Pd08-08 should adjuvant therapy be considered for positive surgical margins in renal cell carcinoma: a stage-based analysis of impact of positive surgical margins on survival outcomes using the inmarc registry

You have accessJournal of UrologyCME1 Apr 2023PD08-08 SHOULD ADJUVANT THERAPY BE CONSIDERED FOR POSITIVE SURGICAL MARGINS IN RENAL CELL CARCINOMA: A STAGE-BASED ANALYSIS OF IMPACT OF POSITIVE SURGICAL MARGINS ON SURVIVAL OUTCOMES USING THE INMARC REGISTRY Margaret Meagher, Clara Cerrato, Dhruv Puri, Franklin Liu, Aastha Shah, Saeed Ghassemzadeh, Sohail Dhanji, Luke Wang, Dattatraya Patil, Kazutaka Saito, Yosuke Yasuda, Ryan Nasseri, Yasuhisa Fujii, Benjamin Schmeusser, Rachel Greenwald, Alexandra Medline, Fatima Kamal, Adil Ali, Sohei Fukuda, Masaki Kobayashi, Wei Chen, Bo Fan, Yusuke Aida, Yuya Maezawa, Shintaro Asai, Hajime Tanaka, Viraj Master, and Ithaar Derweesh Margaret MeagherMargaret Meagher More articles by this author , Clara CerratoClara Cerrato More articles by this author , Dhruv PuriDhruv Puri More articles by this author , Franklin LiuFranklin Liu More articles by this author , Aastha ShahAastha Shah More articles by this author , Saeed GhassemzadehSaeed Ghassemzadeh More articles by this author , Sohail DhanjiSohail Dhanji More articles by this author , Luke WangLuke Wang More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Yosuke YasudaYosuke Yasuda More articles by this author , Ryan NasseriRyan Nasseri More articles by this author , Yasuhisa FujiiYasuhisa Fujii More articles by this author , Benjamin SchmeusserBenjamin Schmeusser More articles by this author , Rachel GreenwaldRachel Greenwald More articles by this author , Alexandra MedlineAlexandra Medline More articles by this author , Fatima KamalFatima Kamal More articles by this author , Adil AliAdil Ali More articles by this author , Sohei FukudaSohei Fukuda More articles by this author , Masaki KobayashiMasaki Kobayashi More articles by this author , Wei ChenWei Chen More articles by this author , Bo FanBo Fan More articles by this author , Yusuke AidaYusuke Aida More articles by this author , Yuya MaezawaYuya Maezawa More articles by this author , Shintaro AsaiShintaro Asai More articles by this author , Hajime TanakaHajime Tanaka 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/JU.0000000000003239.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Impact on survival by positive surgical margins (PSM) in Renal Cell Carcinoma (RCC) is controversial. While current guidelines recommend intensified follow up in PSM, no recommendations or investigation currently exist regarding adjuvant therapy and PSM. We sought to examine the impact of PSM on survival outcomes stratified by pathological AJCC (American Joint Commission on Cancer) Stage. METHODS: Multi-institutional retrospective analysis of patients with RCC utilizing the INMARC (INternational Marker Consortium for Renal Cancer) registry who underwent surgery. Patients were divided by AJCC stage. Primary outcome was cancer specific mortality (CSM). Secondary outcomes included all cause mortality (ACM) and recurrence. Cox regression was utilized to analyze factors associated with outcomes. Kaplan Meier analysis (KMA) was performed to analyze 5-year cancer specific survival (CSS), overall survival (OS), and recurrence free survival (RFS). RESULTS: 5112 patients were analyzed; PSM was present in 253 (114 stage I, 17 stage II, 71 stage III, 51 stage IV). Median follow-up was 49.3 months. Cox regression demonstrated that PSM was associated with worsened CSM (HR 2.1, p<0.001), ACM (HR 1.4, p=0.003), and recurrence (HR 2.1, p<0.001). KMA revealed significant differences in 5-year CSS by margin status across stage II (81% vs. 37%, p<0.001), stage III (82% vs. 61%, p<0.001), and stage IV (65% vs. 50%, p<0.001), but not stage I (99% v.s 98%, p=0.399). KMA revealed significant differences in 5-year OS by margin status across stage II (90% vs. 40%, p=0.003), stage III (67% vs. 41%, p<0.001), and stage IV (39% vs. 21%, p<0.001), but not stage I (87% vs. 91%, p=0.119). KMA revealed significant differences in 5-year RFS by margin status across stage I (97% vs. 83%, p=0.012), stage II (83% vs. 50%, p<0.001), stage III (64% vs. 59%, p<0.001), and stage IV (78% vs. 58%, p<0.001). CONCLUSIONS: Presence of PSM was an independent risk factor for worsened ACM, CSM, and recurrence in RCC patients and was associated with decrements in 5-year RFS across all stages and OS and CSS in Stage II-IV but not Stage I RCC. Our findings highlight the need for investigation of adjuvant therapy for stage ≥II RCC patients with PSM. Source of Funding: Stephen K Weissman Kidney Cancer Research Fund © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e235 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Margaret Meagher More articles by this author Clara Cerrato More articles by this author Dhruv Puri More articles by this author Franklin Liu More articles by this author Aastha Shah More articles by this author Saeed Ghassemzadeh More articles by this author Sohail Dhanji More articles by this author Luke Wang More articles by this author Dattatraya Patil More articles by this author Kazutaka Saito More articles by this author Yosuke Yasuda More articles by this author Ryan Nasseri More articles by this author Yasuhisa Fujii More articles by this author Benjamin Schmeusser More articles by this author Rachel Greenwald More articles by this author Alexandra Medline More articles by this author Fatima Kamal More articles by this author Adil Ali More articles by this author Sohei Fukuda More articles by this author Masaki Kobayashi More articles by this author Wei Chen More articles by this author Bo Fan More articles by this author Yusuke Aida More articles by this author Yuya Maezawa More articles by this author Shintaro Asai More articles by this author Hajime Tanaka More articles by this author Viraj Master More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...