SAN FRANCISCO, CA USA (UroToday.com) - In this session Dr. Todd Morgan discussed the use of various models in driving clinical decision making and the potential role for the use of biomarkers to improve prediction of outcome in RCC.
He highlighted the fact that, to date, we have no way of definitively predicting the clinical course of a patient presenting with a small renal mass – whether the mass is benign or malignant, and if malignant whether it will be indolent or aggressive. Several tools are available from initial presentation to the time of treatment to follow-up that allow one to make a more educated prediction regarding an individual’s likelihood of cancer specific mortality.
He began his discussion of these tools by reviewing those available at initial presentation. Increased tumor size has been shown to be associated with a higher likelihood of development of metastatic disease and lower CSS. Nephrometry Score, a scoring system developed at Fox Chase Cancer Center and based on tumor features found on preoperative imaging, has demonstrated an ability to predict malignancy and grade. Dr. Morgan also discussed the importance of weighing competing comorbidities, utilizing nomograms available online through websites like cancernomograms.com.
Dr. Morgan discussed the controversy regarding whether nephron-sparing surgery (NSS) provides a survival advantage over radical nephrectomy (RN). While renal function over time is improved with NSS in comparison to RN, the literature is mixed regarding whether this confers a survival benefit over time. While worsening CKD is associated with higher mortality, there appears to be a difference between medical and surgically-induced CKD and this may account for the possible lack of survival benefit with NSS.
He then touched on follow-up nomograms available for postoperative risk assessment, including the UCLA integrated scoring system, the Karakiewicz nomogram, and the dynamic SSIGN score. He discussed the potential for biomarkers to contribute to clinical decision-making, though at this time there are none that are at the point of clinical utility. He pointed to nomograms out of UCLA and the Mayo Clinic utilizing biomarkers that demonstrated incremental improvements in risk assessment. He concluded by pointing out that expression profiling of tumors and the use of multiple biomarkers will likely provide the most information for risk assessment in the future, though further studies are needed to further develop this approach.
Highlights of a presentation by Todd M. Morgan, MD at the 2014 Genitourinary Cancers Symposium - January 30 - February 1, 2014 - San Francisco Marriott Marquis - San Francisco, California USA
University of Michigan Health System, Ann Arbor, MI USA