Poster, Podium & Video Sessions
Presentation Authors: Pascal Mouracade*, Onder Kara, Julien Dagenais, Matthew Maurice, Ryan Nelson, Ercan Malkoc, Jaya Sai Chavali, Jihad Kaouk, Cleveland, OH
Introduction: The question of whether upstaged and nonupstaged tumors have different outcomes continue to be discussed in the literature. Few published studies address this question, with a wide range of results. The aim of this study was to evaluate perioperative morbidity, oncological outcome and predictors of pT3a upstaging after partial nephrectomy(PN).
Methods: Retrospective study of 1042 patients who underwent PN for cT1 renal cell carcinoma between 2007 and 2015. A total of 113 cT1 patients were upstaged to pT3a, while 929 were staged pT1. Demographic, perioperative and pathological variables were reviewed. We compared the clinico-pathological characteristics, perioperative morbidity and oncological outcomes between pT3a and pT1 groups. Multivariate regression evaluates variables associated with T3a upstaging. Progression-free survival (PFS) and overall survival analyses were performed.
Results: pT3a tumors had a higher R.E.N.A.L score, higher hilar location, higher grade, and higher positive surgical margins. Patients with pT3a had a higher estimated blood loss, transfusion rate, ischemia time, overall complications, while there were no difference in median e-GFR decline and major (Grade III-V) complications. Five-year PFS was 78.5% for pT3a group, vs 94.6% for pT1 group (Log rank p <0.01). Male gender (OR 2.2, p<0.01), and R.E.N.A.L score (OR 2.3, p=0.01) were preoperative predictors of upstaging.
Conclusions: Perioperative morbidity is acceptable in pT3 tumors, however upstaged patients had a worse oncological outcomes. cT1/pT3a tumors are associated with adverse clinico-pathological features. Preoperative risk predictors of upstaging were, higher R.E.N.A.L score and male gender.
Source Of Funding: None
Pascal M. Mouracade MD, MPH, PhD
Department of Urology Glickman Urological and Kidney Institute-Cleveland Clinic
Expertise in mini-invasive surgery, Laparoscopy and Robotic Surgery : Consultant Mini-invasive surgery and Robotics. Strasbourg University Hospital-Fellowship Cleveland clinic center for robotics and image guided surgery Urologic Surgery, mini-invasive surgery and Robotics. French Teaching Hospitals
Expertise in Epidemiology and Biostatistics.
Active Staff at French University Hospital, Urology Department.
Active as Faculty Member in the education of Residents and Medical Students.
Authored publications and book chapters and presented clinical research in Oncology, Minimally Invasive Urologic Surgery, Urinary Incontinence, Endourology, and neurourology at national and regional Urological Surgery meetings.
Academic Degrees: Medical Doctor, Master of public Health and Doctor of Philosophy.
Post-doctoral training : Residency ( strasbourg, Paris), clinical fellow ( Strasbourg) Research Fellowship ( Strasbourg, Cleveland clinic)
Board Certification : French board of Urologic Surgery-French board of General Surgery
Honors and Rewards : European Urology Resident Education Programme EUREP at Prague in 2006: First price. Coloplast Foundation Reward 2010: Best research protocol in Low urinary tract symptoms. Sessions To Evaluate Progress in the management of urological cancers-European Association of Urology STEPS programme. French Academy of Surgery (Académie Française de Chirurgie) 2013 : First price (pathways involved in the resistance to therapeutic agents in metastatic renal cell carcinoma)
Editorial Reviewer: European Urology-Progrès en Urologie-Journal of endourology-World journal of urology-Urology
Professional Organizations: Member of the French Association of Urology-member of the European Association of Urology-EAU- Associate member of the European Association of Urology Section of Oncological Urology (ESOU)- member of the American Urological Association-Member of the French National Medical Council
Sunday, May 14
9:30 AM – 11:30 AM
Sunday, May 14
3:30 PM – 5:30 PM
Monday, May 15
7:00 AM – 9:00 AM