Nephrometry scores to predict oncological outcomes following partial nephrectomy (UroCCR Study 70).

PURPOSE: Partial nephrectomy (PN) for large or complex renal tumors can be difficult and associated with a higher risk of recurrence than radical nephrectomy. We aim to evaluate the clinical useful of nephrometry scores for predicting oncological outcomes in a large cohort of patients who underwent PN for renal cell carcinomas. METHODS: Our analysis included patients who underwent PN for renal cell carcinoma in 21 French academic centers (2010-2020). RENAL, PADUA, and SPARE scores were calculated based on preoperative imaging. Uni- and multivariate cox models were performed to identify predictors of recurrence-free survival and overall survival. The area under the curve (AUC) was used to identify models with the highest discrimination. Decision curve analyses (DCAs) determined the net benefit associated with their use. RESULTS: A total of 1927 patients were analyzed with a median follow-up of 32 months (14-45). RENAL score (p = 0.01), age (p = 0.002), histological type (p = 0.001), high nuclear grade (p = 0.001), necrotic component (p < 0.001), and positive margins (p = 0.005) were significantly related to recurrence in multivariate analyses. The discriminative performance of the 3 radiological scores was modest (65, 63, and 63%, respectively). All 3 scores showed good calibration, which, however, deteriorated with time. Decision curve analysis of the three models for the prediction of overall and recurrence-free survival was similar for all three scores and of limited clinical relevance. CONCLUSION: The association between nephrometry scores and oncological outcomes after NP is very weak. The use of these scores for predicting oncological outcomes in routine practice is therefore of limited clinical value.

Impact of Renal Cell Carcinoma Histological Variants on Recurrence After Partial Nephrectomy: A Multi-Institutional, Prospective Study (UROCCR Study 82).

BACKGROUND: The prognostic impact of renal cell carcinoma (RCC) morphotype remains unclear in patients who undergo partial nephrectomy (PN). Our objective was to determine the risk factors for recurrence after PN, including RCC morphotype. METHODS: Patients with RCC who had undergone PN were extracted from the prospective, national French database, UroCCR. Patients with genetic predisposition, bilateral or multiple tumours, and those who had undergone secondary totalization were excluded. Primary endpoint was 5-year, recurrence-free survival (RFS), and secondary endpoint was overall survival (OS). Risk factors for recurrence were assessed by multivariable Cox regression analysis. RESULTS: Overall, 2,767 patients were included (70% male; median age: 61 years [interquartile range (IQR) 51-69]). Most (71.5%) of the PN procedures were robot-assisted. Overall, 2,573 (93.0%) patients were recurrence free, and 74 died (2.7%). Five-year RFS was 84.9% (IQR 82.4-87.4). A significant difference in RFS was observed between RCC morphotypes (p < 0.001). Surgical margins (hazard ratio [HR] = 2.0 [95% confidence interval (CI): 1.3-3.2], p < 0.01), pT stage >1 (HR = 2.6 [95% CI: 1.8-3.7], p < 0.01]) and Fuhrmann grade >2 (HR = 1.9 [95% CI: 1.4-2.6], p < 0.001) were risk factors for recurrence, whereas chromophobe subtype was a protective factor (HR = 0.08 [95% CI: 0.01-0.6], p = 0.02). Five-year OS was 94.0% [92.4-95.7], and there were no significant differences between RCC subgroups (p = 0.06). The main study limitation was its design (multicentre national database), which may be responsible for declarative bias. CONCLUSIONS: Chromophobe morphotype was significantly associated with better RFS in RCC patients who underwent PN. Conversely, pT stage, Fuhrman group and positive surgical margins were risk factors for recurrence.

Factors improving the diagnostic performance of targeted biopsies in the diagnosis of significant prostate cancer.

INTRODUCTION: MRI-targeted biopsy improves detection of significant prostate cancer (csPCa) and grade prediction. The aim of this study was to identify factors improving the diagnostic performance of targeted biopsies (TB) in detecting csPCa. METHODS: Retrospective monocenter study of patients who underwent a radical prostatectomy (RP) for prostate cancer (PCa) and diagnosed by transrectal combined biopsies (CB) with elastic MRI/ultrasound fusion. We evaluate the diagnostic performance of standardized (SB), targeted (TB) and CB for csPCa, including sensitivity, specificity, and ROC curve. Univariables and logistic regression analysis were performed to analyze factors improving the diagnostic performance of TB in detecting csPCa on final histopathology. RESULTS: Two hundred and four men underwent RP after CB with suspicious lesions (PI-RADS≥3) on MRI were included. csPCa was significantly associated with prostate volume, PSA density, a lesion index in the peripheral zone, with a diameter≥7mm. TB were positives for 174 patients (85.3%). Prostate volume, PSA density, radiological coherence, previous biopsies, and a number of biopsies≥3 were significantly associated with a cancer detection. csPCa on TB, a prostate volume<60mL, an index lesion≥7mm and a peripheral zone location were significant predictive factors for diagnostic of csPCa on final histopathology. Area under the ROC curve values, sensitivities and specificities of CB and TB (adjusted model) were 0.78 [0.72-0.84], 77.3 [70.3-83.4], 78.1 [60-90.7], and 0.85 [0.79-0.90], 83.7 [77.3-88.9] and 75 [56.6-88.5] respectively. CONCLUSION: This study confirms the benefit of CB and suggests that TB for a selected population could be as effective as CB.