Download Carcinoma renale (I): Posters Review

Carcinoma renale (I): Posters Review
Elena Verzoni
Oncologia Medica 1
SS.Oncologia Genitourinaria
Fondazione IRCCS
Istituto Nazionale Tumori
Milano
Agenda: “Best Posters” in Localized RCC
• Surgery: CN (# 503; # 499), Elderly patients (# 497)
• Genomic profiling: # 513
• Immune profiling: # 511
• DFS as surrogate for OS in adjuvant setting: # 459
# Abstract 503: Impact of cytoreductive nephrectomy on timing of systemic
therapy in metastatic kidney cancer; Macleod LC et al
• Patients identified in the National Cancer Database (NCDB) from
2006-2013 who were ≥ 18yo with biopsy-proven mRCC and who
were treated initially with systemic therapy (N=14,651)
• Main outcome: receipt of cytoreductive nephrectomy after initial
systemic therapy
• Secondary outcomes: surgical characteristics/complication• Unadjusted and multivariable logistic regression was
performed, identifying factors associated with cytoreductive
nephrectomy after initial systemic therapy
Table 2: Factors
associated with
decreased (blue fill)
and increased (yellow
fill) odds of receiving
deferred CN
•
•
Older age, greater comorbidity, poor risk disease
(measured by death ≤ 3 mos.
post-diagnosis), and adverse
histology were associated with
decreased utilization of
deferred CN
Treatment at a cancer center
and/or a higher volume center,
was associated with increased
receipt of deferred CN
Median OS
Fig 2: Overall
survival of
patients with
deferred
surgery
compared with
no surgery
after initial ST
(unadjusted, log
rank p<0.001)
4.9 mo vs 19 mo
•
Median ST to CN 69 days (IQR 28 to128)
# Abstract 499: The role of cytoreductive nephrectomy (CN) in elderly
patients with metastatic renal cell carcinoma in an era of targeted therapy;
Uprety D et al
• Objective: To compare overall survival (OS)
and cancer-specific survival (CSS) between
elderly patients who had or had not
undergone CN.
• Methods: SEER database (2006-2011) RCC
patients > 65 years
• 3365 patients -> 1088 (32%) had CN
OS: 22 months vs 5 months
Cancer-specific survival: 25 months vs 6 months
# Abstract 497: Management of renal masses in an octogenarian cohort: is
there a right approach? Nawlo J et al
• 113 patients > 80 years old referred at Moffitt
Cancer center between 2000-2013
• Mean age: 83 years (range 80-92)
Active Surveillance
(AS)
Partial Nephrectomy
(PN)
Radical Nephrectomy
(RN)
27 (22%)
33(26.8%)
53 (43%)
84
83
81.9
Deaths (30.6 mo Fup)
for any cause
13 (48%)
10 (30.3%)
29 (54.7%)
OS median
55.8 mo
81 mo
57 mo
Patients
Mean age
NOT stats significance on multivariate (p 0.29) or univariate (p 0.588)
Conclusions
Active treatment with PN or RN may not provide
a survival benefit among octogenarians
# Abstract 513: Genomic profiling of nephrectomy and metastatic sites
in patients with advanced clear cell renal cell carcinoma (RCC);
G de Velasco et al.
 Genomic alterations in samples from primary (N) as
compared distant mets (M)
 Tumor mutation burden (TMB) was also assessed as
the number of somatic point mutations per megabase
of targeted territory
 Methods: 237 primary RCC nephrectomy specimen
and 156 samples from unmatched metastases
TMB is similar between primary and
mets
Conclusions: Primary and
Metastatic RCC share the majority
of common genomic alterations
 The study does not provide
evidence of genomic alterations
landscape in paired samples from
the same patients
# Abstract 511: Immune cell phenotyping of clear cell renal cell
carcinoma; Ghanaat M et al
Objective: to characterize the T−cell
populations in a cohort of largely untreated
high risk patients with ccRCC.
We prospectively collected ccRCC tumor and
adjacent normal kidney (NK) from patients
undergoing surgical resection at our
institution from 6/2015-12/2016 (n=37 pts)
• Analysis of immune cell populations were
determined by CD45+ staining and
corresponding proportions of different T−cell
populations (CD3+, CD4+, CD4+Treg and CD8+
T cells).
Mann-Whitney test was
utilized to compare
the immune
populations between
tumor and adjacent
NK tissue.
Analysis was further
conducted by
stratifying patients
who presented with
localized versus
metastatic disease.
A total of 37 tumor and
adjacent NK were analyzed.
Overall 84% of tumors had
higher immune infiltrate with
an average ratio of four-fold
increase compared to adjacent
NK as determined by CD45+
cells.
The other 16% presented with
metastatic disease.
Our data shows a general trend of immune infiltration in
ccRCC when compared to adjacent NK with a diversity of
T cell subsets and possible evidence of immune exclusion.
# Abstract 459: Meta-analysis of disease free survival (DFS) as a
surrogate for overall survival (OS) in localized renal cell carcinoma
(RCC); Harshman LC et al
Take home messages
 Role of CN is still unclear in clinical practice
 Active surveillance, expecially in older
patients could be the first choice
 We have more to learn about the role of
mutations in RCC
 DFS may be a surrogate of OS in adjuvant
setting but we need more data
Grazie per l’attenzione!
[email protected]