MP14-03 THE UCLA HISTO-GENETIC RISK CLASSIFICATION (U-HGRC) TO PREDICT OUTCOMES OF LOCALIZED CLEAR-CELL RENAL CELL CARCINOMA (2019)

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance II (MP14)1 Apr 2019MP14-03 THE UCLA HISTO-GENETIC RISK CLASSIFICATION (U-HGRC) TO PREDICT OUTCOMES OF LOCALIZED CLEAR-CELL RENAL CELL CARCINOMA Cedric Lebacle*, Aydin Pooli, Nagesh Rao, Erika L. Wood, Nils Kroeger, Grace-Hyun Kim, Izak Faiena, Sandy T. Liu, Karim Chamie, Arie S. Belldegrun, Brian Shuch, Alexandra Drakaki, and Allan J. Pantuck Cedric Lebacle*Cedric Lebacle* More articles by this author , Aydin PooliAydin Pooli More articles by this author , Nagesh RaoNagesh Rao More articles by this author , Erika L. WoodErika L. Wood More articles by this author , Nils KroegerNils Kroeger More articles by this author , Grace-Hyun KimGrace-Hyun Kim More articles by this author , Izak FaienaIzak Faiena More articles by this author , Sandy T. LiuSandy T. Liu More articles by this author , Karim ChamieKarim Chamie More articles by this author , Arie S. BelldegrunArie S. Belldegrun More articles by this author , Brian ShuchBrian Shuch More articles by this author , Alexandra DrakakiAlexandra Drakaki More articles by this author , and Allan J. PantuckAllan J. Pantuck More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555299.24108.47AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Thirty percent of patients with localized clear-cell renal cell carcinoma (ccRCC) will ultimately develop recurrence (local or metastatic) after nephrectomy. Current risk stratification systems still misclassify patients. We developed a novel classification integrating cytogenetic findings to better stratify the risk of recurrence and overall survival (OS) after surgery for localized ccRCC. METHODS: A total of 646 patients from UCLA with ccRCC and tumor cytogenetic analysis, were included in this study. After a logistic regression analysis to select histologic parameters and a principal component analysis for cytogenetic parameters, a CHAID decision tree and Kaplan Meier analysis were used to build the UCLA Histo-Genetic Risk Classification (U-HGRC). Survival analyses of the model were validated on two random samples of 323 patients. Recurrence was defined as any local recurrence or development of new metastasis after surgery. RESULTS: The T-stage, tumor size, presence of sarcomatoid features, gain of chromosome 5q, loss 10q, and loss X/Y were used to stratify the risk of recurrence of ccRCC into three U-HGRC groups of low (1), intermediate (2) or high-risk (3). After a mean follow-up of 55 months, risk of recurrence (HR=2.44, p=.001 for U-HGRC 2; HR=9.90, p<.0001 for U-HGRC 3), disease-free survival (DFS) (Log-rank p<.0001), risk of death (HR=1.72, p=.033 for U-HGRC 2; HR=4.74, p<.0001 for U-HGRC 3) and OS (Log-rank p<.0001) were significantly different between groups. These findings were validated on two random samples. For the high-risk group, median DFS and OS were 2.7 and 6.3 years, respectively. The 5-year risks of recurrence for U-HGRC group 1, 2 and 3 were 9%, 25% and 62%, respectively. The AUC of the model was significantly improved comparing to the current UISS system (0.72 for U-HGRC vs 0.65 for UISS, p=.008) with an accuracy of 82.8% for the U-HGRC high-risk group. CONCLUSIONS: The U-HGRC, which integrates genomic alterations with clinical and pathologic features, allowed a better stratification of recurrence risk and overall survival that could help to select appropriate patients for surveillance and adjuvant therapy protocols. Source of Funding: Grants from French urological association, Philippe Foundation, Groupe Pasteur Mutualite, Servier Foundation, Astellas Le Kremlin Bicetre, France; Los Angeles, CA; Greifswald, Germany; Los Angeles, CA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e186-e187 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cedric Lebacle* More articles by this author Aydin Pooli More articles by this author Nagesh Rao More articles by this author Erika L. Wood More articles by this author Nils Kroeger More articles by this author Grace-Hyun Kim More articles by this author Izak Faiena More articles by this author Sandy T. Liu More articles by this author Karim Chamie More articles by this author Arie S. Belldegrun More articles by this author Brian Shuch More articles by this author Alexandra Drakaki More articles by this author Allan J. Pantuck More articles by this author Expand All Advertisement PDF downloadLoading ...