 codes: R52, G89.4, and G89.29. Patients taking the following medications were also queried for the above cohorts: bisphosphonates (zoledronate, ibandronate, risedronate, alendronate, etidronate, pamidronate) and RANKL-inhibitors (RANKL-I) (denosumab). Patients receiving opioids were identified by searching the following: hydrocodone, hydromorphone, morphine, codeine, tramadol, oxycodone, and naloxone (proxy for opioid prescription). Statistical analysis was conducted for the chronic pain cohort using a Fischer's Exact test. Survival analysis was conducted using Kaplan-Meier analysis and the log-rank test. RESULTS: 5-year survival in patients with and without BM, as well as that of patients with BM treated with either bisphosphonates or RANKL-I is shown in Figure 1. Notably, patients treated with a RANKL-I had a significantly lower rate of opioid prescription (65.3%) when compared to patients taking bisphosphonates (OR 0.722, p<0.001, 95% CI: 0.608 - 0.857) or to patients untreated with bone-modifying therapy (OR 1.195, p<0.001, 95% CI: 1.055 - 1.352). Patients treated with a RANKL-I had comparable rates of opioid prescription with patients with no BM whatsoever. CONCLUSIONS: RCC with BM has an overall poor prognosis – however, treatment with bone-modifying agents may confer improved survival rates with less need for opioid pain medications. Also, RANKL-I may serve as a safer alternative to narcotics in the management of pain associated with BM. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e147 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Brian H. Im More articles by this author Aaron Hochberg More articles by this author Joon Yau Leong More articles by this author Costas Lallas More articles by this author Mihir Shah More articles by this author Patrick Gomella More articles by this author J. Ryan Mark More articles by this author Joseph Izes More articles by this author Kayvan Zarrabi More articles by this author Adam Metwalli More articles by this author Expand All Advertisement PDF downloadLoading ...