Kidney Ca: Cytoreductive nephrectomy appears to be protective

Jodi K. Maranchie, MDOther kidney cancer research included an examination of metastasectomy trends in the National Cancer Database and a review of perioperative transfusion's effect on recurrence-free and overall survival. The kidney cancer take-home messages were presented by Jodi K. Maranchie, MD, of the University of Pittsburgh School of Medicine.

In 260 patients, intrahepatic fat, as measured by preoperative computed tomography scan, was an independent predictor of overall and cancer-specific survival irrespective of visceral obesity.

Immunosuppressive M2 macrophage infiltration in the tumor microenvironment is associated with significantly worse cancer-specific survival in clear cell renal cell carcinoma patients.

An 8-gene panel based on the Cancer Genome Atlas project was able to predict high tumor grade in preoperative biopsy specimens and will hopefully improve the accuracy of renal biopsies.

An examination of metastasectomy trends in the National Cancer Database showed improved survival in patients undergoing metastasectomy and chemotherapy compared to chemotherapy alone. Despite this, rates of metastasectomy have been dropping in recent years, suggesting potential undertreatment in this population. In a parallel study looking at more than 13,000 metastatic kidney cancer patients, improved survival was seen following cytoreductive nephrectomy, with a difference of 16.8 months versus 8 months and a hazard ratio of 0.4. Even in the targeted therapy era, it appears that cytoreductive nephrectomy is protective.

Not all chromatin modeling mutations are created equally. In 194 patients with clear cell renal cancer, the presence of only a PBRM1 mutation actually improved survival relative to those with neither mutation. In contrast, the presence of the BAP1 mutation with or without concomitant PBRM1 conferred dismal survival, dropping from a mean of 40 to 18 months.

Continue to the next page for more take-home messages.

• In a group of 606 propensity-matched metastatic renal cancer patients from the Surveillance, Epidemiology, and End Results database, upfront cytoreductive nephrectomy had a 20-month median survival compared to only 8 months without surgery (hazard ratio=0.57).

• Researchers evaluating treatment of small renal masses found a local recurrence rate of less than 1% for surgery and nearly 11% for percutaneous ablation.

• In mice, simultaneous laser thermal ablation and injection of sorafenib (Nexavar)-coated nanorods led to synergistic killing, with 100% absence of viable cells on subsequent inspection compared to 62% with laser thermal ablation alone.

• Follow-up of a large multinational trial of systemic everolimus (Afinitor) versus placebo for renal angiomyolipoma confirmed early findings of safety and efficacy. One hundred and twelve patients followed for more than 4 years had sustained reduction in tumor volume and no episodes of bleeding.

• Researchers presented a preoperative assessment model for metastatic renal cancer based on 313 cytoreductive nephrectomies performed between 1990 and 2010. Using a simple score model, they demonstrated that with a score of 0 points, cancer-specific survival at 1 year was 81% relative to only 30% for 10 points or more.

• Reduction of renal function due to surgery does not confer the same overall survival disadvantage as pre-existing medical renal dysfunction.

Next: Effect of perioperative transfusions on 5-year recurrence free, overall survival survival

• In propensity-matched patients presenting with an estimated glomerular filtration rate (EGFR) between 30 and 60, the risk of progression to an EGFR <30 at 5 years was significantly lower following partial nephrectomy versus radical nephrectomy, and this translated to an improved overall survival for partial nephrectomy in this population. In a similar study, partial nephrectomy was found to be superior to radical nephrectomy for preventing progression to stage III chronic kidney disease (CKD).

• A review of postoperative imaging results following partial nephrectomy revealed a very high rate of false positive studies in the first year that led to secondary testing. The authors concluded that the yield of early surveillance in this group did not justify the added burden and cost of care.

• Patients with coronary artery disease are less likely to develop de novo CKD after renal surgery.

• In a group of RCC patients, those who received perioperative transfusions had significantly poorer 5-year recurrence-free and overall survival. Separately, a review of 2010-2013 National Surgical Quality Improvement Program data found that perioperative transfusion substantially increased the rate of infection and early mortality. Both studies demonstrate an immunosuppressive role for transfusion and the need to minimize transfusion postoperatively.

• In patients who underwent metastatectomy for sarcomatoid-variant versus non-sarcomatoid metastatic renal cancer, there was no survival benefit to surgery in this rare aggressive variant, particularly in the setting of lymph node disease.

• A group 428 patients who had en bloc stapling of the renal hilum at time of laparoscopic nephrectomy demonstrated no arteriovenous fistula formation, with a mean follow-up of more than 3 years.

• Continuation of perioperative clopidogrel (Plavix) therapy increased the risk of postoperative hemorrhage after partial nephrectomy nearly fourfold. In contrast, however, continuation of aspirin did not appear to increase postoperative hemorrhage risk.

More AUA 2016 take-home messages:

Prostate Ca: PSA drop, active surveillance are key themes

Infertility/Andrology: Are vasectomy and prostate Ca linked?

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