Mp10-11 a Propensity Score-Matched Analysis of Outcomes of Neoadjuvant and Adjuvant Systemic Therapy in High-Risk Localized Renal Cell Carcinoma: Impact of Timing of Therapy and Positive Margin

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) I (MP10)1 May 2024MP10-11 A PROPENSITY SCORE-MATCHED ANALYSIS OF OUTCOMES OF NEOADJUVANT AND ADJUVANT SYSTEMIC THERAPY IN HIGH-RISK LOCALIZED RENAL CELL CARCINOMA: IMPACT OF TIMING OF THERAPY AND POSITIVE MARGIN Cesare Saitta, Mimi V. Nguyen, Kevin Hakimi, Dattatraya Patil, Hajime Tanaka, Jonathan A. Afari, Julian Cortes, Jacob Roberts, Margaret F. Meagher, Franklin Liu, Mirha Mahmood, Joshua Matian, Mariam Mansour, Dhruv Puri, Clara Cerrato, Kit L. Yuen, Masaki Kobayashi, Shohei Fukuda, Wei Chen, Edouard Nicaise, Nahar Imtiaz, Rachel Greenwald, Viraj Master, Yasuhisa Fujii, Rana Mckay, and Ithaar H. Derweesh Cesare SaittaCesare Saitta , Mimi V. NguyenMimi V. Nguyen , Kevin HakimiKevin Hakimi , Dattatraya PatilDattatraya Patil , Hajime TanakaHajime Tanaka , Jonathan A. AfariJonathan A. Afari , Julian CortesJulian Cortes , Jacob RobertsJacob Roberts , Margaret F. MeagherMargaret F. Meagher , Franklin LiuFranklin Liu , Mirha MahmoodMirha Mahmood , Joshua MatianJoshua Matian , Mariam MansourMariam Mansour , Dhruv PuriDhruv Puri , Clara CerratoClara Cerrato , Kit L. YuenKit L. Yuen , Masaki KobayashiMasaki Kobayashi , Shohei FukudaShohei Fukuda , Wei ChenWei Chen , Edouard NicaiseEdouard Nicaise , Nahar ImtiazNahar Imtiaz , Rachel GreenwaldRachel Greenwald , Viraj MasterViraj Master , Yasuhisa FujiiYasuhisa Fujii , Rana MckayRana Mckay , and Ithaar H. DerweeshIthaar H. Derweesh View All Author Informationhttps://doi.org/10.1097/01.JU.0001008588.39303.c9.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Adjuvant therapy (AT) has been increasingly utilized for high-risk localized Renal Cell Carcinoma (RCC), with emerging literature demonstrating longer disease-free survival. Neoadjuvant therapy (NT) have been used investigationally to facilitate complete surgical resections in high-risk and complex renal masses. We sought to evaluate the outcomes of patients treated with either AT or NT, and the impact of positive surgical margin, in non-metastatic RCC using a propensity score model (PSM). METHODS: We queried the INMARC database for patients with localized, surgically treated RCC who underwent AT or NT. AT was defined as systemic therapy given postoperatively in the absence of documented metastases within 6 months after surgery; NT referred to presurgical therapy given in the context of localized disease. A PSM model in a 1:2 ratio was conducted with a caliper width of 0.1, including: age, sex, hypertension, Charlson Comorbidity Index, tumor size/necrosis/grade/stage, surgical margin, and type of surgery (radical vs. partial nephrectomy). Primary outcome was cancer-specific mortality (CSM); secondary outcome was recurrence. Multivariable analysis (MVA) via Cox regression was fitted to elucidate predictors of outcomes. RESULTS: After PSM, 293 patients were analyzed [AT n=203 (109/203) targeted molecular therapy (TMT)/ (94/203) immunotherapy (IO); NT n=90 (59/90) TMT and (31/90) IO. Median follow-up was 50 months (IQR 20-76). MVA revealed that AT vs. NT (HR=2.18, p=0.016) and positive margin (HR=2.41, p=0.028) were associated with an increased risk of CSM, while IO (HR=0.35, p<0.001) was associated with a decreased risk. MVA for recurrence showed that AT vs. NT (HR=1.72, p=0.011) and positive margin (HR=3.38, p<0.001) were associated with an increased risk of recurrence, while IO was not (p=0.79). Subanalyses of the AT and NT cohorts to examine the impact of positive margins revealed that positive margin (HR=2.68, p=0.001) was an independent factor associated with an increased risk of recurrence in the AT group, while it was not significant in the NT group (p=0.074). Conversely, positive margin was not associated with increased CSM after either AT or NT (p=0.070 and p=0.42, respectively). CONCLUSIONS: In a comparison of patients who underwent AT or NT, receipt of NT was associated with superior survival outcomes. Positive margins were associated with an increased risk of recurrence after AT, while this was not the case in the NT cohort. Source of Funding: Stephen Weissman Kidney Cancer Research Fund © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e142 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Cesare Saitta More articles by this author Mimi V. Nguyen More articles by this author Kevin Hakimi More articles by this author Dattatraya Patil More articles by this author Hajime Tanaka More articles by this author Jonathan A. Afari More articles by this author Julian Cortes More articles by this author Jacob Roberts More articles by this author Margaret F. Meagher More articles by this author Franklin Liu More articles by this author Mirha Mahmood More articles by this author Joshua Matian More articles by this author Mariam Mansour More articles by this author Dhruv Puri More articles by this author Clara Cerrato More articles by this author Kit L. Yuen More articles by this author Masaki Kobayashi More articles by this author Shohei Fukuda More articles by this author Wei Chen More articles by this author Edouard Nicaise More articles by this author Nahar Imtiaz More articles by this author Rachel Greenwald More articles by this author Viraj Master More articles by this author Yasuhisa Fujii More articles by this author Rana Mckay More articles by this author Ithaar H. Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...