Monday July 01, 2019 from 07:30 to 09:00
Prognostic impact of paraneoplastic syndromes on patients with non-metastatic renal cell carcinoma undergoing surgery: Results from Canadian Kidney Cancer
Ryan Sun1, Anil Kapoor2, Antonio Finelli3, Frédéric Pouliot4, Ricardo A. Rendon5, Alan I. So6, Adrian Fairey7, Simon Tanguay8, Luke T. Lavallée9, Rodney H. Breau9, Jean-Baptiste Lattouf10, Jun Kawakami11, Lori A. Wood5, Daniel Heng12, Naveen Basappa7, Georg Bjarnason13, Ranjeeta Mallick14, Rahul Bansal1.
1Urology, University of Manitoba, Winnipeg, MB, Canada; 2Urology, St. Joseph's Hospital, Hamilton, ON, Canada; 3Urology, University Health Network, Toronto, ON, Canada; 4Urology, CHUQ, Québec City, QC, Canada; 5Urology, Dalhousie University, Halifax, NS, Canada; 6Urology, University of British Columbia, Vancouver, BC, Canada; 7Urology, University of Alberta, Edmonton, AB, Canada; 8Urology, McGill University, Montréal, QC, Canada; 9Urology, University of Ottawa, Ottawa, ON, Canada; 10Urology, CHUM, Montréal, QC, Canada; 11Urology, Alberta Health Services, Calgary, AB, Canada; 12Medical Oncology, University of Calgary, Calgary, AB, Canada; 13Urology, Sunnybrook Hospital, Toronto, ON, Canada; 14Ottawa Hospital Research Institute, Ottawa, ON, Canada
Introduction: The impact of paraneoplastic syndromes (PNS) on survival in patients with renal cell carcinoma (RCC) is uncertain. This study was conducted to analyze the association of PNS with recurrence-free survival (RFS) and overall survival (OS) in patients with non-metastatic RCC undergoing nephrectomy.
Methods: From the Canadian Kidney Cancer information system (CKCis) database, a prospective cohort of patients who underwent nephrectomy for non-metastatic RCC from 2011–2018 was identified. Patients with PNS were identified and compared to patients without PNS. PNS identified were one or more of anemia, polycythemia, hypercalcemia, and weight loss. Association of PNS with RFS and OS was examined. Univariate and multivariate analyses were performed.
Results: Of 2724 patients, 1004 (36.9%) had evidence of one or more PNS. Mean age was 60.6 years (standard deviation [SD] 11.6) and 1769 (64.9%) were males. Median Charlson comorbidity index (CCI) score was 3 (interquartile range [IQR] 1–4). There was no significant difference between groups with regards to gender, race, or family history of kidney cancer. In the group with PNS, patients were of advanced age, had higher CCI score, and advanced clinical tumour stage as compared to patients without PNS. The five-year projected OS in patients without PNS was 87.8% (95% confidence interval [CI] 84.2–90.6) as compared to 80.3% (95% CI 75.5–84.3) in patients with PNS (p<0.0001). On univariate analysis, presence of PNS adversely affected RFS (hazard ratio [HR] 1.68; 95% CI 1.47–1.92; p<0.0001) and OS (HR 1.90; 95% CI 1.38–2.63; p<0.0001) (Table 1). On multivariate analysis, PNS did not predict RFS or OS when adjusted for age, CCI score, tumour size, grade, pathological stage, and tumour margin (Table 2).
Conclusions: In non-metastatic RCC patients undergoing surgery from CKCis database, the presence of PNS (one or more of anemia, polycythemia, hypercalcemia, and weight loss) is associated with advanced age, higher CCI score, and advanced tumour stage but not with poor RFS or OS.