Alessandro, Antonelli

Alessandro, Volpe

Carini, Marco

Carlo, Terrone

Claudio, Simeone

Ettore Di Trapani,

Federica, Regis

Francesco, Montorsi

Maria, Furlan

Minervini, Andrea

Paolo De Angeli,

Rayan, Matloob

Renzo, Colombo

Roberto, Bertini

Serni, Sergio

Umberto, Capitanio

English

Florence Research

e650 THE JOURNAL OF UROLOGY Vol. 191, No. 4S, Supplement, Monday, May 19, 2014Kidney Cancer: Localized IVModerated PosterMonday, May 19, 2014 1:00 PM-3:00 PMMP59-01NEPHRON SPARING SURGERY DOES NOT DECREASEOTHER-CAUSES MORTALITY RELATIVE TO RADICALNEPHRECTOMY IN PATIENTS WITH CLINICAL T1A-T1BRENAL MASS: RESULTS FROM A LARGE MULTI-INSTITUTIONALSTUDYUmberto Capitanio*, Milan, Italy; Carlo Terrone, Novara, Italy;Alessandro Antonelli, Brescia, Italy; Andrea Minervini, Florence, Italy;Alessandro volpe, Novara, Italy; Maria Furlan, Brescia, Italy;Rayan Matloob, Milan, Italy; Federica Regis, Novara, Italy; Ettore DiTrapani, Milan, Italy; Paolo De Angeli, Novara, Italy; Sergio Serni,Florence, Italy; Renzo Colombo, Milan, Italy; Marco Carini, Florence,Italy; Claudio Simeone, Brescia, Italy; Francesco Montorsi,Roberto Bertini, Milan, ItalyINTRODUCTION AND OBJECTIVES: Some reports suggestedthat nephron sparing surgery (NSS) may better protect against other-cause mortality (OCM) when compared with radical nephrectomy (RN)in patients with small renal masses. However, the majority of thosestudies could not adjust their results for potential selection bias sec-ondary to clinical baseline characteristics of patients. In the currentstudy, we aimed to test the effect of treatment type (NSS vs. RN) afteraccounting for clinical characteristics, comorbidities and individual car-diovascular risk.METHODS: A multi-institutional collaboration among fourEuropean Tertiary Care Centers allowed collecting 2685 patients witha clinical T1a-T1b N0 M0 renal mass. Patients underwent RN(n¼1059, 39.4%) or NSS (n¼1626, 60.6%) and showed normalestimated glomerular filtration rates (eGFR) before surgery (definedas a pre-operative eGFR60 milliliters per minute per 1.73 m2).Descriptive, univariable and multivariable Cox regression analyseswere used to predict the risk of OCM. To adjust for inherent baselinedifferences among patients, we included as covariates: age, clinicaltumor size, gender, presence of hypertension at diagnosis, baselineCharlson comorbidity index (CCI), body mass index and smokerstatus.RESULTS: Mean follow up period was 76 months (median 61).Mean patient age resulted 60 years (median 62). Mean body massindex resulted 25 kg/m2. Overall, 37.2% and 9.4% of the patients hadhypertension or diabetes, respectively. CCI resulted 0-1 in 73.2% ofthe patients.The 5- and 10-yr OCM rates after nephrectomy were 5.2% and13.2% for NSS versus 7.4% and 15.1% for RN, respectively (p¼0.3).At multivariable analyses, patients who underwent PN showed similarrisk to die for OCM compared with their RN-treated counterparts(hazard ratio [HR]: 0.77; 95% confidence interval, 0.48-1.25; p¼0.3).Increasing age (HR: 1.12, p<0.001), higher CCI (HR: 1.21, p¼0.04)and smoker status (HR: 1.94, p¼0.02) resulted independent predictorsof OCM.CONCLUSIONS: After correcting for clinical characteristics,comorbidities and cardiovascular risk at diagnosis, NSS does notdecrease other-causes mortality relative to RN in patients withclinical T1a-T1b renal masses and a normal kidney function beforesurgery.Source of Funding: NoneMP59-02RENAL FUNCTION IMPAIRMENT AFTER NEPHRON SPARINGSURGERY OR RADICAL NEPHRECTOMY IN PATIENTS WITHCLINICAL T1A-T1B RENAL MASS AND NORMAL PREOPERATIVEGLOMERULAR FILTRATION RATES: RESULTS FROM A LARGEMULTI-INSTITUTIONAL STUDYUmberto Capitanio*, Milan, Italy; Carlo Terrone, Novara, Italy;Alessandro Antonelli, Brescia, Italy; Andrea Minervini, Florence, Italy;Alessandro Volpe, Novara, Italy; Fabio Castiglione, Milan, Italy;Maria Furlan, Brescia, Italy; Rayan Matloob, Milan, Italy;Federica Regis, Luisa Zegna, Novara, Italy; Gianni Vittori, Florence,Italy; Ettore Di Trapani, Milan, Italy; Marco Carini, Florence, Italy;Claudio Simeone, Brescia, Italy; Francesco Montorsi, Roberto Bertini,Milan, ItalyINTRODUCTION AND OBJECTIVES: Some reports suggestedthat nephron sparing surgery (NSS) may protect against renal functionimpairment (RFI) when compared with radical nephrectomy (RN) inpatients with small renal masses. In the current study, we aimed to testthe effect of treatment type (NSS vs. RN) on prevalence of RFI andrenal end-stage kidney disease (ESRD) after accounting for clinicalcharacteristics, comorbidities and individual cardiovascular risk.METHODS: A multi-institutional collaboration among four Eu-ropean Tertiary Care Centers allowed collecting 2024 patients with aclinical T1a-T1b N0 M0 renal mass and complete functional follow-updata. Patients underwent RN (n¼765, 37.8%) or NSS (n¼1259, 62.2%)and showed normal estimated glomerular filtration rates (eGFR) beforesurgery (defined as a pre-operative eGFR60 ml/min/1.73 m2). Uni-variable and multivariable Cox regression analyses predicting RFI wereperformed. To adjust for inherent baseline differences among patients,we included as covariates: preoperative creatinine, age, clinical tumorsize, gender, presence of hypertension or diabetes at diagnosis,baseline Charlson comorbidity index (CCI), body mass index andsmoker status.RESULTS: At a mean follow up period of 68.2 months, 81.1%vs. 55.8% patients showed normal renal function after NSS vs. RN,respectively (p<0.001). The prevalence of mild RFI, severe RFI andESRD resulted 25.3, 1.0% and 2.1%. However, after stratifying fortreatment type, the prevalence of mild RFI, severe RFI and ESRDresulted higher in the group of patients treated with RN relative to NSS(39.7 vs. 16.6%, 1.4 vs. 0.8% and 3.0 vs. 1.5%, respectively, p<0.001).At multivariable analyses, patients who underwent PN showed signifi-cantly lower risk to harbour RFI compared with their RN-treated coun-terparts (hazard ratio [HR]: 0.63; 95% confidence interval, 0.44-0.89;p¼0.008). Increasing age (HR: 1.06, p<0.001), larger tumors (HR: 1.04,p<0.001), presence of hypertension (HR: 5.39, p¼0.006) and presenceof diabetes (HR: 1.56, p¼0.05) resulted independent predictors of RFI.CONCLUSIONS: Although the risk of severe renal functionimpairment and ESRD is negligible, up to 30% of the patients withclinical T1a-T1b renal masses and a normal preoperative kidney func-tion harbour mild RFI after surgery. Also after accounting for clinicalcharacteristics, comorbidities and cardiovascular risk at diagnosis, NSSsignificantly decrease the risk of RFI relative to RN.Source of Funding: NoneMP59-03RENAL TISSUE ABLATION PRODUCED WITH WST-11 VASCULARTARGETED PHOTODYNAMIC THERAPY: SAFETY ASSESSMENT,HISTOPATHOLOGIC AND RADIOGRAPHIC ANALYSISSimon Kimm*, New York, NY; Tatum Tarin, Pittsburg, PA;Thomas Wimmer, Srinivasaraghavan Srimathveeravalli, Ashley Winter,Jeremy Durack, Stephen Solomon, New York, NY; Avigdor Scherz,Rehovot, Israel; Peter Scardino, Jonathan Coleman, New York, NYINTRODUCTION AND OBJECTIVES: Vascular targetedphotodynamic therapy (VTP) with WST-11 is a focal therapy modalitywith many potential advantages over existing thermal and non-thermal

NEPHRON SPARING SURGERY DOES NOT DECREASE

OTHER-CAUSES MORTALITY RELATIVE TO RADICAL

NEPHRECTOMY IN PATIENTS WITH CLINICAL T1A-T1B

RENAL MASS: RESULTS FROM A LARGE MULTI-INSTITUTIONAL

STUDY

https://flore.unifi.it/bitstream/2158/1056774/1/MP59-01.pdf

NEPHRON SPARING SURGERY DOES NOT DECREASE OTHER-CAUSES MORTALITY RELATIVE TO RADICAL NEPHRECTOMY IN PATIENTS WITH CLINICAL T1A-T1B RENAL MASS: RESULTS FROM A LARGE MULTI-INSTITUTIONAL STUDY

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