Mp36-09 Parenchymal Obliteration: Oncologic Implications

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I (MP36)1 May 2024MP36-09 PARENCHYMAL OBLITERATION: ONCOLOGIC IMPLICATIONS Akira Kazama, Carlos Munoz-Lopez, Worapat Attawettayanon, Melissa Boumitri, Eran Maina, Zaeem Lone, Nityam Rath, Kieran Lewi, Rebecca A. Campbell, Jihad Kaouk, Georges-Pascal Haber, Samuel Haywood, Nima Almassi, Christopher Weight, Amy Nowacki, and Steven C. Campbell Akira KazamaAkira Kazama , Carlos Munoz-LopezCarlos Munoz-Lopez , Worapat AttawettayanonWorapat Attawettayanon , Melissa BoumitriMelissa Boumitri , Eran MainaEran Maina , Zaeem LoneZaeem Lone , Nityam RathNityam Rath , Kieran LewiKieran Lewi , Rebecca A. CampbellRebecca A. Campbell , Jihad KaoukJihad Kaouk , Georges-Pascal HaberGeorges-Pascal Haber , Samuel HaywoodSamuel Haywood , Nima AlmassiNima Almassi , Christopher WeightChristopher Weight , Amy NowackiAmy Nowacki , and Steven C. CampbellSteven C. Campbell View All Author Informationhttps://doi.org/10.1097/01.JU.0001008612.93052.9d.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Substantial parenchymal volume replacement (PVR) by renal cell carcinoma (RCC) may negatively associate with functional and oncologic outcomes following renal surgery. However, studies regarding PVR remain limited. Our primary objective was to evaluate the oncologic implications associated with parenchymal obliteration by RCC. METHODS: 1,122 patients managed with partial nephrectomy(PN)/radical nephrectomy(RN) at Cleveland Clinic (2011-2014) with necessary studies were evaluated. Parenchymal volume analysis via novel semiautomated-software was used to estimate split renal function and pre/postoperative parenchymal volumes. Presuming that the contralateral kidney serves as a control, %PVR was defined: (parenchymal volumecontralateral–parenchymal volumeipsilateral) normalized by parenchymal volumecontralateral x100%. Patients were grouped according to degree of PVR: <5% (N=566), 5-25% (N=414), and ≥25% (N=142). Kaplan-Meier plots were used to evaluate recurrence-free/cancer-specific survival relative to degree of PVR. Multivariable Cox regression models evaluated predictors of recurrence-free survival (RFS). Partition analysis identified predictors of aggressive pathologic features. RESULTS: Of 1,122 patients, 801 (71%) underwent PN. Overall, median tumor-size was 3.1cm/6.8cm for PN/RN, respectively, and median follow-up was 8.6 years. Median percent PVR was 15% (IQR=6-29%) in RN patients and negligible in PN patients. Percent PVR correlated indirectly with preoperative ipsilateral GFR (r=-0.49, p<0.01) and directly with advanced pathologic stage, high tumor grade, clear cell histology, and sarcomatoid features (Figure 1A; all p<0.01). PVR≥25% associated with shortened recurrence-free, cancer-specific, and overall survival (Figure 1B; all p<0.01). Male sex, ≥pT3a, tumor grade 4, positive surgical-margins and PVR≥25% independently associated with reduced RFS (all p<0.02). Partition analysis identified PVR as an independent predictor of aggressive pathologic features. CONCLUSIONS: Our data suggests that obliteration of normal parenchyma by RCC occurs in aggressive tumors and substantially impacts preoperative renal function. Percent PVR is primarily driven by aggressive tumor characteristics and independently associates with RFS. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e595 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Akira Kazama More articles by this author Carlos Munoz-Lopez More articles by this author Worapat Attawettayanon More articles by this author Melissa Boumitri More articles by this author Eran Maina More articles by this author Zaeem Lone More articles by this author Nityam Rath More articles by this author Kieran Lewi More articles by this author Rebecca A. Campbell More articles by this author Jihad Kaouk More articles by this author Georges-Pascal Haber More articles by this author Samuel Haywood More articles by this author Nima Almassi More articles by this author Christopher Weight More articles by this author Amy Nowacki More articles by this author Steven C. Campbell More articles by this author Expand All Advertisement PDF downloadLoading ...