Mp51-11 Renal Tumor Characteristics in Immunosuppressed and Renal Dysfunction Populations

You have accessJournal of UrologyKidney Cancer: Epidemiology however, due to immunosuppression, there is a well-documented increase in the risk of malignancy. This is especially true in the RTx recipient population where previous end-stage renal disease (ESRD) and dialysis treatment are further risk factors for the development of renal cell carcinoma (RCC) in the retained native kidneys. RCC diagnosed in the RTx population is thought to carry a favorable prognosis with low risk of mortality or metastasis. However, some studies have shown a significant rate of high-grade malignancies; some have even reported mortality rates as high as 25%. Therefore, it is important to appropriately characterize this disease in a vulnerable population. METHODS: This was a retrospective cohort study of all patients who had nephrectomy for a renal mass at our institution from 2009 to 2019. All transplant status and ESRD diagnoses were identified by ICD coding and confirmed by chart review. Patients were excluded for missing pathological data or non-tumor indication. Patients were divided into groups of those with ESRD, RTx, or control for comparison. Our primary endpoint was the pathologic diagnosis for each patient's tumor after nephrectomy. Tumors were classified into aggressive, indolent, or benign categories based on their histology and grade. RESULTS: We identified 1150 radical and partial nephrectomies performed at our institution, of which 1062 met inclusion criteria. Of these, 36 (4%) patients were ESRD and 32 (3%) patients had a renal transplant at time of nephrectomy. Median tumor size was 4cm (IQR 2.5 – 6) and 574 (54%) patients had tumors defined as small renal masses that are 4 cm or less. After pathologic review, 270 (25%) tumors were classified as aggressive, 677 (64%) tumors were pT1a or pT1b, and 79 (7%) of surgeries had positive margins. On multivariate analysis controlling for age and gender, having an aggressive tumor was not significantly associated with ESRD or transplant. CONCLUSIONS: RTx recipients and ESRD patients are high-risk, vulnerable populations for the development of RCC. Although previous studies have shown a predominance of indolent tumors in this group, these data suggest that these patients are just as prone to aggressive RCCs. Further research should be done to replicate these results in larger RTx and ESRD cohorts. Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e846 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Benjamin I. Joffe More articles by this author Luis Pina Martina More articles by this author Mason Stillman More articles by this author Dylan Rust More articles by this author Prakash Gorroochurn More articles by this author Andrew T. Lenis More articles by this author G. Joel DeCastro More articles by this author James M. McKiernan More articles by this author Christopher B. Anderson More articles by this author Expand All Advertisement PDF downloadLoading ...