ASCO GU 2018: Defining Individual Recurrence Risk Following Surgery for High Risk Non-Metastatic Renal Cell Carcinoma
Data from 3 independent centers were analyzed for consecutive ≥ pT3a RCC patients without evidence of lymph node or distant metastases, who were treated surgically from 2000-2016. Univariate and multivariable Cox proportional hazard models were used to evaluate associations of common clinical and pathological variables with recurrence risk. A risk model was constructed using independent predictors and recurrence risk was evaluated using Kaplan-Meier analysis.
Of 771 patients, 190 (24.6%) had RCC recurrence following attempted curative surgery at a median of 10.2 months (IQR 4.4-20.7). Median overall follow-up interval was 21.4 months (IQR 6.6-53.5). Multivariable Cox proportional hazard analysis could not identify significant associations with RCC recurrence with: age, gender, race, systemic symptoms, local symptoms, pT stage, perinephric fat invasion, tumor thrombus, sinus fat invasion, serum hemoglobin, or serum albumin. However, independent statistically significant predictors that were found in the model included: grade 4 HR 3.27 (95% CI 2.17, 4.92); tumor diameter > 7cm HR 1.70 (95% CI 1.18, 2.45), tumor necrosis HR 1.47 (95% CI 1.06, 2.02), and sarcomatoid/ rhabdoid features HR 1.86 (95% CI 1.12, 3.09).
An unweighted risk model was created by assigning one point for each independent predictor. Estimated 3-year recurrence risk was 14%, 25%, 40%, 49%, and 69% for patients with 0,1,2,3 and 4 risk factors (p < 0.001) respectively.
Independent predictors of recurrence for high risk non-metastatic RCC include: tumor diameter, necrosis, nuclear grade 4, and sarcomatoid/ rhabdoid features. The use of this model should be considered to estimate individual risk in clinical trials of adjuvant therapy in RCC
Presented by: Edwin J Abel, MD, FACS, Madison, WI, USA
Co Authors: Jay D. Raman, Daniel D Shapiro, Wilson Chan, Glenn O. Allen, Dattatraya Patil, Viraj A. Master; University of Wisconsin School of Medicine and Public Health, Madison, WI; Penn State Health Milton S. Hershey Medical Center, Hershey, PA; Emory University School of Medicine, Atlanta, GA; Emory University Winship Cancer Institute, Atlanta, GA
Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA