PD41-12 RENAL MASS BIOPSY MAY IMPACT SURGICAL TREATMENT DECISION MAKING IN PATIENTS WITH A >4CM RENAL MASS: A MULTI-INSTITUTIONAL ANALYSIS (2019)

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (PD41)1 Apr 2019PD41-12 RENAL MASS BIOPSY MAY IMPACT SURGICAL TREATMENT DECISION MAKING IN PATIENTS WITH A >4CM RENAL MASS: A MULTI-INSTITUTIONAL ANALYSIS Aeen Asghar*, Andrew McIntosh, Zachary Smith, Neil Kocher, Ziho Lee, Nimrod Barashi, Jay Raman, Scott Eggener, Robert Uzzo, and Alexander Kutikov Aeen Asghar*Aeen Asghar* More articles by this author , Andrew McIntoshAndrew McIntosh More articles by this author , Zachary SmithZachary Smith More articles by this author , Neil KocherNeil Kocher More articles by this author , Ziho LeeZiho Lee More articles by this author , Nimrod BarashiNimrod Barashi More articles by this author , Jay RamanJay Raman More articles by this author , Scott EggenerScott Eggener More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Alexander KutikovAlexander Kutikov More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556556.24223.9eAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: The decision to perform partial nephrectomy (PN) for an organ-confined >4 cm renal mass is often complex. Albeit often feasible, oncologic safety of PN in this cohort is debated. Yet, a significant portion of large renal masses that undergo radical nephrectomy (RN) prove benign or indolent. Since renal mass biopsy (RMB) is highly accurate in diagnosing oncocytic neoplasms, we assessed whether patients with a large renal mass treated by RN could have benefited from pre-operative RMB. METHODS: We queried prospectively maintained kidney cancer databases from three institutions to identify patients who underwent RN for localized renal mass >4 cm. We excluded patients with nodal or distant metastases. Clinicopathologic variables, mass anatomic complexity and patient co-morbidities were indexed. Wilcoxon-Mann-Whitney test was used to compare patients with oncocytic neoplasms to the remainder of the cohort. RESULTS: A total of 722 patients (median age 62 years, 64% male, 83% Caucasian, median serum creatinine [SCr] 0.97 ng/dL, median Charlson comorbidity index [CCI] 1) underwent RN for localized >4 cm renal mass (median tumor size 7 cm [IQR 4-9.1 cm]). Final pathology revealed that 12.5% (n=91) of patients harbored oncocytic neoplasm (n=28, 3.8%) or chromophobe RCC (n=63, 8.7%). When stratified by tumor size, oncocytic tumors comprised 9.3% of 4-7 cm masses, 16.0% of ≥7-10 cm masses, and 17.6% of ≥10 cm tumors. Median RENAL Nephrometry Score was 9 (IQR 4-10). Oncocytic tumors were more common in younger patients (56.5 vs. 62.5 years, p<0.01), larger tumors (7.6 vs 6.8 cm, p=0.02), those with lower CCI (0 vs. 2, p=0.01) and lower pre-operative SCr (0.9 vs. 1.0 mg/dL, p=0.02). CONCLUSIONS: Approximately 1 in 8 patients with renal mass >4 cm harbored benign or low-risk oncocytic lesions. Although these patients had larger tumors, they were younger and less co-morbid than patients with oncologically higher risk lesions. As such, RMB may help calibrate the complex choice of PN vs. RN in patients with large renal mass. Source of Funding: none Philadelphia, PA; Chicago, IL; Hershey, PA; Philadelphia, PA; Chicago, IL; Hershey, PA; Chicago, IL; Philadelphia, PA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e749-e749 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aeen Asghar* More articles by this author Andrew McIntosh More articles by this author Zachary Smith More articles by this author Neil Kocher More articles by this author Ziho Lee More articles by this author Nimrod Barashi More articles by this author Jay Raman More articles by this author Scott Eggener More articles by this author Robert Uzzo More articles by this author Alexander Kutikov More articles by this author Expand All Advertisement PDF downloadLoading ...