You have accessJournal of UrologyKidney Cancer: Epidemiology & Evaluation/Staging/Surveillance I (MP36)1 May 2024MP36-17 RENAL FUNCTIONAL IMPROVEMENT AFTER PARTIAL NEPHRECTOMY: PREDICTORS AND CONSEQUENCES Kit L. Yuen, Cesare Saitta, Yasuhisa Fujii, Edouard Nicaise, Riccardo Autorino, Andrea Minervini, Gabriele Tuderti, Giuseppe Simone, Riccardo Campi, Clara Cerrato, Antonio Franco, Dhruv Puri, Mimi V. Nguyen, Margaret Meagher, Jacob Roberts, Jonathan A. Afari, Luke Wang, Kevin Hakimi, Franklin Liu, Rachel Greenwald, Chen Wei, Sahar Imtiaz, Dattatraya Patil, Kobayashi Masaki, Kazutaka Saito, Fukuda Shohei, Hajime Tanaka, Viraj Master, and Ithaar H. Derweesh Kit L. YuenKit L. Yuen , Cesare SaittaCesare Saitta , Yasuhisa FujiiYasuhisa Fujii , Edouard NicaiseEdouard Nicaise , Riccardo AutorinoRiccardo Autorino , Andrea MinerviniAndrea Minervini , Gabriele TudertiGabriele Tuderti , Giuseppe SimoneGiuseppe Simone , Riccardo CampiRiccardo Campi , Clara CerratoClara Cerrato , Antonio FrancoAntonio Franco , Dhruv PuriDhruv Puri , Mimi V. NguyenMimi V. Nguyen , Margaret MeagherMargaret Meagher , Jacob RobertsJacob Roberts , Jonathan A. AfariJonathan A. Afari , Luke WangLuke Wang , Kevin HakimiKevin Hakimi , Franklin LiuFranklin Liu , Rachel GreenwaldRachel Greenwald , Chen WeiChen Wei , Sahar ImtiazSahar Imtiaz , Dattatraya PatilDattatraya Patil , Kobayashi MasakiKobayashi Masaki , Kazutaka SaitoKazutaka Saito , Fukuda ShoheiFukuda Shohei , Hajime TanakaHajime Tanaka , Viraj MasterViraj Master , and Ithaar H. DerweeshIthaar H. Derweesh View All Author Informationhttps://doi.org/10.1097/01.JU.0001008612.93052.9d.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) has emerged as the reference standard for localized renal mass management due superior functional preservation over radical nephrectomy. A proportion of patients experience renal function improvement post-PN. We sought to identify and characterize factors contributing to this phenomenon. METHODS: This was a retrospective multicenter analysis of patients who underwent open or minimally invasive (MIS) PN. Post-PN functional improvement was defined as eGFR ≥10% of preoperative baseline at last follow-up. Cox regression multivariable analysis (MVA) was performed to identify factors associated with improved function and non-cancer mortality (NCM). Kaplan-Meier analysis (KMA) assessed non-cancer specific survival (NCS) comparing eGFR≥10%, GFR improvement less than 10%/decline greater than 25% (+10%<ΔGFR<-25%), and eGFR decline>25% (ΔGFR>-25%). RESULTS: We analyzed 3,845 patients [1,535 (39.9%) female/2,310 (59.2%) male; median follow-up 48.2 months]. Improved eGFR was noted in 626 (16.3%). Clear cell RCC (cc RCC; HR 1.46, p=0.038), and clampless technique (HR 1.43, p=0.018) were associated with greater likelihood of eGFR≥10%. Increasing age (HR 0.93, p=0.001), diabetes mellitus (HR\ 0.071, p=0.012), MIS (HR 0.76, p=0.009), increasing Charlson comorbidity index (HR 0.92, p=0.019), decreasing preoperative eGFR (HR 0.97, p<0.001) and increasing tumor size (HR 0.92, p=0.002) had decreased likelihood of eGFR≥10%. Cox regression revealed eGFR≥10% (HR 0.54, p=0.006), Latino and Asian ethnicity (HR 0.41, p=0.001-0.021) to be associated with decreased NCM, while increasing age (HR 1.03, p<0.001), male (HR 1.63, p=0.002), and DM (HR 1.42, p=0.014) were associated with increased NCM. KMA comparing eGFR≥10%, +10%<∆GFR<-25%, and ∆GFR>-25% revealed 5-year NCS of 95.5%, 96.1%, and 93.2%, respectively (p=0.0001). CONCLUSIONS: A small but significant proportion of patients experience improved eGFR post-PN; eGFR improvement was associated with decreased NCM risk. When feasible and safe, clampless technique may optimize functional preservation and recovery leading to improved function and NCM reduction in select patients. Improvement after ccRCC excision suggests impact of tumor histology-driven renal microenvironment on function. Further investigation is requisite. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e599 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Kit L. Yuen More articles by this author Cesare Saitta More articles by this author Yasuhisa Fujii More articles by this author Edouard Nicaise More articles by this author Riccardo Autorino More articles by this author Andrea Minervini More articles by this author Gabriele Tuderti More articles by this author Giuseppe Simone More articles by this author Riccardo Campi More articles by this author Clara Cerrato More articles by this author Antonio Franco More articles by this author Dhruv Puri More articles by this author Mimi V. Nguyen More articles by this author Margaret Meagher More articles by this author Jacob Roberts More articles by this author Jonathan A. Afari More articles by this author Luke Wang More articles by this author Kevin Hakimi More articles by this author Franklin Liu More articles by this author Rachel Greenwald More articles by this author Chen Wei More articles by this author Sahar Imtiaz More articles by this author Dattatraya Patil More articles by this author Kobayashi Masaki More articles by this author Kazutaka Saito More articles by this author Fukuda Shohei More articles by this author Hajime Tanaka More articles by this author Viraj Master More articles by this author Ithaar H. Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyBladder Cancer: Invasive III (PD34)1 May 2024PD34-07 LONG-TERM ONCOLOGIC OUTCOMES OF TETRAMODAL BLADDER-PRESERVATION THERAPY INCORPORATING INDUCTION CHEMORADIOTHERAPY AND CONSOLIDATIVE PARTIAL CYSTECTOMY WITH PELVIC LYMPHNODE DISSECTION FOR MUSCLE-INVASIVE BLADDER CANCER Hajime Tanaka, Motohiro Fujiwara, Akira Hasegawa, Hiroki Tanaka, Kotaro Suzuki, Tomoki Kimura, Rikuto Yasujima, Tsubasa Ito, Riko Ikeda, Shunya Matsumoto, Kasumi Yoshitomi, Masaki Kobayashi, Yuki Nakamura, Bo Fan, Wei Chen, Yudai Ishikawa, Shohei Fukuda, Yuma Waseda, Soichiro Yoshida, Ryoichi Yoshimura, Kazunori Kihara, and Yasuhisa Fujii Hajime TanakaHajime Tanaka , Motohiro FujiwaraMotohiro Fujiwara , Akira HasegawaAkira Hasegawa , Hiroki TanakaHiroki Tanaka , Kotaro SuzukiKotaro Suzuki , Tomoki KimuraTomoki Kimura , Rikuto YasujimaRikuto Yasujima , Tsubasa ItoTsubasa Ito , Riko IkedaRiko Ikeda , Shunya MatsumotoShunya Matsumoto , Kasumi YoshitomiKasumi Yoshitomi , Masaki KobayashiMasaki Kobayashi , Yuki NakamuraYuki Nakamura , Bo FanBo Fan , Wei ChenWei Chen , Yudai IshikawaYudai Ishikawa , Shohei FukudaShohei Fukuda , Yuma WasedaYuma Waseda , Soichiro YoshidaSoichiro Yoshida , Ryoichi YoshimuraRyoichi Yoshimura , Kazunori KiharaKazunori Kihara , and Yasuhisa FujiiYasuhisa Fujii View All Author Informationhttps://doi.org/10.1097/01.JU.0001008768.36634.79.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chemoradiation (CRT)-based bladder-preservation therapy is currently acknowledged as a curative treatment option for muscle-invasive bladder cancer (MIBC). However, one of the major concerns is the risk of MIBC recurrence, which may be originated from latent cancer cells remaining after CRT. We developed tetramodal bladder-preservation therapy (TeMT) incorporating induction CRT and consolidative partial cystectomy (PC) with pelvic lymphnode dissection (PLND). This study assessed the long-term oncologic outcomes of MIBC patients treated with TeMT. METHODS: Following the institutional review board approval (# M2000-453), we prospectively enrolled 201 patients with N0M0 MIBC between 1997 and 2020. All the patients met the inclusion criteria for the enrollment (Figure 1). After maximal transurethral resection and induction CRT, patients who had complete remission of cancer or small amount of microscopic Ta/is cancer remaining at the original tumor site underwent consolidative PC with PLND and achieved bladder preservation; salvage radical cystectomy was offered to the other patients. RESULTS: The median age was 69, and 157 patients (78%) were male. Overall 171 patients (85%) sufficiently responded to induction CRT. Among them, 148 (74%) underwent consolidative PC according to the protocol. Pathological examination of the PC specimens revealed that residual bladder cancer in 15 patients (10%) including 3 (2.0%)/2 (1.4%)/10 (6.8%) showing ypTis/T1/T2-3, respectively and lymphnode metastasis in 4 (2.7%) were surgically removed in this surgery. During the median follow up of 6.2 years (IQR: 4.1-9.8), 31 (15%) in the intent-to-treat (ITT) patients and 13 (8.8%) in those who underwent PC died of bladder cancer. 5/10 year-cancer-specific survival was 85%/82% in ITT patients, respectively, and 92%/90% in patients undergoing PC, respectively. The cumulative incidences of MIBC recurrence after PC were 6.0% at 5 years and 8.8% at 10 years. CONCLUSIONS: TeMT protocol incorporating induction CRT and consolidative PC with PLND yielded favorable long-term oncologic outcomes for optimally selected patients with MIBC. Consolidative PC may contribute to decreasing the risk of MIBC recurrence. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e721 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Hajime Tanaka More articles by this author Motohiro Fujiwara More articles by this author Akira Hasegawa More articles by this author Hiroki Tanaka More articles by this author Kotaro Suzuki More articles by this author Tomoki Kimura More articles by this author Rikuto Yasujima More articles by this author Tsubasa Ito More articles by this author Riko Ikeda More articles by this author Shunya Matsumoto More articles by this author Kasumi Yoshitomi More articles by this author Masaki Kobayashi More articles by this author Yuki Nakamura More articles by this author Bo Fan More articles by this author Wei Chen More articles by this author Yudai Ishikawa More articles by this author Shohei Fukuda More articles by this author Yuma Waseda More articles by this author Soichiro Yoshida More articles by this author Ryoichi Yoshimura More articles by this author Kazunori Kihara More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement PDF downloadLoading ...

Cabozantinib plus nivolumab (Cabo/Nivo) for patients with previously untreated advanced or metastatic clear cell renal cell carcinoma (ccRCC) demonstrated significant improvement of clinical outcomes, compared with sunitinib, in a randomized phase III trial (CheckMate-9ER). The results support Cabo/Nivo as standard regimen in global guidelines for those patients. However, limited numbers of Japanese patients were enrolled in the trial, and little information on the safety and efficacy in Japanese patients is available. Several previous studies, especially on vascular endothelial growth factor receptor (VEGFR) inhibitor-induced toxicity, have reported ethnic differences; therefore, it is important to clarify toxicity profiles in Japanese patients. Furthermore, there is limited information on this regimen for special populations in the real-world, such as patients with non-clear cell renal cell carcinoma (nccRCC) or those undergoing dialysis. This study evaluates the real-world efficacy and toxicity of Cabo/Nivo in Japanese patients with both ccRCC and nccRCC. We conducted a prospective observational study to evaluate Cabo/Nivo treatment in Japanese patients with advanced or metastatic RCC in the realworld. A total of 72 institutions throughout Japan have been participating in this study from April 2023. This study consists of two cohorts: cohort A (ccRCC) and cohort B (nccRCC). The target enrollment is 150 in cohort A and 50 in cohort B. Key inclusion criteria includes (1) histologically diagnosed with ccRCC or nccRCC, (2) clinically diagnosed with advanced or metastatic RCC, (3) patients received Cabo/Nivo, (4) previously untreated with systemic therapy (patients who recur more than 180 days after the last administration of adjuvant PD-1 or PD-L1 inhibitor therapy are allowed), (5) KPS score of ≥70%. Primary endpoint is overall response rate in each cohort, Secondary endpoints are progression-free survival, duration of response, overall survival, and safety in each cohort. Forty-three and 13 patients have been enrolled in cohorts A and B, respectively, as of July 2023. UMIN000050778. Clinical Research Support Center Kyushu. Takeda Pharmaceutical Company Limited.

ABSTRACT Introduction Radical cystectomy (RC) is still gold standard for muscle invasive bladder cancer (MIBC). Whereas, bladder-sparing therapy with transurethral resection of bladder tumor (TUR) and chemoradiation therapy (CRT) has been recognized as an alternative treatment to RC for selected patients with MIBC. We have developed and implemented tetra-modality bladder-sparing therapy (TeMT) incorporating partial cystectomy (PC) in addition to maximal TUR and induction CRT to overcome local recurrence after bladder-sparing therapy (Kageyama et al. Am J Clin Oncol 2003, Koga et al. BJU Int 2012, Kijima et al. BJU Int 2019). There are few studies on erectile and ejaculatory functions after bladder-sparing therapy. Objective To cross-sectionally survey erectile and ejaculatory functions after TeMT in patients with MIBC. Methods Of the total 117 male patients with MIBC who completed TeMT between 2006 and 2019, 70 patients were set as the target to distribute the questionnaires after excluding patients lost to follow up as of February 2020, patients with local recurrence of MIBC or additional prostate cancer treatment. Erectile function was assessed using the International Index of Erectile Function short form (IIEF-5), and ejaculatory function using Male Sexual Health Questionnaire Ejaculatory Dysfunction short form (MSHQ-EjD-SF). Attending physicians handed the questionnaires to the patients at the first regular outpatient visit after February 2020 and had the patients complete them outside the office. Results Of 44 patients received the questionnaires between February and August 2020, 35 completed the questionnaires. The median age (range) of the eligible patients was 70 (50-87) years old, and the median time from the date of PC to the date of response was 5.2 (0.35-14) years. The results of IIEF-5 showed that 3 (9%) had no erectile dysfunction (ED) (22-25 points), 9 (26%) had mild ED (17-21 points), 4 (11%) had mild to moderate ED (12-16 points), 4 (11%) had moderate ED (8-11 points), and 15 (43%) had severe ED (5-7 points). Based on the results of MSHQ-EjD-SF, 23 patients (66%) responded that they could ejaculate. Of those, 5 patients (14%) scored 4 or higher on all questions 1-3 of MSHQ-EjD-SF, suggesting that they did not have ejaculatory dysfunction. Conclusions Preservation of erectile and ejaculatory functions was observed in MIBC patients treated with bladder-sparing therapy. Along with that of lower urinary tract function, preservation of male sexual function in bladder-sparing therapy, especially ejaculatory function which is inevitably lost by RC, is considered to be an advantage over RC. Disclosure Work supported by industry: no.