PD58-11 IMPACT OF PRE-OPERATIVE KIDNEY FUNCTION ON SURVIVAL OUTCOMES IN UPPER TRACT UROTHELIAL CARCINOMA: ANALYSIS OF THE ROBUUST REGISTRY (2022)

You have accessJournal of UrologyCME1 May 2022PD58-11 IMPACT OF PRE-OPERATIVE KIDNEY FUNCTION ON SURVIVAL OUTCOMES IN UPPER TRACT UROTHELIAL CARCINOMA: ANALYSIS OF THE ROBUUST REGISTRY Kevin Hakimi, Umberto Carbonara, Hooman Djaladat, Reza Mehrazin, Daniel Eun, Adam Reese, Mark Gonzalgo, Vitaly Margulis, Robert Uzzo, James Porter, Chandru Sundaram, Firas Abdollah, Alexandre Mottrie, Riccardo Tellini, Matteo Ferro, Margaret Meagher, Ava Saidian, Arman Walia, Alessandro Veccia, Alireza Ghoreifi, Giovanni Cacciamani, Amit Bhattu, Xiaosong Meng, Jason Farrow, Marcus Jamil, Andrea Minervini, Koon Rha, Zhenjie Wu, Giuseppe Simone, Riccardo Autorino, and Ithaar Derweesh Kevin HakimiKevin Hakimi More articles by this author , Umberto CarbonaraUmberto Carbonara More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , Daniel EunDaniel Eun More articles by this author , Adam ReeseAdam Reese More articles by this author , Mark GonzalgoMark Gonzalgo More articles by this author , Vitaly MargulisVitaly Margulis More articles by this author , Robert UzzoRobert Uzzo More articles by this author , James PorterJames Porter More articles by this author , Chandru SundaramChandru Sundaram More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Alexandre MottrieAlexandre Mottrie More articles by this author , Riccardo TelliniRiccardo Tellini More articles by this author , Matteo FerroMatteo Ferro More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Ava SaidianAva Saidian More articles by this author , Arman WaliaArman Walia More articles by this author , Alessandro VecciaAlessandro Veccia More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , Amit BhattuAmit Bhattu More articles by this author , Xiaosong MengXiaosong Meng More articles by this author , Jason FarrowJason Farrow More articles by this author , Marcus JamilMarcus Jamil More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Koon RhaKoon Rha More articles by this author , Zhenjie WuZhenjie Wu More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002643.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephroureterectomy is cornerstone of management of localized and locally advanced upper tract urothelial carcinoma (UTUC), however impact of pre-operative renal functional status on outcomes is unknown. We evaluated the impact of pre-operative kidney function on outcomes in patients with UTUC using a multi-institutional database. METHODS: We retrospectively analyzed the ROBUUST (RObotic surgery for Upper Tract Urothelial Cancer Study) registry of UTUC patients undergoing nephroureterectomy from 2006-2019. The cohort was divided into patients with preoperative estimated glomerular filtration rate<60 mL/min/1.73m2 (eGFR<60) and preoperative eGFR ≥60 for descriptive and survival analyses. Primary outcome was overall survival (OS); secondary outcomes included cancer specific (CSS) and recurrence free survival (RFS). Cox regression multivariable analyses (MVA) were conducted for predictors of survival outcomes. Kaplan-Meier analyses (KMA) were utilized to compare survival outcomes between eGFR <60 and ≥60 groups. RESULTS: We analyzed 767 patients (eGFR≥60 400 patients/eGFR<60 309 patients; median follow up 19.1 months). Compared to eGFR ≥60, patients with eGFR<60 were older (p<0.001) and had greater incidence of high tumor grade (86.9% vs. 80.9%, p=0.031) and lymphovascular invasion (24.8% vs. 17.3%, p=0.001). MVA identified pre-operative eGFR<60 (HR 2.1, p=0.017) and positive lymph nodes (HR 4.2, p<0.001) as risk factors for worsened all cause mortality, while pre-operative eGFR (HR 2.3, p=0.048) and positive lymph nodes (HR 7.0, p<0.001) are risk factors for worsened cancer specific mortality. MVA noted positive lymph nodes (HR 1.9, p=0.02) and systemic therapy (HR 1.6, p=0.018) as risk factors for recurrence. KMA comparing pre-op GFR≥60 vs <60 demonstrated: 5-year OS of 81% and 68% (p<0.001); 5-year CSS of 89% vs. 78% (p<0.001) and 5-year RFS of 40% vs. 41% (p=0.107), respectively (Figure). CONCLUSIONS: In this multi-institutional cohort of patients, worsened pre-operative functional status in patients with UTUC is associated with worsened oncologic survival outcomes post-nephroureterectomy. Our findings suggest consideration of preoperative renal function in risk stratification protocols to optimize outcomes in at risk patients. Source of Funding: Stephen Weissman Kidney Cancer Fund © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1016 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Hakimi More articles by this author Umberto Carbonara More articles by this author Hooman Djaladat More articles by this author Reza Mehrazin More articles by this author Daniel Eun More articles by this author Adam Reese More articles by this author Mark Gonzalgo More articles by this author Vitaly Margulis More articles by this author Robert Uzzo More articles by this author James Porter More articles by this author Chandru Sundaram More articles by this author Firas Abdollah More articles by this author Alexandre Mottrie More articles by this author Riccardo Tellini More articles by this author Matteo Ferro More articles by this author Margaret Meagher More articles by this author Ava Saidian More articles by this author Arman Walia More articles by this author Alessandro Veccia More articles by this author Alireza Ghoreifi More articles by this author Giovanni Cacciamani More articles by this author Amit Bhattu More articles by this author Xiaosong Meng More articles by this author Jason Farrow More articles by this author Marcus Jamil More articles by this author Andrea Minervini More articles by this author Koon Rha More articles by this author Zhenjie Wu More articles by this author Giuseppe Simone More articles by this author Riccardo Autorino More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF DownloadLoading ...