Pd18-06 Validation of the Selection for Cytoreductive Nephrectomy (Screen) Model Using an Independent Contemporary Multi-Center Cohort

You have accessJournal of UrologyKidney Cancer: Advanced (Including Drug Therapy) II (PD18)1 May 2024PD18-06 VALIDATION OF THE SELECTION FOR CYTOREDUCTIVE NEPHRECTOMY (SCREEN) MODEL USING AN INDEPENDENT CONTEMPORARY MULTI-CENTER COHORT E. Jason Abel, Viraj A. Master, Philippe E. Spiess, Charles C. Peyton, Sarah P. Psutka, Jay D. Raman, Chiara Mercinelli, Daniel D. Shapiro, Edouard Nicaise, Nicholas D. Robertson, Brendan K. Dolan, R. Barry Sirard, Meghana Noonavath, Amber Jani, Andrea Necchi, Wade J. Sexton, Brandon Manley, Dattatraya Patil, Glenn O. Allen, Surena F. Matin, and Jose A. Karam E. Jason AbelE. Jason Abel , Viraj A. MasterViraj A. Master , Philippe E. SpiessPhilippe E. Spiess , Charles C. PeytonCharles C. Peyton , Sarah P. PsutkaSarah P. Psutka , Jay D. RamanJay D. Raman , Chiara MercinelliChiara Mercinelli , Daniel D. ShapiroDaniel D. Shapiro , Edouard NicaiseEdouard Nicaise , Nicholas D. RobertsonNicholas D. Robertson , Brendan K. DolanBrendan K. Dolan , R. Barry SirardR. Barry Sirard , Meghana NoonavathMeghana Noonavath , Amber JaniAmber Jani , Andrea NecchiAndrea Necchi , Wade J. SextonWade J. Sexton , Brandon ManleyBrandon Manley , Dattatraya PatilDattatraya Patil , Glenn O. AllenGlenn O. Allen , Surena F. MatinSurena F. Matin , and Jose A. KaramJose A. Karam View All Author Informationhttps://doi.org/10.1097/01.JU.0001008596.32809.c5.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The SCREEN model includes radiographic measures of tumor burden among prognostic variables to predict overall survival (OS) and first year mortality in metastatic renal cell carcinoma (mRCC) patients treated with upfront cytoreductive nephrectomy (CN). The purpose of this study was to evaluate the prognostic value of preoperative factors from the SCREEN model using data from contemporary mRCC patients treated at six centers. METHODS: Data from a separate cohort of synchronous mRCC patients treated with upfront CN was compared to the SCREEN model development cohort. Prognostic variables from the SCREEN model were evaluated for associations with OS and first year mortality using multivariable Cox regression. RESULTS: The SCREEN development cohort includes 914 upfront CN patients (2006-2017) and the validation cohort includes 254 different upfront CN patients (2017-2022). Median OS for the development and validation cohorts was 28 and 55 months. After multivariable analysis, 6/7 SCREEN prognostic factors were independently predictive of first year mortality in the validation cohort including total metastatic burden>5 cm (OR 2.2 95% CI 1.1-4.2, p=0.02), number of metastatic sites>2 (OR 2.8 95% CI 1.4-5.9, p=0.005), neutrophil to lymphocyte ratio>4 (OR 2.0 95% CI 1.0-3.9, p=0.05), low albumin (OR 4.1 95% CI 2.0-8.2 , p<0.001), low hemoglobin (OR 3.8 95% CI 1.6-9.1, p=0.002) and systemic symptoms (OR 2.7 95% CI 1.3-5.4 , p=0.005). Bone metastasis was not statistically associated (OR 0.46 95% CI 0.2-1.4, p=0.2). Validation cohort groups were separated based on the number of risk factors: favorable (0-1), intermediate (2-3) and poor risk (≥4) groups comprising 28%, 47% and 25% of all patients, similar to the development cohort at 25%, 48% and 27%. First year mortality was 5.5%, 14.6% and 28.3% corresponding to estimated OS (Figure 1). Predictive accuracy for first year mortality was evaluated using ROC curves. AUC was higher for SCREEN vs. the IMDC model, (0.76 vs. 0.55 development) and (0.76 vs. 0.54 validation). CONCLUSIONS: The SCREEN model demonstrates prognostic ability for first year mortality and OS following CN using a contemporary validation cohort. Future clinical studies should evaluate the ability of this model to improve selection of patients for cytoreductive nephrectomy. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e434 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information E. Jason Abel More articles by this author Viraj A. Master More articles by this author Philippe E. Spiess More articles by this author Charles C. Peyton More articles by this author Sarah P. Psutka More articles by this author Jay D. Raman More articles by this author Chiara Mercinelli More articles by this author Daniel D. Shapiro More articles by this author Edouard Nicaise More articles by this author Nicholas D. Robertson More articles by this author Brendan K. Dolan More articles by this author R. Barry Sirard More articles by this author Meghana Noonavath More articles by this author Amber Jani More articles by this author Andrea Necchi More articles by this author Wade J. Sexton More articles by this author Brandon Manley More articles by this author Dattatraya Patil More articles by this author Glenn O. Allen More articles by this author Surena F. Matin More articles by this author Jose A. Karam More articles by this author Expand All Advertisement PDF downloadLoading ...