Pd33-08 Comparison of Outcomes of Radical and Partial Nephrectomy for Sarcomatoid Renal Cell Carcinoma: Analysis of the National Cancer Database

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD33)1 May 2024PD33-08 COMPARISON OF OUTCOMES OF RADICAL AND PARTIAL NEPHRECTOMY FOR SARCOMATOID RENAL CELL CARCINOMA: ANALYSIS OF THE NATIONAL CANCER DATABASE Luke Wang, Kit Yuen, Cesare Saitta, Margaret Meagher, Franklin Liu, Dhruv Puri, Yu-Wei Chen, Rana R. McKay, Juan Javier-Desloges, and Ithaar Derweesh Luke WangLuke Wang , Kit YuenKit Yuen , Cesare SaittaCesare Saitta , Margaret MeagherMargaret Meagher , Franklin LiuFranklin Liu , Dhruv PuriDhruv Puri , Yu-Wei ChenYu-Wei Chen , Rana R. McKayRana R. McKay , Juan Javier-DeslogesJuan Javier-Desloges , and Ithaar DerweeshIthaar Derweesh View All Author Informationhttps://doi.org/10.1097/01.JU.0001008912.25331.d7.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical Nephrectomy (RN) is the reference standard for localized Renal Cell Carcinoma (RCC) with clinically aggressive features, such as Sarcomatoid Dedifferentiated RCC (sRCC). While increasingly utilized in larger and more complex masses, Partial Nephrectomy (PN) in sRCC has been seldom studied. We compared RN and PN in sRCC utilizing a large national cohort. METHODS: This is a retrospective analysis of the National Cancer Database from 2004-2019 for patients who underwent PN and RN for sRCC (T1-T3N0-N1M0). We performed multivariable logistic regression and cox regression to determine variables associated with receipt of PN and to evaluate variables associated with all-cause mortality (ACM). Kaplan Meier Analysis (KMA) evaluated overall survival (OS) in RN vs. PN Charlson 0 for clinical T1, T2, and T3 sRCC. RESULTS: 5,265 patients were analyzed RN 4,582 (87.0%)/PN 683 (13.0%). No difference was noted between RN and PN in positive margin rate (11% vs 12%, p=0.27). Increased odds of receiving PN was associated with papillary (OR 1.69, p=0.015); while increasing age (OR 0.99, p=0.004), larger tumor size (OR 0.15-0.27, p<0.001), cT2/T3 stage (OR 0.23, p<0.001), cN1 (OR 0.2, p<0.001), and grade 3-4 (OR 0.38-0.39, p=0.011) were associated with decreased receipt of PN. Worsened ACM was associated with positive margins (HR 1.59, p<0.001), male (HR 1.1, p=0.044), Charlson ≥2 (HR 1.47, p<0.001), larger tumor size (HR 1.39-1.53, p<0.001), cT2/cT3 (HR 1.17-1.39, p<0.001-0.035), and cN1 (HR 1.59, p<0.001), while PN (HR 0.64, p<0.001) and increasing income (HR 0.77-0.79, p<0.001) was associated with decreased ACM. KMA showed higher 5-year OS in PN compared to RN in cT1 (86.5% vs 63.2%, p<0.001), and cT3 (61.0% vs 44.0%, p<0.001), but not cT2 (58.2% vs 58.4%, p=0.67; Figure 1). CONCLUSIONS: Significantly greater proportion of patients with sRCC underwent RN, while PN was more likely to be performed in sRCC patients who were younger, with smaller and less aggressive tumors, indicative of selection bias. While margin positivity was associated with increased risk of ACM, no difference in margin positive rate was noted between RN and PN. Our findings suggest that in select patients, PN did not compromise oncologic outcomes and may provide benefit when indicated. Download PPT Source of Funding: Stephen Weissman Kidney Cancer Research Fund © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e713 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Luke Wang More articles by this author Kit Yuen More articles by this author Cesare Saitta More articles by this author Margaret Meagher More articles by this author Franklin Liu More articles by this author Dhruv Puri More articles by this author Yu-Wei Chen More articles by this author Rana R. McKay More articles by this author Juan Javier-Desloges More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...