294 Background: Black men have the highest incidence of clear cell renal cell carcinoma (ccRCC) and have a worse prognosis than women or White patients in the curative setting. We previously reported that women with metastatic ccRCC have an inferior prognosis to men which is dynamic with age. The prognosis of Black patients with metastatic ccRCC is not well described. Methods: Clinicopathologic features and survival of patients diagnosed with clinical stage IV ccRCC between 2004-2016 were obtained from the National Cancer Database (NCDB). Patients were stratified according to their age at diagnosis, race, and sex. Uni- and multi-variable chi-square, logistic regression, and overall survival (OS) analyses were used for comparisons. Results: In this cohort, there were 900 Black men, 461 Black women, 13,422 White men, and 6363 White women. Black patients were less likely to have private insurance, lung metastases, or to live in high income zip codes and were more likely to have liver metastases. Compared to White race, Black race was associated with worse OS in the overall cohort (HR 1.17 [95% CI 1.10-1.24], p<0.001; multivariate HR 1.14 [95% CI 1.06-1.21], p<0.001) and in a smaller cohort limited to patients receiving systemic therapy as their initial treatment modality (n=10,869; HR 1.22 [95% CI 1.11-1.33], p<0.001). Within age groups, the highest disparity was observed among younger patients (<50yr: median OS 12.0 vs 22.1mo, p=0.004; 50-64yr: 14.6 vs 20.7mo, p=0.0001; >65yr 9.7 vs 14.5mo, p=0.002). When stratified by age and race, males had similar or superior survival compared to females in most subgroups, however Black males under 50yrs had markedly inferior OS compared with Black females (median OS 10.4mo vs 17.1mo for Black females, p=0.0083) and compared with White patients (Table). Conclusions: Young Black males with metastatic ccRCC demonstrate remarkably poor OS in this cohort; whereas males otherwise have a more favorable prognosis. Potential hypotheses to explain this disparity include differences in obesity and smoking incidence in this population as well as unmeasured factors impacting access to care.[Table: see text]
e15018 Background: This study sought to evaluate cancer-specific outcomes among patients who received perioperative mitomycin C (MMC) prior to induction BCG versus those who received induction BCG alone. Methods: Between January 2000 and August 2010, 260 patients were identified who underwent a course of induction BCG with or without concomitant perioperative MMC. Specifically, patients who received 40 mg MMC following transurethral resection of all visible tumor followed by an induction course of BCG were compared to a similar cohort of patients who received induction BCG alone. The primary endpoints were overall and recurrence-free survival (RFS). Results: A total of 212 patients were identified who received induction BCG alone, and 48 who received perioperative MMC with induction BCG. The aggregate patient cohort was comprised of those with non-muscle-invasive disease (NMI), and there was no difference between groupings with respect to common demographic and pathologic variables. Over a median follow-up of 34.5 months, there was no difference in overall survival between cohorts. RFS was superior among patients who received combined therapy (5 year survival: 37.5% vs 56.3%, p=0.023). Nevertheless, the regimen of intravesical therapy did not reach significance as an independent predictor (HR 0.61, p= 0.055, CI 0.36-1.01). Conclusions: Although the combination therapy group demonstrated a significant RFS advantage, the intravesical therapy regimen did not independently modulate this benefit. Further investigation is warranted to determine if immediate MMC prior to a course of induction BCG confers a benefit to RFS.
To assess 30-day morbidity and mortality following partial nephrectomy (PN) and radical nephrectomy (RN) with relation to the administration of perioperative blood transfusions PBT).The National Surgical Quality Improvement Program was queried for patients with malignant renal tumors (International Classification of Diseases Ninth Revision codes 189-189.2) who underwent RN (Current Procedure Terminology codes 50220, 50225, 50230, 50234, 50236, 50545, 50546, 50548) or PN (50240, 50543) between 2005-2013. Patients were stratified by transfusion status and assessed for postoperative outcomes both separately and in composite, including morbidity, mortality, infectious complications, and pulmonary complications. Univariate and multivariate analyses were performed to identify significant independent predictors of these composite outcomes.The overall transfusion rates were 15.8% and 8.2% for RN and PN, respectively. On multivariate analysis, PBT was associated with increased morbidity (RN: OR 2.147, 95% CI 1.687-2.733; PN: OR 2.081, 95% CI 1.434-3.022), mortality (RN: OR 2.308, 95% CI 1.159-4.598; PN: OR 5.166, 95% CI 1.207-22.12), infectious complications (RN: OR 1.656, 95% CI 1.151-2.383; PN: OR 1.945, 95% CI 1.128-3.354) and pulmonary complications (RN: OR 3.040, 95% CI 2.125-4.349; OR 3.771, 95% CI 2.108-6.746).For patients undergoing RN or PN there is a significant association between receipt of PBT and 30-day postoperative outcomes, specifically overall morbidity, mortality, infectious complications, and pulmonary complications. The mechanism that underlies these effects has not been elucidated, but it most likely involves immunomodulation and acute lung injury. Future research should focus on formulating comprehensive transfusion guidelines for oncologic-related nephrectomies.
