Hironori Fukuda

Predictive value of inflammation-based prognostic scores in patients with metastatic renal cell carcinoma treated with cytoreductive nephrectomy

Inflammation-based prognostic scores are useful for predicting survival in various cancers. Here, we aimed to determine the most useful inflammation-based prognostic score for predicting survival in patients with metastatic renal cell carcinoma undergoing cytoreductive nephrectomy. We retrospectively analyzed the data of 152 patients who underwent cytoreductive nephrectomy for metastatic renal cell carcinoma between 1986 and 2015. In the multivariate stepwise analysis, the combination of age, Memorial Sloan-Kettering Cancer Center score, histology, sarcomatoid change, clinical nodal stage, brain metastasis, and liver metastasis was a significant predictor for survival (Harrells concordance index [c-index]: 0.638). The c-index of the combination improved with the addition of an inflammation-based prognostic score: C-reactive protein (c-index: 0.672), Glasgow prognostic score (c-index: 0.674), neutrophil-to-lymphocyte ratio (c-index: 0.685), lymphocyte-to-monocyte ratio (c-index: 0.670), platelet-to-lymphocyte ratio (c-index: 0.666), systemic inflammation response index (c-index: 0.652), and systemic immune-inflammation index (c-index: 0.678). The neutrophil-to-lymphocyte ratio provided the greatest improvement in the c-index. Additional multivariate analysis showed that the neutrophil-to-lymphocyte ratio was an independent prognostic factor for survival (P < 0.0001). The neutrophil-to-lymphocyte ratio was the most useful inflammation-based prognostic score for predicting survival in patients with metastatic renal cell carcinoma treated with cytoreductive nephrectomy.

Evaluation of renal function change during first-line tyrosine kinase inhibitor therapy for metastatic renal cell carcinoma

Sunitinib and sorafenib therapy for metastatic renal cell carcinoma can induce the renal dysfunction. Thus, renal function should be carefully monitored, especially during sunitinib therapy, because the impact of sunitinib on renal dysfunction was stronger.

Acquired cystic disease-associated renal cell carcinoma is the most common subtype in long-term dialyzed patients: Central pathology results according to the 2016 WHO classification in a multi-institutional study: RCC in ESRD patients by 2016 WHO classification

New pathological subtypes of renal cell carcinoma (RCC) were designated in the 2016 World Health Organization (WHO) classification corresponding to the features commonly seen in patients with end‐stage renal disease (ESRD). To determine the clinicopathological findings of new subtypes, we reanalyzed all sections from 315 kidneys in 291 ESRD patients bearing RCC tumors surgically resected in three Japanese institutes by the central pathologist. Clear cell RCC was diagnosed in 144 kidneys (45.7%), acquired cystic disease (ACD)‐associated RCC in 100 (31.7%), papillary RCC in 41 (13.0%), and other minor subtypes in 30 (9.52%). Multivariate analysis showed that longer duration of dialysis, young age, and male sex were independent prognostic clinical factors for the occurrence of ACD‐associated RCC. ACD‐associated RCC included more WHO/International Society of Urologic Pathology (ISUP) grade 3/4 cases compared to other RCCs. In contrast, other unfavorable findings were less frequent in ACD‐associated RCC, including the presence of a sarcomatoid component, lymphovascular invasion, and necrosis. In conclusion, ACD‐associated RCC is a common histology in Japanese patients with ESRD. In addition, ACD‐associated RCC showed more cases with a higher WHO/ISUP grade, but fewer cases with other unfavorable pathological features, suggesting a favorable prognosis of ACD‐associated RCC.

Impact of the Mayo Adhesive Probability Score on the Complexity of Robot-Assisted Partial Nephrectomy

OBJECTIVES Mayo adhesive probability (MAP) score quantifies adherent perinephric fat (APF) and is associated with the prolongation of surgery duration or the increase of surgical complication rates. PATIENTS AND METHODS In this study, 311 patients who underwent robot-assisted partial nephrectomy (RAPN) at our institute were included. APF was quantified using the MAP score calculated using perinephric fat thickness and stranding seen on a preoperative enhanced CT scans. The surgery duration was classified into the dissection (robotic manipulation to hilar clamping) and resection (hilar clamping to robotic surgery completion) phases. RESULTS The MAP score was found to be 0, 1, 2, 3, 4, and 5 in 98 (32%), 86 (28%), 21 (7%), 48 (15%), 44 (14%), and 14 (4%) patients, respectively. The dissection and resection phase times increased with an increase in the MAP score. The median dissection phase times for MAP scores of 0, 1, 2, 3, 4, and 5 were 71.7, 79.1, 88.9, 97.0, 99.7, and 118.8 minutes, respectively. The MAP score was more strongly associated with the prolongation of the dissection phase than with the prolongation of the resection phase. In multivariate analysis for dissection phase time of more than 90 minutes, the body mass index [odds ratio (OR) = 1.09, p = 0.0209], early surgical experience (first 100 cases) (OR = 2.32, p = 0.0024), and MAP score ≥3 (OR = 6.20, p < 0.0001) significantly associated with the prolongation of dissection phase in a logistic regression model. CONCLUSIONS The MAP score is a factor significantly associated with the prolongation of the dissection phase during RAPN.

Durable response after discontinuation of nivolumab therapy in patients with metastatic renal cell carcinoma

We investigated the efficacy of nivolumab treatment in patients with metastatic renal cell carcinoma who discontinued nivolumab treatment due to reasons other than disease progression. Of the 34 patients, 3 patients discontinued nivolumab therapy due to adverse events and were subsequently observed without additional treatment. The first patient discontinued nivolumab after 14 cycles of treatment due to type 1 diabetes mellitus and has maintained partial remission for 8 months. The second patient discontinued nivolumab after 11 cycles of treatment due to interstitial pneumonitis, and durable response was confirmed for 5 months. However, multiple lung lesions reappeared at 6 months after discontinuing nivolumab. The third patient discontinued nivolumab due to elevated liver enzymes after three cycles of treatment. At the time of discontinuation, a new liver lesion appeared, but the lesion decreased in size at 6 months after discontinuation. In the present study, a relatively durable response was observed in three patients who discontinued nivolumab without additional treatment.

MP78-10 HIGHER RISK OF RECURRENCE AT EXTRAREGIONAL NODES AFTER RADICAL NEPHROURETERECTOMY IN PATIENTS WITH LEFT THAN IN PATIENTS WITH RIGHT URETERAL CANCER

INTRODUCTION AND OBJECTIVES: A preoperative nomogram to predict complications following radical nephroureterectomy (RNU) has previously been created. This nomogram incorporated 5 variables (patient age, race, ECOG performance status, CKD stage, and Charlson Comorbidity Index [CCI]) with an area under the curve of 72%. We externally validate this nomogram with a distinct international RNU patient population. METHODS: Amongst 610 RNU patients treated at 7 academic medical centers between 2005 and 2015, 382 (63%) had complete data with all variables reported as the initial nomogram. Logistic regression determined the association between preoperative variables and postRNU complications. Nomogram validation was performed by analyzing the area under the receiver operating characteristics (AUC-ROC) curve. A calibration plot compared the nomogram-predicted probability of complications with the observed rate of complications within 30 days. RESULTS: 225 men and 157 women with a median age of 71 were included. 85% of the patients were Caucasian, 18% has an ECOG 2, 25% had a CCI score >5 and 52% had baseline chronic kidney disease (CKD) stage III. Overall, 93 patients (24%) experienced a complication, including 31 (8%) with Clavien grade III. The performance of the nomogram was evaluated using two methods. Discrimination between individual patients was assessed by analyzing the AUC-ROC curve, which was 67.0% (95% CI 60.3%-73.7%). (Figure 1) A calibration plot compared the performance of the ideal nomogram (indicated by the dotted line), whereas the solid line represents the performance of this specific nomogram. There was a slight underestimation of complications for patients with high nomogram-predicted probabilities. (Figure 2) CONCLUSIONS: External validation of a preoperative RNU complications nomogram noted an AUC-ROC curve of 67% with underestimation of complications for higher predicted probabilities. These observations may be a result of a lower complication rate observed in the validation versus original cohort (24% vs. 38%). Source of Funding: None