Mp10-09 Differential Impact of Positive Surgical Margin in High-Risk Localized Renal Cell Carcinoma After Adjuvant and Neoadjuvant Systemic Therapy: A Multicenter Analysis

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) I (MP10)1 May 2024MP10-09 DIFFERENTIAL IMPACT OF POSITIVE SURGICAL MARGIN IN HIGH-RISK LOCALIZED RENAL CELL CARCINOMA AFTER ADJUVANT AND NEOADJUVANT SYSTEMIC THERAPY: A MULTICENTER ANALYSIS Cesare Saitta, Margaret F. Meagher, Umberto Capitanio, Francesco Porpiglia, Alessandro Antonelli, Jonathan A. Afari, Paolo Casale, Hajime Tanaka, Mimi V. Nguyen, Dattatraya Patil, Kevin Hakimi, Julian Cortes, Jacob Roberts, Franklin Liu, Mirha Mahmood, Joshua Matian, Mariam Mansour, Dhruv Puri, Clara Cerrato, Kit L. Yuen, Masaki Kobayashi, Shohei Fukuda, Nicolò M. Buffi, Giovanni Lughezzani, Yasuhisa Fujii, Viraj Master, Gabriele Tuderti, Giuseppe Simone, Alessandro Veccia, Riccardo Autorino, Francesco Montorsi, and Ithaar H. Derweesh Cesare SaittaCesare Saitta , Margaret F. MeagherMargaret F. Meagher , Umberto CapitanioUmberto Capitanio , Francesco PorpigliaFrancesco Porpiglia , Alessandro AntonelliAlessandro Antonelli , Jonathan A. AfariJonathan A. Afari , Paolo CasalePaolo Casale , Hajime TanakaHajime Tanaka , Mimi V. NguyenMimi V. Nguyen , Dattatraya PatilDattatraya Patil , Kevin HakimiKevin Hakimi , Julian CortesJulian Cortes , Jacob RobertsJacob Roberts , 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 , Nicolò M. BuffiNicolò M. Buffi , Giovanni LughezzaniGiovanni Lughezzani , Yasuhisa FujiiYasuhisa Fujii , Viraj MasterViraj Master , Gabriele TudertiGabriele Tuderti , Giuseppe SimoneGiuseppe Simone , Alessandro VecciaAlessandro Veccia , Riccardo AutorinoRiccardo Autorino , Francesco MontorsiFrancesco Montorsi , and Ithaar H. DerweeshIthaar H. Derweesh View All Author Informationhttps://doi.org/10.1097/01.JU.0001008588.39303.c9.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Presence of positive surgical margin (PSM) in renal cell carcinoma (RCC) has been associated with increased risk of cancer specific mortality (CSM) and recurrence. While the US Food and Drug Administration recently approved adjuvant pembrolizumab and sunitinib to decrease the risk of recurrence, trials for adjuvant therapy have typically excluded those with PSM. Herein we sought to evaluate impact of PSM on oncological outcomes in patients treated with adjuvant or neoadjuvant systemic therapy in non-metastatic RCC. METHODS: We conducted a multicenter retrospective analysis for patients with localized surgically treated RCC who underwent systemic adjuvant or neoadjuvant therapy. Adjuvant therapy was defined as systemic therapy given postoperatively in the absence of documented metastases; neoadjuvant therapy was presurgical therapy given in the setting of localized disease. Primary outcome was recurrence/progression free survival (PFS), and secondary outcome was CSM/cancer specific survival (CSS). Multivariable analysis (MVA) via Cox regression adjusted for tumor size, surgery approach (partial vs. radical nephrectomy), stage, tumor necrosis, tumor grade and type of systemic therapy (Immunotherapy vs. Target Therapy), was fitted to elucidate predictors of outcomes. Kaplan-Meier analysis (KMA) was fitted for the outcomes of interest to corroborate survival estimates. RESULTS: Overall, 347 patients (90 neoadjuvant/257 adjuvant) were analyzed. Median follow-up period for neoadjuvant and adjuvant was 40 (17-73) and 44 (22-76) months (p=0.33). MVA revealed presence of PSM (HR=2.60, p=0.002) as an independent risk factor associated with increased risk of recurrence for adjuvant, while in neoadjuvant was not (p=0.065). MVA in adjuvant cohort for CSM revealed PSM (HR=1.95, p=0.048) as independent risk factor associated with increased risk of CSM, while for neoadjuvant cohort was not (p=0.61). KMA comparing negative surgical margin (NGM) vs. PSM for neoadjuvant revealed 5-year PFS of 77.4% vs. 47.6% (p=0.23), while for adjuvant was 61.8% vs. 16% (p<0.001). Comparing NGM vs. PSM in neoadjuvant showed 5-year CSS was 87.9% vs. 85.7% (p=0.67), while for adjuvant was 72.7% vs. 51.9% (p=0.03). CONCLUSIONS: In a comparison of patients with localized RCC who underwent adjuvant or neoadjuvant systemic therapy, PSM was associated with worsened oncological outcomes after adjuvant systemic therapy, while in the neoadjuvant cohort was not. Further investigation is requisite. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e141 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Cesare Saitta More articles by this author Margaret F. Meagher More articles by this author Umberto Capitanio More articles by this author Francesco Porpiglia More articles by this author Alessandro Antonelli More articles by this author Jonathan A. Afari More articles by this author Paolo Casale More articles by this author Hajime Tanaka More articles by this author Mimi V. Nguyen More articles by this author Dattatraya Patil More articles by this author Kevin Hakimi More articles by this author Julian Cortes More articles by this author Jacob Roberts 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 Nicolò M. Buffi More articles by this author Giovanni Lughezzani More articles by this author Yasuhisa Fujii More articles by this author Viraj Master More articles by this author Gabriele Tuderti More articles by this author Giuseppe Simone More articles by this author Alessandro Veccia More articles by this author Riccardo Autorino More articles by this author Francesco Montorsi More articles by this author Ithaar H. Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...