608 Background: To investigate the association of serum uric acid (SUA) levels along with statin use in Renal Cell Carcinoma (RCC), as statins may be associated with improved outcomes in RCC and SUA elevation is associated with increased risk of chronic kidney disease (CKD). Methods: Retrospective study of patients undergoing surgery for RCC with preoperative and postoperative SUA levels between 8/2005-8/2014. Increased SUA was defined as > 7mg/dL for males and > 5.7 mg/dL for females. Analysis was carried out between patients with increased postoperative SUA vs. patients with decreased/stable postoperative SUA. Kaplan-Meier analysis (KMA) calculated overall survival (OS). Multivariable analysis (MVA) was performed to identify factors associated with increased SUA levels and all-cause mortality. Results: 905 patients were analyzed. Decreased/stable SUA levels were noted in 675(74.6%) and increased SUA levels were noted in 230(25.4%). A higher proportion of patients with decreased/stable SUA levels took statins (27.9% vs 18.3%, p = 0.004). Increased SUA had significantly greater de novo CKD (38.7% vs. 18.4%, p < 0.001) and proteinuria (30.9% vs. 20.7%, p = 0.002). KMA demonstrated improved 5-year OS for patients with decreased/stable SUA compared to increased SUA for stage I, (93% vs. 60%), stage II (87% vs. 50%), and stage III (88% vs. 62%) RCC (all p < 0.001). MVA revealed that increasing BMI (OR 1.05, p = 0.009), statin use (OR 0.11, p < 0.001), dyslipidemia (OR 2.66, p = 0.004), stage III/IV cancer (OR 1.89, p = 0.015 and OR = 10.78, p < 0.001), and postoperative de novo CKD stage 3 (OR 5.95, p < 0.001) were predictors for increased postoperative SUA levels. MVA revealed increasing BMI (OR 1.09, p = 0.002), increasing SUA (OR = 4.70, p < 0.001), stage IV RCC (OR = 7.7, p < 0.001, and de novo CKD stage 3 (OR 7.07, p < 0.001) to be independent risk factors for worsened all-cause mortality. Conclusions: Increasing SUA post operatively was associated with worsened outcomes in RCC patients. Decreased SUA levels were associated with statin intake and lower stage disease as well as lack of progression to CKD and anemia. Further investigation is requisite.

Neoadjuvant sunitinib may facilitate partial nephrectomy in imperative indications. A retrospective comparison was performed of outcomes in patients who received neoadjuvant sunitinib before nephrectomy and inferior vena caval thrombectomy; results indicated that neoadjuvant sunitinib was associated with a reduction in primary tumor and thrombus size and improved survival. These findings represent the largest single-agent series and the first reported comparison. Background: We analyzed outcomes of neoadjuvant sunitinib in patients with renal-cell carcinoma (RCC) and inferior vena caval (IVC) tumor and compared outcomes to patients who did not undergo neoadjuvant therapy before surgery. Patients and Methods: We performed a multicenter retrospective comparison of RCC patients with IVC tumor who underwent neoadjuvant sunitinib before surgery versus those who did not. Response to sunitinib was defined by Response Evaluation Criteria in Solid Tumors (RECIST). Primary outcome was cancer-specific survival. Secondary outcomes included overall survival. Multivariate analysis was performed to identify risk factors associated with primary and secondary outcomes. Kaplan-Meier analysis compared survival in neoadjuvant and primary surgery groups. Results: Data of 53 patients were analyzed (19 neoadjuvant sunitinib, 34 primary surgery; median follow-up, 58 months). Eighteen (9 in each group, P = .143) had metastatic RCC. There was no difference in IVC tumor level between the 2 groups (P = .76). After neoadjuvant sunitinib, median primary tumor decreased size from 8.1 to 6.8 cm, and IVC tumor decreased by 1.3 cm. IVC tumor level decreased in 8 (42.1%) of 19 and was stable in 10 (52.6%) of 19; 5 (26.3%) of 19 experienced partial response. Similar proportions of patients underwent robot-assisted or minimally invasive approaches (P = .351), and no differences were noted in complications (P = .194). Multivariate analysis showed neoadjuvant sunitinib was associated with improved cancer-specific survival (odds ratio = 3.28; P = .021). Kaplan-Meier analysis demonstrated significantly longer median cancer-specific survival (72 vs. 38 months, P = .023) for neoadjuvant sunitinib. Conclusion: Neoadjuvant sunitinib was associated with a reduction in primary tumor and thrombus size as well as improved survival. Further investigation is needed to determine the utility of neoadjuvant sunitinib in RCC with IVC tumor. (C) 2019 Elsevier Inc. All rights reserved.

Aim and Background: To investigate the association of serum uric acid (SUA) levels along with statin use in Renal Cell Carcinoma (RCC), as statins may be associated with improved outcomes in RCC and SUA elevation is associated with increased risk of chronic kidney disease (CKD). Methods: Retrospective study of patients undergoing surgery for RCC with preoperative/postoperative SUA levels between 8/2005-8/2018. Analysis was carried out between patients with increased postoperative SUA vs. patients with decreased/stable postoperative SUA. Kaplan-Meier analysis (KMA) calculated overall survival (OS) and recurrence free survival (RFS). Multivariable analysis (MVA) was performed to identify factors associated with increased SUA levels and all-cause mortality. The prognostic significance of variables for OS and RFS was analyzed by cox regression analysis. Results: Decreased/stable SUA levels were noted in 675 (74.6%) and increased SUA levels were noted in 230 (25.4%). A higher proportion of patients with decreased/stable SUA levels took statins (27.9% vs. 18.3%, p = 0.0039). KMA demonstrated improved 5- and 10-year OS (89% vs. 47% and 65% vs. 9%, p < 0.001) and RFS (94% vs. 45% and 93% vs. 34%, p < 0.001), favoring patients with decreased/stable SUA levels. MVA revealed that statin use (Odds ratio (OR) 0.106, p < 0.001), dyslipidemia (OR 2.661, p = 0.004), stage III and IV disease compared to stage I (OR 1.887, p = 0.015 and 10.779, p < 0.001, respectively), and postoperative de novo CKD stage III (OR 5.952, p < 0.001) were predictors for increased postoperative SUA levels. MVA for all-cause mortality showed that increasing BMI (OR 1.085, p = 0.002), increasing ASA score (OR 1.578, p = 0.014), increased SUA levels (OR 4.698, p < 0.001), stage IV disease compared to stage I (OR 7.702, p < 0.001), radical nephrectomy (RN) compared to partial nephrectomy (PN) (OR 1.620, p = 0.019), and de novo CKD stage III (OR 7.068, p < 0.001) were significant factors. Cox proportional hazard analysis for OS revealed that increasing age (HR 1.017, p = 0.004), increasing BMI (Hazard Ratio (HR) 1.099, p < 0.001), increasing SUA (HR 4.708, p < 0.001), stage III and IV compared to stage I (HR 1.537, p = 0.013 and 3.299, p < 0.001), RN vs. PN (HR 1.497, p = 0.029), and de novo CKD stage III (HR 1.684, p < 0.001) were significant factors. Cox proportional hazard analysis for RFS demonstrated that increasing ASA score (HR 1.239, p < 0.001, increasing SUA (HR 9.782, p < 0.001), and stage II, III, and IV disease compared to stage I (HR 2.497, p < 0.001 and 3.195, p < 0.001 and 6.911, p < 0.001) were significant factors. Conclusions: Increasing SUA was associated with poorer outcomes. Decreased SUA levels were associated with statin intake and lower stage disease as well as lack of progression to CKD and anemia. Further investigation is requisite.

475 Background: Upper tract urothelial cell carcinoma (UTUC) is an uncommon malignancy with disparate outcomes. We developed a novel morphometric scoring system for prediction of oncologic and survival outcomes before nephroureterectomy (NU). Methods: Retrospective, multicenter analysis of UTUC patients who underwent NU after negative metastatic workup. Preoperative CT-urography was used to evaluate scores, based on 3 factors (Tumor Size, Focality, Invasion of architecture) with a score of 1-3 based on degree of each factor (total score 3-9). Primary outcome was overall survival (OS). Secondary outcomes were recurrence and recurrence free survival (RFS). Multivariable (MVA) and Kaplan-Meier (KMA) analyses were utilized. Results: We analyzed 244 patients (mean age 70.9, mean follow up 29.5 months). 61% with SFI-UTUC score 3-6 and 39% were score 7-9. No difference in age, gender, comorbid conditions, surgical approach, or complications between groups. Score 7-9 had a higher rate of pN+ disease (24.2% vs. 8.1%, p=0.002) but similar nuclear grade. All-cause mortality was higher for score 7-9 (47.4% vs. 28.9%, p=0.004). On MVA for all-cause mortality, age (OR 1.1), recurrence (OR 4.4) and score 7-9 (OR 2.0) were significant (p<0.05). KMA for OS demonstrated 5 year OS of 57.0% for score 3-6 and 34.1% for score 7-9 (p<0.01). KMA for RFS was significant for renal UTUC location with 5 year RFS of 72.3% for score 3-6 and 54.2% for score 7-9, (p<0.01). Conclusions: A novel scoring system for UTUC preoperative imaging may predict OS for tumors in renal and ureteral locations, as well as RFS for renal locations. Renal location. [Table: see text]

474 Background: Upper tract urothelial cell carcinoma (UTUC) is an uncommon malignancy with disparate outcomes. Although use of lymph node dissection (LND) for urothelial cell carcinoma of the bladder has survival benefit even in setting of negative nodal status, therapeutic benefit of LND in the setting of clinical node negative disease for UTUC is unclear. We evaluated survival outcomes for UTUC after LND. Methods: Multicenter retrospective analysis of UTUC patients undergoing nephroureterectomy (NU) for clinical node negative, non-metastatic disease from 2001-2016 (cTis/1-T3N0M0). The cohort was divided based on pathologic lymph node status (pNx, pN0, and pN+). Primary outcome was overall survival (OS). Secondary outcome was recurrence free survival (RFS). Cox regression (CR), logistic regression (LR) and Kaplan−Meier (KMA) analyses were utilized. Results: 191 patients were analyzed (mean age 71.1 years, mean follow up 30.4 months, 27% ureteral location). LND was performed in 40.8% (78) and pN+ was noted in 11.0% (21). Mean number of nodes removed for pN0 = 6.6 and pN+ = 3.9 (p = 0.22). On CR for worsened all-cause mortality, significance was noted for ≥pT2 (OR 1.9, p = 0.031), recurrence (OR 2.3, p = 0.003), and pN+ (OR 2.8, p = 0.004). On KMA, 5 year OS stratified by pathologic node status and nuclear grade (grade 1-2 = LG; grade 3-4 = HG) noted negative survival effect associated with pN+ and HG disease (pN0 LG 85.7%, pN0 HG 41.2%, pNx LG 58.1%, pNx HG 51.1%, pN+ HG 10.7%, log-rank p < 0.001). No patient with pN+ had LG disease. On LR HG disease was predicted only by increasing clinical tumor size (OR 1.3, p = 0.032). No significant difference in complications was noted between the groups (p = 0.1). Conclusions: In clinical node negative disease, LND for UTUC did not have survival benefit; however, LND for UTUC provided prognostic information without significantly increasing risk of complications. Finding of pN+ disease was associated with worsened prognosis. LND may be omitted in LG disease yet should be considered in patients with HG disease and increasing tumor size. Further investigation is requisite.

642 Background: Incidental pathological upstaging to pT3a disease can occur after surgical treatment of clinical T1 and T2 Renal Cell Carcinoma (RCC), and upstaged pT3a disease is associated with worsened outcomes. Oncologic and survival outcomes within the pT3a category are heterogeneous. We investigated recurrence and survival outcomes in pT3a disease, and aimed to better categorize this cohort for improvement on current TMN staging. Methods: Multi-center retrospective analysis of patients with renal cell carcinoma (cT1-3aN0M0) from 1987-2016. After initial comparison of outcomes between pT1, pT2 and pT3a, patients were substratified within the pT3a category based on presenting clinical stage. Comparison was drawn between pT1, pT2 and the subdivided pT3a group (cT1 → pT3a, cT2 → pT3a, and cT3a → pT3a). Primary outcome was recurrence free survival (RFS). Secondary outcome was overall survival (OS). Kaplan−Meier (KM) analysis was utilized. Results: 2640 patients were analyzed (2125 cT1, 448 cT2, 67 cT3a, mean follow up 67.8 months). Rate of incidental T3a upstaging from cT1-2 was 14.7%. Compared to pT1-2 disease, patients with incidental pT3a upstaging had higher rate of recurrence (7.5% vs. 29.6%, p < 0.001) and all-cause mortality at last follow up (15.9% vs. 25.4%, p < 0.001). With regards to RFS, when pT3a was subdivided based on presenting clinical stage, significant differences in RFS emerged which aligned differently. Compared to 5 year RFS of pT1 (94.4%), cT1 → pT3a aligned with pT2 (76.6% and 81.2%, p = 0.346) while cT2 → pT3a aligned with cT3a → pT3a 47.4% and 44.0%, p = 0.815). With regards to OS, a similar alignment was noted for 5 year OS after subdivision, where pT1 was 89.9%, while cT1 → pT3a correlated with pT2 (79.8% and 83.1%, p = 0.640) and cT2 → pT3a correlated with cT3a → pT3a 67.0% and 64.2%; p = 0.893). Conclusions: Patients with cT1 → pT3a have outcomes more similar to pT2, than patients with cT2 → pT3a which align more closely to cT3a → pT3a. Future refinements of the TNM staging system for RCC should consider re-grouping cT1 → pT3a into the pT2 group. Further confirmation is requisite.

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V1 Apr 2017MP72-09 TRENDS IN UTILIZATION AND QUALITY OUTCOMES OF PARTIAL NEPHRECTOMY IN CT1B AND CT2A RENAL CELL CARCINOMA: ANALYSIS OF THE NATIONAL CANCER DATABASE Katherine Fero, Zachary Hamilton, Daniel Han, Aaron Bloch, Charles Field, and Ithaar Derweesh Katherine FeroKatherine Fero More articles by this author , Zachary HamiltonZachary Hamilton More articles by this author , Daniel HanDaniel Han More articles by this author , Aaron BlochAaron Bloch More articles by this author , Charles FieldCharles Field More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2245AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Emerging data from centers of excellence suggests that partial nephrectomy (PN) for cT1b and cT2a Renal Cell Carcinoma (RCC) are oncologically safe and may confer renal functional benefit. We sought to study trends in utilization and short term quality outcomes of PN among patients with cT1b and cT2a RCC using the National Cancer Database (NCDB). METHODS We identified 39,561 patients with localized cT1b or cT2a RCC who underwent PN from 2004-2013. Primary outcome was utilization of PN over time. Secondary outcomes included hospital length of stay (LOS, short hospitalization: 0-4 days), margin status and 30-day readmissions. Cochrane-Armitage test was used to describe trends over time. Multivariable (MVA) logistic regression models were used to investigate associations between tumor stage and outcomes. RESULTS The study consisted of 28,620 (72.3%) patients with cT1b and 10,941 (27.7%) with cT2a masses. Overall, 8,953 (22.6%) patients underwent PN. More patients with cT1b vs. cT2a tumors underwent PN (28.1% vs. 8.34%; p<0.01). PN increased over the study period (cT1b: 13.7% to 37.1%, p<0.01; cT2a: 3.2% to 11.0%, p<0.01; Figure). For all PN, positive margin rates increased from 4.3% in 2004 to 6.8% in 2013, (p<0.01); 30-day readmission was not significantly changed (2.2% in 2004 to 5.1% in 2013, p=0.76). Proportion of short LOS increased, from 51.6% in 2004 to 75.2% in 2013 (p<0.01). MVA for positive margins was notable for increasing age (OR 1.01, p=0.012), year of diagnosis (OR 1.07, p=0.01), and facility type (comprehensive community OR 1.362, p=0.002, integrated network cancer program OR 1.53, p=0.009, free standing cancer center program OR 3.44, p=0.003). MVA for 30-day readmission demonstrated high Charlson score (OR 1.38, p=0.046), and facility type (integrated network cancer program OR 0.56, p=0.022) as being significant. On MVA, patients with cT2a tumors were no more likely than those with cT1b to require 30-day readmission (OR 0.86, p=0.36) or have positive margins (OR 0.96, p=0.75). CONCLUSIONS Utilization of PN for cT1b and cT2a renal mass has increased over time. While length of hospital stay has shortened and 30-day readmission rates are not significantly different, an increase in positive margin rates has been noted, with predictive factors including patient age and facility type. PN in cT2a does not confer increased risk compared to PN in cT1b RCC. Focused emphasis and strategies to reduce positive margin rates in this higher risk population of localized renal masses should be considered. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e957-e958 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Katherine Fero More articles by this author Zachary Hamilton More articles by this author Daniel Han More articles by this author Aaron Bloch More articles by this author Charles Field More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging II1 Apr 2017MP67-07 PATHOLOGICAL DETERMINANTS OF ONCOLOGIC OUTCOMES IN STAGE II RENAL CELL CARCINOMA: AN INTERNATIONAL MULTICENTER ANALYSIS Zachary Hamilton, Daniel Han, Alp Tuna Beksac, Sean Berquist, Abd-elrahma Hassan, Charles Field, Aaron Bloch, Sumi Dey, Adam Bezinque, Samer Kirmiz, Fang Wan, James Proudfoot, Anthony Patterson, Bulent Akdogan, Haluk Ozen, Brian Lane, and Ithaar Derweesh Zachary HamiltonZachary Hamilton More articles by this author , Daniel HanDaniel Han More articles by this author , Alp Tuna BeksacAlp Tuna Beksac More articles by this author , Sean BerquistSean Berquist More articles by this author , Abd-elrahma HassanAbd-elrahma Hassan More articles by this author , Charles FieldCharles Field More articles by this author , Aaron BlochAaron Bloch More articles by this author , Sumi DeySumi Dey More articles by this author , Adam BezinqueAdam Bezinque More articles by this author , Samer KirmizSamer Kirmiz More articles by this author , Fang WanFang Wan More articles by this author , James ProudfootJames Proudfoot More articles by this author , Anthony PattersonAnthony Patterson More articles by this author , Bulent AkdoganBulent Akdogan More articles by this author , Haluk OzenHaluk Ozen More articles by this author , Brian LaneBrian Lane More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2043AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Stage II Renal Cell Carcinoma (RCC) is characterized by varied oncological outcomes, as the risk of progression and recurrence can vary widely. We analyzed clinical and pathological risk factors associated with oncological outcomes in a multicenter, international cohort. METHODS Retrospective multicenter analysis of patients who underwent surgical excision of clinically localized stage 2 (T2) renal mass from 1987-2015. Patients with tumors amenable to nephron-sparing surgery, baseline chronic kidney disease, or bilateral renal masses were provided an option for partial nephrectomy (PN), otherwise radical nephrectomy (RN) was performed. Lymphadenectomy (LND) was performed when clinically indicated. Primary endpoint was Recurrence Free Survival (RFS). Secondary outcome was overall survival (OS). Kaplan-Meier (KM) log-rank test and multivariable analysis (MVA) for factors related to RFS and OS were performed. RESULTS 1328 patients were analyzed (mean age 59.2 years, median follow up 62.7 months, 66.4% male/33.6% female, 20% PN/80% RN). Overall recurrence rate was 22.3%. MVA for factors associated with recurrence was significant for RN (OR 4.68, p=0.010), positive margin (OR 34.19, p=0.012), tumor grade 3/4 (OR 2.35, p=0.001), and lymphovascular invasion (LVI, OR 2.03, p=0.018). MVA for tumor related factors associated with worsened OS was significant only for RN (OR 4.16, p=0.001). KM analysis revealed 5 year RFS of 78.7% for LVI negative and 49.9% for LVI positive patients (p<0.001), as well as a 5 year RFS of 81.8% for tumor grade 1/2 and 62.1% for tumor grade 3/4 (p<0.001, figure). CONCLUSIONS For Stage II RCC, LVI and tumor grade 3/4 are independently associated with increased risk of recurrence. Stage II RCC patients with these pathological findings represent a high risk subgroup that requires close follow up and has implications for clinical trial design. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e873-e874 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Zachary Hamilton More articles by this author Daniel Han More articles by this author Alp Tuna Beksac More articles by this author Sean Berquist More articles by this author Abd-elrahma Hassan More articles by this author Charles Field More articles by this author Aaron Bloch More articles by this author Sumi Dey More articles by this author Adam Bezinque More articles by this author Samer Kirmiz More articles by this author Fang Wan More articles by this author James Proudfoot More articles by this author Anthony Patterson More articles by this author Bulent Akdogan More articles by this author Haluk Ozen More articles by this author Brian Lane More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

532 Background: Renal Cell Carcinoma (RCC) is a metabolically driven neoplasm. Inflammatory markers and morphometric measures have been suggested to be predictive for prognosis. We investigated the impact of a novel combination of preoperative tumor morphology (RENAL score) and a laboratory based inflammatory marker (DeRitis Ratio, AST/ALT) on survival outcomes in localized RCC. Methods: Single center, retrospective analysis of 264 patients with RCC (112 PN, 152 RN, mean follow-up 45 months) from 2003−2015. A priori, we assigned a positive marker score of “1” if RENAL >8 or DeRitis >1.5. Patients were stratified by increasing positive markers (“0”=RENAL ≤8 and DeRitis ≤1.5, “1”=RENAL >8 or DeRitis >1.5, “2”=RENAL >8 and DeRitis>1.5). Primary outcome was overall survival (OS). Cox models and Kaplan−Meier curves were utilized. Results: 264 patients, 61.7% male, mean age 64.5 ± 12.8 years, mean BMI 28.5 ± 5.6, mean AST/ALT 1.1 ± 0.4. With regards to tumor characteristics, mean clinical tumor size 4.7 ± 3.2cm and median RENAL score 9 (IQR 7−10). For clinical staging, 75.7% were cT1, 17.4% were cT2, and 6.9% were >cT2. 32.6% had 0 positive markers, 60.2% had 1 marker, and 7.2% had 2 markers. Kaplan−Meier analysis for “0”, “1”, and “2”demonstrated significantly worsened OS (log−rank p=0.03). On Cox model for OS, RENAL >8 (HR 2.13, p=0.01) or AST/ALT >1.5 (HR 2.25, p=0.028) were significantly associated with worsened survival, as was combined RENAL >8 and DeRitis > 1.5 (HR 5.1, p<0.001). Conclusions: Novel combination of a morphological score (RENAL) and an inflammatory marker (DeRitis ratio) was associated with worsened OS in localized RCC. Our findings point toward development and validation of a prognostic index to assist in risk stratification for localized RCC.

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging I1 Apr 2017MP22-10 COMPARATIVE ANALYSIS OF PREOPERATIVE INFLAMMATORY MARKERS FOR ONCOLOGIC AND RENAL FUNCTIONAL OUTCOMES AFTER SURGICAL TREATMENT OF RENAL CELL CARCINOMA Charles Field, Zachary Hamilton, Aaron Bloch, Katherine Fero, Daniel Han, Richmond Owusu, James Proudfoot, and Ithaar Derweesh Charles FieldCharles Field More articles by this author , Zachary HamiltonZachary Hamilton More articles by this author , Aaron BlochAaron Bloch More articles by this author , Katherine FeroKatherine Fero More articles by this author , Daniel HanDaniel Han More articles by this author , Richmond OwusuRichmond Owusu More articles by this author , James ProudfootJames Proudfoot More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.664AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), De Ritis Ratio (AST/ALT), and C-reactive protein (CRP) are inflammatory markers with varying predictive ability of treatment outcomes in malignancy. We sought to evaluate the utility of these markers for oncologic and renal functional outcomes in patients who have undergone partial or radical nephrectomy for suspected renal cell carcinoma (RCC). METHODS Single center, retrospective analysis 945 patients from 2003-2016 (494 PN, 451 RN, mean follow up 41.9 months). Primary outcome was de novo estimated Glomerular Filtration Rate (GFR<45 ml/min/1.73m2) at last follow up Secondary outcomes included overall survival (OS) and recurrence. Kaplan Meier (KM) and multivariate analysis (MVA) were utilized to evaluate association of preoperative markers (NLR, PLR, De Ritis Ratio, CRP) with outcomes. Predetermined cutoffs of NLR >3, PLR >185, De Ritis >1.5, and CRP >3 were used. RESULTS MVA for GFR <45 noted De Ritis ratio (HR 1.99, p<0.01), hypertension (HR 1.69, p=0.02), and coronary artery disease (HR 1.81, p<0.01). Cox model results using predetermined cutoffs for GFR<45 was significant for NLR (HR 2.09, p<0.01), PLR (1.88, p=0.01), and De Ritis (2.24, p<0.01). MVA for worsened OS noted CRP (HR 1.26, p<0.01) and RN (HR 6.99, p<0.01). Cox model results using predetermined cutoffs for OS was significant for NLR (HR 2.24, p=0.049), De Ritis (HR 3.92, p<0.01), and CRP (HR 4.0, p<0.01). Preoperative markers were not associated with recurrence on MVA. CONCLUSIONS De Ritis ratio and comorbid conditions are independent predictors of GFR <45, while CRP and RN are predictive of worsened OS. Using predetermined cutoffs of NLR >3, PLR >185, De Ritis >1.5, and CRP >3 shows significant associations for NLR, PLR, and De Ritis for GFR <45 and NLR, De Ritis, and CRP for worsened OS. Our data suggest a focus on these markers for development of prognostic models. Further investigation is requisite to validate our findings. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e260 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Charles Field More articles by this author Zachary Hamilton More articles by this author Aaron Bloch More articles by this author Katherine Fero More articles by this author Daniel Han More articles by this author Richmond Owusu More articles by this author James Proudfoot More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2017MP59-20 MULTICENTER ANALYSIS OF ONCOLOGIC AND RENAL FUNCTIONAL OUTCOMES OF RADICAL AND PARTIAL NEPHRECTOMY IN STAGE II RENAL CELL CARCINOMA Zachary Hamilton, Andres Correa, Alessandro Larcher, Zineddine Khene, Katherine Fero, Daniel Han, Aaron Bloch, Charles Field, Benoit Peyronnet, Umberto Capitanio, Francesco Montorsi, Karim Bensalah, Robert Uzzo, and Ithaar Derweesh Zachary HamiltonZachary Hamilton More articles by this author , Andres CorreaAndres Correa More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Zineddine KheneZineddine Khene More articles by this author , Katherine FeroKatherine Fero More articles by this author , Daniel HanDaniel Han More articles by this author , Aaron BlochAaron Bloch More articles by this author , Charles FieldCharles Field More articles by this author , Benoit PeyronnetBenoit Peyronnet More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Karim BensalahKarim Bensalah More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1836AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While partial nephrectomy (PN) is an accepted standard for small renal mass, utilization for large (>7cm) renal mass is controversial. We conducted a comparative analysis of survival and functional outcomes of PN and radical nephrectomy (RN) for clinical T2 Renal Mass (cT2RM). METHODS Retrospective international multicenter analysis of PN and RN for cT2RM (T2N0M0) from 1987-2016. Primary outcome was change in glomerular filtration rate (delta eGFR). Secondary outcomes were de novo Stage 3 Chronic Kidney Disease (CKD, eGFR<60), eGFR<45 at last follow up, overall survival (OS), and complication rates. Multivariable (MV) logistic regression was used for outcomes, and Kaplan-Meier (KM) curves were created for OS. RESULTS Study cohort with 1125 patients (239 PN, 886 RN), mean age 60.3 years, median follow up 38.9 months, mean clinical tumor size 9.9 cm, 70.5% cT2a / 29.5% cT2b. PN had higher BMI (29.6 vs. 27.3, p<0.001), as well as higher rate of hypertension (HTN, 59% vs. 47%, p=0.001) and diabetes (DM, 20.9% vs. 13.4%, p=0.005). RN cohort had larger tumor size (10.0 vs. 9.2 cm, p<0.001) and more cT2b disease (32.6% vs. 18.0%, p<0.001). Mean ischemia time for PN was 34.6 min. No significant differences were noted in hospital stay (p=0.697) or 30 day complications (36.0% vs. 36.9%, p=0.821). RN had higher all-cause mortality rate (32.6% vs. 13.4%, p<0.001). KM analysis revealed 5 year OS of 66.9% for RN and 82.2% for PN (p<0.001). KM stratified by cT stage PN vs. RN revealed 5 year OS for cT2a (83.2% vs. 70.1%, p=0.004) and for cT2b (84.6% vs. 60.2%, p=0.003) (figure). Preoperative eGFR was similar (79.4 vs. 77.3, p=0.23), and mean delta eGFR was higher for RN (-20.2 vs. -10.4, p<0.001). RN had worsened renal functional outcomes with respect to de novo GFR <60 (51.2% vs. 28.9%, p<0.001) and de novo GFR <45 (22.8% vs. 14.0%, p<0.001). MV Cox model for OS was significant for age (HR 1.02, p<0.001), DM (HR 1.54, p=0.021), tumor grade 3/4 (HR 2.22, p<0.001), lymphovascular invasion (LVI, HR 1.74, p=0.001), and RN (HR 3.24, p<0.001). CONCLUSIONS PN when performed in the setting of cT2RM provides renal functional benefit and may have survival benefit. Consideration may be given to PN when technically feasible for cT2RM in appropriately selected patients. Prospective data are requisite to confirm. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e789 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Zachary Hamilton More articles by this author Andres Correa More articles by this author Alessandro Larcher More articles by this author Zineddine Khene More articles by this author Katherine Fero More articles by this author Daniel Han More articles by this author Aaron Bloch More articles by this author Charles Field More articles by this author Benoit Peyronnet More articles by this author Umberto Capitanio More articles by this author Francesco Montorsi More articles by this author Karim Bensalah More articles by this author Robert Uzzo More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy VII1 Apr 2017PD73-07 ANALYSIS OF RISK FACTORS ASSOCIATED WITH INFECTIONS COMPLICATIONS FOLLOWING PARTIAL NEPHRECTOMY Richmond Owusu, Michael Liss, Sean Berquist, Abd-elrahma Hassan, Charles Field, Aaron Bloch, Unwanaobong Nseyo, Fang Wan, Zachary Hamilton, and Ithaar Derweesh Richmond OwusuRichmond Owusu More articles by this author , Michael LissMichael Liss More articles by this author , Sean BerquistSean Berquist More articles by this author , Abd-elrahma HassanAbd-elrahma Hassan More articles by this author , Charles FieldCharles Field More articles by this author , Aaron BlochAaron Bloch More articles by this author , Unwanaobong NseyoUnwanaobong Nseyo More articles by this author , Fang WanFang Wan More articles by this author , Zachary HamiltonZachary Hamilton More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3200AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy (PN) is the standard for management for cT1a renal mass and is increasingly used for larger tumors. Compared to radical nephrectomy, however, it may carry a higher risk of procedure-specific complications, including perioperative infections. We determined to identify risk factors for infectious complications after PN METHODS Single-center retrospective analysis of patients who underwent PN from 7/2008-1/2015. Demographics, disease and operative characteristics (including surgical approach and length of antibiotic coverage), and occurrence and site of infectious complications were reviewed. Rate of infectious complications following PN at the 30 day and 90 day postoperative mark was calculated. Multivariable analyses (MVA) for risk factors associated with infectious complications during the first 30 and 90 days postoperatively were performed RESULTS 481 patients were analyzed (mean age 63.1 years, 61.3% male/38.7% Female). Median tumor size was 3.5 cm (IQR 1.9-4.7). Minimally invasive PN was performed in 63.1% (N=299) and open PN was performed in 36.9% (N=175). Urine leak occurred in 21 (4.4%). Infection in first 30 days postoperatively occurred in 29 patients (6%), while infection in first 90 days postoperatively occurred in 42 patients (8.7%). Infection sites during the first 30 day period were wound (N=9), urinary tract (N=8), respiratory (N=7), abscess/sepsis (N=4), and C. difficile (N=3). De novo infectious events >30 and < 90 days were wound (N=6), urinary tract (N=4), and abscess/sepsis (N=4). MVA for infectious complications in first 30 days revealed duration of antibiotic therapy >24 hours (OR 1.91, p=0.01) as being the only independent risk factor for development of infectious complication. MVA for infectious complications during first 90 days postoperatively revealed urine leak (OR 6.21, p<0.001) and increasing delta GFR (OR 1.02, p=0.006) as being independent risk factors CONCLUSIONS Postoperative infectious complications occurred in less than 10% of patients undergoing PN, with most occurring in the first 30 days. Overall wound and urinary tract infections were most common throughout, while abscess/sepsis increased over time, and respiratory and GI/C. difficile decreased over time. Perioperative antibiotics should be limited to <24 hours as part of strategies to reduce risk of infectious sequelae © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1369 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Richmond Owusu More articles by this author Michael Liss More articles by this author Sean Berquist More articles by this author Abd-elrahma Hassan More articles by this author Charles Field More articles by this author Aaron Bloch More articles by this author Unwanaobong Nseyo More articles by this author Fang Wan More articles by this author Zachary Hamilton More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Neoadjuvant sunitinib might facilitate partial nephrectomy (PN) in imperative indications. We performed a retrospective comparison of functional outcomes in patients who had and had not received neoadjuvant sunitinib before PN for imperative indications. We noted similar renal functional outcomes between the 2 groups. To the best of our knowledge, these findings represent the first such reported comparison. Background: Sunitinib might optimize the feasibility of partial nephrectomy (PN) for complex renal tumors with imperative indications. We compared the renal functional outcomes of patients with complex renal masses who had undergone sunitinib before PN with those of patients who had not required neoadjuvant sunitinib before PN. Patients and Methods: We performed a multicenter retrospective analysis of patients with renal cell carcinoma who had undergone PN for a complex renal mass (R.E.N.A.L. nephrometry score, 10-12) and imperative indications from January 2012 to July 2014. Neoadjuvant sunitinib was used in cases for which PN was not considered feasible. The cohort was divided into those patients who had undergone PN without neoadjuvant sunitinib and those who had undergone PN after sunitinib (no-neoadjuvant vs. neoadjuvant). The change in tumor size and R.E.N.A.L. score were assessed. The primary outcome was the change in the estimated glomerular filtration rate (DeGFR) from preoperatively to the last postoperative follow-up visit. Results: The data from 125 consecutive patients were analyzed (47 neoadjuvant and 78 no-neoadjuvant; median follow-up, 21 months). The neoadjuvant plus PN patients had had a greater median tumor size preoperatively (7.2 vs. 6 cm; P=.045). Sunitinib caused a significant decrease in the median tumor size (from 7.2 to 5.8 cm [19.4%]; P=.012) and R.E.N.A.L. score (from 11 to 9; P=.001). No significant differences were found between the neoadjuvant and no-neoadjuvant groups in the ischemia time (P=.413) or incidence of complications (P=.728). The median DeGFR was similar (neoadjuvant, 6.4; no-neoadjuvant, 6.1; P=.534). Linear regression analysis for factors associated with an increasing DeGFR demonstrated increasing age (estimate, -0.074; P=.009) increasing body mass index (estimate, -0.087; P=.043), and decreasing baseline eGFR (estimate, -0.104; P=.02) as significant factors. Conclusion: The use of neoadjuvant sunitinib might facilitate complex PN and result in renal functional outcomes similar to those of patients with a complex renal mass who had not required neoadjuvant sunitinib. Published by Elsevier Inc.

BACKGROUND:We compared quality outcomes between transperitoneal (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN). METHODS:Two-center retrospective analysis of TRPN and RRPN from 10/2009 to 10/2015. Perioperative/renal function outcomes were analyzed. Primary endpoint was Pentafecta, a composite measure of quality [negative margin, no 30-day complication, ischemia time ≤25 min, return of glomerular filtration rate (eGFR) to >90% from baseline at last follow-up, and no chronic kidney disease upstaging]. Multivariable analysis (MVA) for factors associated with lack of optimal outcome was performed. RESULTS:404 patients (TRPN 263, RRPN 141) were analyzed. Comparing TRPN vs. RRPN, mean tumor size (3.1 vs. 2.9 cm, p = 0.122) and RENAL score (7.4 vs. 7.2, p = 0.503) were similar. Most TRPN were anterior (65.0%) and most RRPN posterior (65.3%, p < 0.001). Operative time (p = 0.001) was less for RRPN. No significant differences between TRPN vs. RRPN were noted for ischemia time (23.1 vs. 22.8 min, p = 0.313), blood loss (p = 0.772), positive margins (p = 0.590), complications (p = 0.537), length of stay (p = 0.296), ΔeGFR (p = 0.246), eGFR recovery to >90% (55.9 vs. 57.4%, p = 0.833), and lack of CKD upstaging (84.0 vs. 87.2%, p = 0.464). Pentafecta rates were not significantly different (TRPN 33.9 vs. RRPN 43.3%, p = 0.526). MVA revealed increasing RENAL score (OR 1.5, p < 0.001) and decreasing baseline eGFR (OR 2.4, p = 0.017) as predictive for lack of Pentafecta. CONCLUSIONS:TRPN and RRPN have similar quality outcomes, though RRPN may offer modest benefit for operative time and have utility in posterior tumors. Association of increasing RENAL score and decreased baseline eGFR with lack of Pentafecta suggests dominant role of non-modifiable factors.

BACKGROUND:The aim of this study was to compare outcomes of laparoendoscopic single-site surgery (LESS) and multiport laparoscopic (MPL) radical nephrectomy (RN) for clinical T1b/T2a renal masses, as concerns continue regarding suitability and benefit of LESS for larger renal masses.METHODS:Retrospective single-surgeon comparison of LESS- and MPL-RN between 7/2005 and 11/2014. Sixty-three patients underwent LESS-RN (44 cT1b/19 cT2a); 133 underwent MPL (83 cT1b/50 cT2a). All patients were managed with a standardized care pathway. Primary outcome was length of hospital stay (LOS). Secondary outcomes included operative time, estimated blood loss (EBL), complications, discharge pain score (visual analog pain, VAP), narcotic requirement (morphine equivalents, MSO4eq).RESULTS:130/133 MPL and 62/63 LESS were successfully performed. For MPL and LESS groups: mean tumor diameter (cm) for cT1b was 5.3 vs. 5.4 (P=0.689); and for cT2a was 8.2 vs. 8.3 (P=0.728); mean OR time (min) was 126.3 vs. 132.7 (P=0.314); mean EBL (mL) was 139.5 vs.127.8 (P=0.49). No significant differences in complications were noted (P=0.781). LESS was associated with significant reductions in LOS (2.14 vs. 2.45 days, P=0.043), discharge VAP (1.3 vs. 2.2, P<0.001), and narcotic use (5.9 vs. 10.7 MSO4eq, P<0.001).CONCLUSIONS:LESS is comparable to MPL-RN for cT1b and T2a renal tumors in terms of perioperative parameters and may confer benefit with respect to LOS and analgesic requirement.

continuous and categorical variables, respectively.Outcomes of interest included estimated blood loss, warm ischemia time, estimated glomerular filtration rate at 6 months, length of stay, margin status, Fuhrman grade, tumor size, pathological histology, and symptoms index at presentation RESULTS: Among our cohort, 376 (62%) and 228 (38%) patients with were scheduled for RN and PN, respectively.Of the 228 patients originally scheduled for PN, 12% were converted to RN intraoperatively.A smaller proportion of patients scheduled to undergo PN had clear cell/conventional histology (77% vs 88%; p¼0.001) on pathology compared to patients scheduled for RN.Among patients with clear cell or papillary histology, a larger proportion of patients scheduled for PN had lower Fuhrman grade (24% vs 10.3% had FG 1 or 2; p<0.0001) on pathology than patients scheduled for RN.Of our 604 patients, 111 patients died, 33 from kidney disease.The median follow up time for survivors was 2.0 years from surgery.On multivariable analysis, scheduled PN was non-significantly associated with better OS (HR 0.62; 95% C.I. 0.37, 1.03; p ¼ 0.064), better CSS (HR 0.51; 95% C.I. 0.18, 1.49; p ¼ 0.2), and better RFS (HR 0.56; 95% C.I. 0.29, 1.07; p¼0.081).From the estimates of the hazard ratio, we suspect that the bias related to surgeons choosing PN or RN based on low or high risk disease is not appropriately adjusted for in our model CONCLUSIONS: We found no evidence to suggest that PN has poorer outcomes than RN in patients with pT3a tumors.The inherent benefits of PN on renal function preservation make this approach very attractive even in larger and complex tumors

535 Background: Clinical Stage II Renal Cell Carcinoma (RCC) is a heterogeneous disease characterized by disparate oncological outcomes. The risk of progression and recurrence can vary widely. We analyzed risk factors associated with oncological outcomes in a contemporary cohort. Methods: Retrospective multicenter analysis of patients who underwent surgical excision of clinical stage 2 (T2) renal mass between 1998-2015. Patients with tumors amenable to nephron−sparing surgery, baseline chronic kidney disease, or bilateral renal masses were provided an option for partial nephrectomy (PN), otherwise radical nephrectomy (RN) was performed. Lymphadenectomy (LND) was performed at the discretion of the surgeon due to concern for lymphadenopathy on preoperative imaging or at time of surgery. Patients with pN+ disease and pathological pT upstaging/downstaging were excluded. Primary endpoint was Recurrence Free Survival (RFS). Univariable linear regression, Kaplan−Meier Analysis (KMA) log−rank test, and multivariable analysis (MVA) for factors related to RFS and overall survival (OS) were performed. Results: 695 patients were analyzed (mean age 59.3 years, median follow up 49.6 months, 61.4% male/38.6% female, 545 RN/150 PN, 193 LND/502 no LND). MVA for factors associated with worsened RFS revealed lymphovascular invasion (LVI, HR 2.27, p=0.002), positive margins (HR 2.67, p=0.008), and tumor grade 3/4 (HR 2.04, p<0.008). MVA for decreased OS revealed LVI (HR 2.58, p=0.003), positive margins (HR 2.34, p=0.044), and tumor grade 3/4 (HR 2.08, p=0.023) as risk factors. KMA revealed 5 year RFS of 76.1% for LVI negative and 46% for LVI positive patients (p<0.001), and 5 year RFS of 78.1% for Tumor Grade I/II and 53.7% for Tumor Grade III/IV (p<0.001). KMA revealed 5 year OS of 79.2% for LVI negative and 60.6% for LVI positive patients (p<0.001). Conclusions: For Stage II RCC, LVI, positive margin, and tumor grade III/IV are independently associated with worsened RFS and OS. Further investigation is requisite and may add weight to consider these specific stage II RCC patients as a higher risk subgroup with implications for staging revision and clinical trial design.

You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging I1 Apr 2017MP22-02 SYNERGISTIC PROGNOSTIC IMPACT OF ELEVATED DE RITIS RATIO AND RENAL SCORE FOR PREDICTION OF SURVIVAL OUTCOMES IN RENAL CELL CARCINOMA AFTER SURGICAL TREATMENT Aaron Bloch, Zachary Hamilton, Charles Field, Katherine Fero, Sean Berquist, Abd-elrahma Hassan, Brittney Cotta, Daniel Han, Richmond Owusu, Sunil Patel, Fang Wan, James Proudfoot, and Ithaar Derweesh Aaron BlochAaron Bloch More articles by this author , Zachary HamiltonZachary Hamilton More articles by this author , Charles FieldCharles Field More articles by this author , Katherine FeroKatherine Fero More articles by this author , Sean BerquistSean Berquist More articles by this author , Abd-elrahma HassanAbd-elrahma Hassan More articles by this author , Brittney CottaBrittney Cotta More articles by this author , Daniel HanDaniel Han More articles by this author , Richmond OwusuRichmond Owusu More articles by this author , Sunil PatelSunil Patel More articles by this author , Fang WanFang Wan More articles by this author , James ProudfootJames Proudfoot More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.656AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal Cell Carcinoma (RCC) is a metabolically driven neoplasm. Inflammatory markers and morphometric measures have been suggested to be predictive for prognosis. We investigated the impact of a novel combination of preoperative tumor morphology (RENAL score) and a laboratory based inflammatory marker (DeRitis Ratio, AST/ALT) on survival outcomes in localized RCC. METHODS Single center, retrospective analysis of 524 patients with RCC (312 PN, 212 RN, mean follow up 35.8 months) from 2003-2015. A priori, we assigned a positive marker score of 1 if RENAL >8 or DeRitis >1.5. Patients were stratified by increasing positive markers (0=RENAL ≤8 and DeRitis ≤1.5, 1=RENAL >8 or DeRitis >1.5, 2=RENAL >8 and DeRitis>1.5). Primary outcome was overall survival (OS). Cox models and Kaplan-Meier curves were utilized. RESULTS 524 patients, 68% male, mean age 64.8 ± 12.6 years, mean BMI 29.1 ± 6.5, mean DeRitis 1.1 ± 0.4. With regards to tumor characteristics, mean clinical tumor size was 4.8 ± 3.3cm and median RENAL score was 8 (IQR 6-10). For clinical staging, 74% were cT1, 19% cT2, and 6% were >T2. On Cox model for OS, RENAL >8 (HR 1.95, p=0.003) and DeRitis >1.5 (HR 3.74, p<0.001) were significantly associated with worsened survival. On Cox model output for OS and marker score, we found 1 marker (HR 1.83, p=0.011) and 2 markers (HR 7.68, p<0.001) were significantly associated with worsened survival (figure). CONCLUSIONS Novel combination of a morphological score (RENAL) and an inflammatory marker (DeRitis ratio) was associated with worsened OS in RCC after surgical treatment. Our findings point towards development and validation of a prognostic index to assist in risk stratification and follow up protocols for RCC. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e256-e257 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Aaron Bloch More articles by this author Zachary Hamilton More articles by this author Charles Field More articles by this author Katherine Fero More articles by this author Sean Berquist More articles by this author Abd-elrahma Hassan More articles by this author Brittney Cotta More articles by this author Daniel Han More articles by this author Richmond Owusu More articles by this author Sunil Patel More articles by this author Fang Wan More articles by this author James Proudfoot More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...