AUA 2023: Evaluation of American Urological Association Renal Cell Carcinoma Risk Groups for Chromophobe Renal Cell Carcinoma

(UroToday.com) Dr. Cameron Britton from Mayo Clinic presented an abstract evaluating current AUA guidelines for Chromophobe renal cell carcinoma management. Previously prognostic models have been developed for progression-free (PFS) and cancer-specific survival (CSS); however, AUA risk stratification system is not applicable in assessment of chromophobe RCC (chRCC) as histologic grading is not recommended. Dr. Cameron Britton and his team sought to compare the Mayo risk stratification system (Leibovich 2018, Eur Urol) with three modified version of AUA RCC stratification system for chRCC.


Patients undergoing radical or partial nephrectomy treatment plan for uni-lateral, sporadic, M0, chRCC between 1970 to 2012 were included in the study. Based on the reported data from Mayo Clinic Nephrectomy registry, AUA risk groups were defined with the exclusion of cancer grade. Modified AUA risk groups comprised two grading systems: Paner grading system and the Mayo extension of the Paner grade (Avulova 2021, Eur Urol). Kaplan Meier method was used to estimate PFS and CSS, and Cox proportional hazard regression models summarized the predictive ability of each system.
table

A total of 257 patients diagnosed with chRCC met the inclusion criteria for the study. After a 120-month follow-up post-surgery, the rates of progression-free survival (PFS) and cancer-specific survival (CSS) were found to be 84% and 90%, respectively. Figure 1A shows the estimated PFS rates using the AUA risk groups, while Figure 1B presents the PFS rate calculated using the Mayo Clinic risk stratification system. Both the AUA and Mayo risk groups reported similar values of 0.76 and 0.75, respectively, for PFS. Additionally, the AUA and Mayo risk groups had estimated CSS values of 0.77 and 0.76, respectively. Table 1 compares the three AUA risk stratifications with and without the grading scale.

PFS_AUA.png

PFS MAYo 
In conclusion, AUA and Mayo Clinic risk assessment stratification systems have vigorous c-indexes for PFS and CSS in patients diagnosed with chRCC. The evaluated systems can be further used by physicians and urologist to council patients, based on available pathology reports.

The session moderators agreed with the findings of Dr. Britton’s findings and the comprehensive presentation left audience without any questions in the findings.

Presented by: Cameron Britton, MD, PGY IV,  Department of Urology, Mayo Clinic, Rochester, MN

Written by: Seyedamirvala Saadat, B.S. Research Specialist, Department of Urology, University of California Irvine, @val_Saadat on Twitter during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023

References:
  1. Leibovich BC, Lose CM, Cheville JC, et al. Predicting Oncologic Outcomes in Renal Cell Carcinoma After Surgery. Eur Urol. 2018;73:772-80.
  2. Avulova S, Cheville JC, Lose CM, et al. Grading Chromophobe Renal Cell Carcinoma: Evidence for a Four-tiered Classification Incorporating Coagulative Tumor Necrosis. Eur Urol. 2021;79:225-31.
  3. Paner GP, Amin MB, Alvarado-Cabrero I, Young AN, et a;. A novel tumor grading scheme for chromophobe renal cell carcinoma: prognostic utility and comparison with Fuhrman nuclear grade. Am J Surg Pathol. 2010
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