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Sources of Funding: Stephen Weissman Kidney Cancer Research Fund_x000D_ NIH grants UL1TR000100 and UL1TR001442

Introduction

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.

Funding

Stephen Weissman Kidney Cancer Research Fund_x000D_ NIH grants UL1TR000100 and UL1TR001442