AUA 2022: Machine Learning Approach to Predict pT3a Upstaging of Clinically Localized Renal Cell Carcinoma and Oncological Outcomes After Surgery (UroCCR 15 Study)

( Dr. Astrid Boulenger De Hauteclocque presented the moderated poster regarding the use of artificial intelligence and machine learning to predict upstaging of renal tumors after partial or radical nephrectomy. As tumor size increases there is a risk of pathologic upstaging of cT1/cT2 lesions to locally advanced T3a lesions. As such the safety of partial nephrectomy in patients who may be upstaged on final pathology has been brought into question.

In her study, Dr. Hauteclocque and her co-authors retrospectively analyzed the French Kidney Cancer UroCCR database for patients who underwent partial or radical nephrectomy for cT1/cT2a tumors between 2009-2019. A total of 4395 patients were included in the study with final pathology revealing 3728 pT1-2 lesions and 667 pathologic upstaging to T3a lesions. Seven machine learning algorithms were used to develop a model for predicting pathologic upstaging to T3a lesions following surgery. Additionally, disease free survival (DFS) and overall survival (OS) were compared for upstaged pT3a tumors in partial vs radical nephrectomy and laparoscopic vs open partial nephrectomy. Multivariate regression analysis was used to assess for predictors of disease recurrence and death.

Of the cohort studied 15.2% (667 patients) were upstaged to pT3a on final pathology. Male gender, higher ASA score and tumors > 8 cm were predictive of upstaging on final pathology with young age and non-hilar location being protective factors. 

There was no difference in DFS or OS between partial or radical nephrectomy and open partial vs laparoscopic partial nephrectomy. This suggests that partial nephrectomy remains a safe treatment modality despite some higher risk tumors that are upstaged on final pathology.

Dr. Hautoclocque concludes that machine learning can be a useful adjunct and play a role in the evaluation and prognosis of upstaged RCC.

Presented by: Dr. Astrid Boulenger De Hauteclocque, Bordeaux University Hospital, Urology Department, France

Written by: Sohrab Naushad Ali MD, MSc, FRCSC Endourology Fellow, Department of Urology, University of California Irvine, @sohrabnaushad on Twitter during the 2022 American Urological Association (AUA) Annual Meeting, New Orleans, LA, Fri, May 13 – Mon, May 16, 2022.