PD07-03 PROPOSAL FOR TRIPARTITE RECLASSIFICATION OF CT1 RENAL CELL CARCINOMA INTO CT1A (VERY LOW RISK), CT1B (LOW RISK), AND CT1C (INTERMEDIATE RISK) SUBSTAGES (2019)

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I (PD07)1 Apr 2019PD07-03 PROPOSAL FOR TRIPARTITE RECLASSIFICATION OF CT1 RENAL CELL CARCINOMA INTO CT1A (VERY LOW RISK), CT1B (LOW RISK), AND CT1C (INTERMEDIATE RISK) SUBSTAGES Aaron Bradshaw*, Umberto Capitanio, Robert Uzzo, Dattatraya Patil, Ahmed Eldefrawy, Alessandro Larcher, Shreyas Joshi, Stephen Ryan, Margaret Meagher, Brittney Cotta, Addison Yee, Fang Wan, Francesco Montorsi, Viraj Master, and Ithaar Derweesh Aaron Bradshaw*Aaron Bradshaw* More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Ahmed EldefrawyAhmed Eldefrawy More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Shreyas JoshiShreyas Joshi More articles by this author , Stephen RyanStephen Ryan More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Brittney CottaBrittney Cotta More articles by this author , Addison YeeAddison Yee More articles by this author , Fang WanFang Wan More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Viraj MasterViraj Master More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555236.13861.e6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Criteria for staging of T1 renal tumors into T1a (≤4cm) and T1b (4cm< and ≤7cm) have remained unchanged since 1997. Advancements in tumor biology have led to great understanding of the heterogeneous potential of T1 renal tumors. We hypothesized that a three-tier classification may more rationally risk stratify T1 renal masses than the current T1a/T1b system. METHODS: Multicenter (UCSD, Emory, Fox Chase Cancer Center, Ospadele San Raffaele) retrospective analysis of patients with cT1 renal cell carcinoma (RCC) undergoing partial or radical nephrectomy. Patients were stratified by tumor size into three groups cT1a (≤2cm, very low risk), cT1b (2cm< and ≤5cm, low risk), and cT1c (5cm< and ≤7cm, intermediate risk). Primary outcome was recurrence-free survival (RFS). Secondary outcome was overall survival (OS). Multivariable Cox Regression analysis (MVA) and Kaplan-Meier analyses (KMA) were utilized for outcomes. RESULTS: 4710 patients were stratified into proposed T1 groups (T1a=856, T1b=2909, T1c=945; median follow-up 39 months). Mean age increased with tumor size (T1a 57.4 yrs, T1b 60.1 yrs, T1c 70.0 yrs, p<0.001) as did total RENAL scores (T1a 6.5, T1b 7.6, T1c 9.0, p<0.001). For cT1a, cT1b and cT1c tumors, KMA revealed 5 year RFS of 95.7%, 90.8%, and 80.8%, (p<0.001; Figure 1a) and 5 year OS of 89.3%, 85.5%, and 73.3% (p=<0.001, Figure 1b). MVA of RFS revealed increasing age (HR=1.02, p<0.001), diabetes mellitus (HR=1.41, p=0.017), high tumor grade (HR=2.65, p<0.001) and increasing tumor stage (Referent T1a; cT1b HR=1.927 p=0.002, cT1c HR=3.687 p<0.001) as independent risk factors. MVA of OS revealed increasing age (HR=1.05, p<0.001), diabetes mellitus (HR=1.57, p<0.001), high tumor grade (HR=1.80, p<0.001) and increasing tumor stage (Referent T1a; cT1b HR=1.10 p=0.44, cT1c HR=1.747 p<0.001) as independent risk factors. CONCLUSIONS: Subclassification of cT1 RCC into three clinical stage categories corresponds to distinctive tumor groups whose biological potential varies significantly. Division into three distinct categories may enhance risk stratification, refine preoperative counseling, and augment postoperative follow-up protocols by delineating a very low risk and intermediate risk subset of renal tumors. Source of Funding: Stephen Weissman Kidney Cancer Research Fund San Diego, CA; Milan, Italy; Philadelphia, PA; Atlanta, GA; San Diego, CA; Milan, Italy; Philadelphia, PA; San Diego, CA; Milan, Italy; Atlanta, GA; San Diego, CA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e143-e143 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Bradshaw* More articles by this author Umberto Capitanio More articles by this author Robert Uzzo More articles by this author Dattatraya Patil More articles by this author Ahmed Eldefrawy More articles by this author Alessandro Larcher More articles by this author Shreyas Joshi More articles by this author Stephen Ryan More articles by this author Margaret Meagher More articles by this author Brittney Cotta More articles by this author Addison Yee More articles by this author Fang Wan More articles by this author Francesco Montorsi More articles by this author Viraj Master More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...