Abstracts from the Abstracts from the Mid-Atlantic Section of the AUA 2021

MA-AUA 2021 Abstracts Moderated Poster Session 4: Kidney/Bladder/Penile/Testicular/ Adrenal Cancer Surgical Delay After Biopsy and Risk of Upstaging for Clinical T1a Renal Cell Carcinoma L. Xia, R. Talwar, R. Chelluri, D. Lee, T. Guzzo Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, Philadelphia, PA, USA Introduction andObjective: Renal mass biopsy (RMB) has been increasingly used as the initial management of small renal masses (SRMs). However, little is known about whether surgical delay after the positive biopsy increases the risk of upstaging for small renal cell carcinomas (RCCs). Methods: Patients with clinical T1aN0M0 RCCs (≤4cm) diagnosed between 2010 and 2016 who underwent RMB and then partial nephrectomy (PN) or radical nephrectomy (RN) were identified from National Cancer Database (NCDB). Surgical delay time (SDT) was defined as days between RMB and PN or RN. SDT was categorized into 1-30 days, 31-60 days, 61-90 days, 91- 120 days, and 121-180 days. Upstaging to pT3a was the primary outcome. Positive surgical margin (PSM) was secondary outcome (PN cohort only). Results: A total of 4,340 patients were included and 237 (5.5%) patients had pT3a upstaging. PSM rate was 8.2% in the PN cohort. pT3a upstaging and PSM rates stratified by SDT is shown in the Figure. Compared with SDT of 1-30 days, SDT of 31-60 days (odds ratio [OR]=1.04, P=0.833), 61-90 days (OR=1.17, P=0.481), and 91-120 days (OR=1.14, P=0.631) were not associated with increased odds of pT3a upstaging. Patients with SDT of 121-180 days had a higher risk of pT3a upstaging (OR=1.93, P=0.016). No significant associations between SDT and PSM were found. Conclusions: In this NCDB study, increased SDT from RMB to definitive surgical resection of cT1aN0M0 RCCs was not associated with worse oncologic outcomes within 120 days after the RMB but patients with SDT > 120 days might have increased risk of upstaging. These findings have significant implications for patient counseling regarding active surveillance, RMB, and definitive surgical resection for SRMs. MP4-11 Survival Outcomes in Late, Intermediate and Early Recurrence Renal Cell Carcinoma M. Rostom, J. Cheaib, J. Campbell, S. Patel,M.Allaf,Y. Ged,N. Singla, P. Pierorazio Johns Hopkins Brady Institute of Urology, Baltimore, MD, USA Introduction and Objective: Despite increasing kidney cancer detection, mortality from the disease remains steady. Unfortunately, the group of patients that die from kidney cancer largely consists of those have a recurrence after surgical intervention. This study aims to explore survival differences in patients with recurrent renal cell carcinoma based on various clinical metrics. Methods: We identified 226 patients with a median age of 61.4 years who had recurrent RCC after nephrectomy. We examined sites of recurrence, time to recurrence, mortality, and chemotherapy they received. Multivariable logistic regression models were utilized to evaluate survival outcomes based on time to recurrence. Data was further stratified based on chemotherapy and sites of metastases. Results: Univariable andmultivariable analyses show that early recurrences (<2 years) are associated with significantly worse survival than those with intermediate or late recurrences. There is no significant difference in survival after recurrence based on tumor histology. Patients with multiple recurrence sites rather than a single site were at 2.32 times greater risk of death at 10 years. Patients with recurrence or new tumors in the ipsilateral or contralateral kidney demonstrated favorable long-term survival. Conclusions: Early recurrence in RCC portends a poor prognosis for patients. Time to recurrence in RCC reflects a number of biological parameters including a higher likelihood of multiple, distant metastases. There is no survival difference among patients who recur within 2-5 years and those that recur after >5 years. Patients with recurrences in the ipsilateral or contralateral kidney have favorable survival outcomes, indicating the likely de novo etiology of these tumors. MP4-10 29