Pd18-05 Patient Selection for Upfront Cytoreductive Nephrectomy: Assessment of Two Clinical Risk Stratification Tools

You have accessJournal of UrologyKidney Cancer: Advanced (Including Drug Therapy) II (PD18)1 May 2024PD18-05 PATIENT SELECTION FOR UPFRONT CYTOREDUCTIVE NEPHRECTOMY: ASSESSMENT OF TWO CLINICAL RISK STRATIFICATION TOOLS Grant M. Henning, Ekamjit S. Deol, Madeline Dorr, Spyridon P. Basourakos, Daniel D. Shapiro, E. Jason Abel, R. Houston Thompson, Stephen A. Boorjian, Bradley C. Leibovich, and Vidit Sharma Grant M. HenningGrant M. Henning , Ekamjit S. DeolEkamjit S. Deol , Madeline DorrMadeline Dorr , Spyridon P. BasourakosSpyridon P. Basourakos , Daniel D. ShapiroDaniel D. Shapiro , E. Jason AbelE. Jason Abel , R. Houston ThompsonR. Houston Thompson , Stephen A. BoorjianStephen A. Boorjian , Bradley C. LeibovichBradley C. Leibovich , and Vidit SharmaVidit Sharma View All Author Informationhttps://doi.org/10.1097/01.JU.0001008596.32809.c5.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patient selection is crucial for cytoreductive nephrectomy (CN) and factors including pathologic features, metastatic tumor burden, and surgical fitness must be incorporated into decision making. Varied nomograms exist for CN prognostication. We evaluated the predictive accuracy of the recently described Selection for Cytoreductive Nephrectomy (SCREEN) score, which assesses preoperative variables, as well as the Leibovich metastatic clear cell renal cell carcinoma (ccRCC) score, which incorporates final pathologic features. METHODS: Consecutive patients who underwent upfront CN for metastatic RCC from 2005-2021 were identified in our institutional nephrectomy registry. Preoperative axial imaging was analyzed for measures of tumor burden and clinicopathologic features were recorded. Laboratory variables were considered normal for patients missing only one variable to calculate a modified SCREEN score and the Leibovich metastatic ccRCC score. Our primary outcome of interest was overall survival (OS) following CN. Kaplan-Meier survival estimates were calculated, and multivariable cox regression and Harrell's c-index was used to determine predictive accuracy. RESULTS: 248 patients were identified, of whom 89 patients had complete data and a total of 157 were deemed eligible for calculation of both scoring systems. The mortality rate was 86% for the analyzed cohort. SCREEN score risk groups demonstrated median OS of 3.9 years (95% CI 2.3-NE) for favorable risk, 2.1 years (95% CI 1.6-27) for intermediate risk and 1.6 years (95% CI 1.2-2.3) for poor risk (p<0.01) (Figure 1). Risk of death following CN was increased in intermediate (HR 1.81; 1.13-2.90, p=0.01) and poor risk SCREEN score (HR 2.32, 1.38-3.90, p<0.01) with a c-index of 0.57 (95% CI 0.52-0.62). Those with highest Leibovich ccRCC score were found to have increased risk of death compared to the lowest risk group (HR 5.40; 2.84-10.29, p<0.01) with a c-index of 0.66 (95% CI 0.60-0.71). CONCLUSIONS: Both the SCREEN score and Leibovich metastatic ccRCC score can be used for prognostication prior to and following CN, although with modest discriminative accuracy. Advanced preoperative risk stratification tools such as radiomics, tumor sequencing, or biopsy of metastatic sites should be considered for future study and incorporation into existing nomograms. 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 Grant M. Henning More articles by this author Ekamjit S. Deol More articles by this author Madeline Dorr More articles by this author Spyridon P. Basourakos More articles by this author Daniel D. Shapiro More articles by this author E. Jason Abel More articles by this author R. Houston Thompson More articles by this author Stephen A. Boorjian More articles by this author Bradley C. Leibovich More articles by this author Vidit Sharma More articles by this author Expand All Advertisement PDF downloadLoading ...