690 PREDICTING PATIENTS AT HIGH RISK FROM NON-EXTIRPATIVE TREATMENT OF LOCALIZED RENAL MASSES USING PRE-OPERATIVE FACTORS (2011)

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging1 Apr 2011690 PREDICTING PATIENTS AT HIGH RISK FROM NON-EXTIRPATIVE TREATMENT OF LOCALIZED RENAL MASSES USING PRE-OPERATIVE FACTORS Rebecca L. O'Malley, MD Matthew H. Hayn, MD Katherine A. Brewer, Michael A. Poch, MD Hyung L. Kim, andMD Thomas SchwaabMD, PhD Rebecca L. O'MalleyRebecca L. O'Malley Buffalo, NY More articles by this author , Matthew H. HaynMatthew H. Hayn Buffalo, NY More articles by this author , Katherine A. BrewerKatherine A. Brewer Buffalo, NY More articles by this author , Michael A. PochMichael A. Poch Buffalo, NY More articles by this author , Hyung L. KimHyung L. Kim Los Angeles, CA More articles by this author , and Thomas SchwaabThomas Schwaab Buffalo, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1657AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Due to increasing detection of incidental renal masses, and the many possibilities for management, identifying reliable means of selecting patients (pts) in need of extirpative therapy is paramount. Existing nomograms include operative factors or symptomatic pts making them difficult to apply in pre-treatment decision-making for pts with the asymptomatic, clinical stage T1 renal mass. METHODS Using our institutional renal tumor database, we identified pts who were candidates for elective partial nephrectomy (solitary tumors ≤ 7cm, no venous involvement, creatinine ≤ 1.5 mg/dL and normal contralateral kidney). High-risk disease (HRD) was defined as pathologic stage ≥T3 or grade ≥3. Pre-operative variables hypothesized to predict risk of malignancy and HRD were analyzed including: age, gender, race, smoking history (hx), cancer hx, hx of hypertension (HTN), body mass index (BMI), Charlson comorbidity index (CCI), glomerular filtration rates (eGFR), as estimated by the Chronic Kidney Disease Epidemiology Collaboration formula, tumor size, and tumor centrality (defined as abutting renal sinus or collecting system). RESULTS A total of 309 pts were identified, with mean age, BMI and eGFR of 61 years, 31 kg/m2 and 76 ml/min/1.73m2, respectively. The cohort was mostly male (60%) and Caucasian (89%) with a CCI ≥1 in 42%. Hx of cancer was seen in 12%, HTN in 60% and smoking in 57%. Mean tumor size was 3.6 ± 1.6 cm, 64% of which were central. Malignancy was found in 83.1% and HRD in 29.5%. On univariable analysis male gender and tumor size predicted malignancy (OR 1.96, p=0.29 and OR 1.88, p<0.001, respectively). Tumor size and centrality predicted HRD (OR 1.39, p<0.001 and 3.05, p=0.002, respectively). Tumor size > 4cm correlated with both malignancy and HRD (OR 4.09, p<0.001 and OR 2.46, p<0.001, respectively). On multivariable analysis, male gender and tumor size remained predictive of malignancy (OR 2.59, p=0.015 and OR 1.48, p=0.031, respectively), while centrality was marginally predictive (OR 2.27, p=0.062). Age and tumor size were the only factors marginally predictive of HRD (OR 1.02, p=0.073 and OR 1.26, p=0.072, respectively). When factors were combined, 100% of men with a central tumor >4 cm had malignancy with a risk of HRD of 2.43 (p=0.029). CONCLUSIONS Male gender, tumor size > 4cm and central tumors portend a high risk of malignancy and HRD. If validated, these factors could serve as the basis for a pre-operative nomogram to aid in identifying pts at high risk from non-extirpative management of a localized renal mass. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e278 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rebecca L. O'Malley Buffalo, NY More articles by this author Matthew H. Hayn Buffalo, NY More articles by this author Katherine A. Brewer Buffalo, NY More articles by this author Michael A. Poch Buffalo, NY More articles by this author Hyung L. Kim Los Angeles, CA More articles by this author Thomas Schwaab Buffalo, NY More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...