MP36-11 CLINICOPATHOLOGIC AND GENOMIC FACTORS ASSOCIATED WITH RECURRENCE IN PATIENTS WITH STAGE III-IV CHROMOPHOBE RENAL CELL CARCINOMA

297 Background: Palliative care (PC) offers various benefits for patient with cancer that include, but are not limited to, decrease in disease-specific symptoms and improvement in functional status. Several oncological guidelines have adopted early integration of PC into oncologic care to improve quality of life among patients with advanced malignancies. However, PC utilization patterns and factors associated with its use in advanced renal cell carcinoma (RCC) remain poorly understood. Methods: Using the National Cancer Database (NCDB), we abstracted patients with stage III and IV RCC from 2004-2014 and evaluated PC utilization amongst this cohort. Socioeconomic and clinical factors were compared for patient receiving and not receiving PC for advanced RCC. Multivariable logistic regression identified factors that were associated with receipt of PC. Results: We identified 20,122 and 42,014 patients with stage III and IV RCC, respectively. Among this cohort, 329 and 9,317 patients received PC for stage III and IV RCC, respectively. From 2004 to 2014, PC utilization has been stable at ~1% for stage III RCC and has significantly increased from 17% to 20% for stage IV RCC. Multivariable analysis demonstrated that Blacks, income >$48,000, regions outside of Northeast, stage III RCC, and patients that received surgery were less likely to receive PC. Patients that were female, with more comorbidities, uninsured or with government insurance, lower educational status, treated at academic or integrated cancer program, with sarcomatoid histology, receiving systemic therapy were more likely to receive PC. Conclusions: While PC utilization has significantly increased for stage IV RCC, there are several demographic, socioeconomic, and clinical factors that predict PC usage among patients with advanced RCC. Taken together, this suggests the need for more equitable and systematic use of PC among patients with advanced RCC.

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Factors associated with palliative care utilization in advanced and metastatic renal cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.146 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 146-146

Author(s):

Hiren V. Patel ◽

Joshua Sterling ◽

Arnav Srivastava ◽

Sinae Kim ◽

Biren Saraiya ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Palliative Care ◽

Cell Carcinoma ◽

Renal Cell ◽

Stage Iv ◽

Stage Iii ◽

Care Utilization ◽

Clinical Factors ◽

Factors Associated ◽

Specific Manner

146 Background: Palliative care (PC) offers various benefits for patient with cancer that include, but are not limited to, decrease in disease-specific symptoms and improvement in functional status. Several oncological guidelines have adopted early integration of PC into oncologic care to improve quality of life among patients with advanced malignancies. However, PC utilization patterns and factors associated with its use in advanced renal cell carcinoma (RCC) remain poorly understood. Methods: Using the National Cancer Database (NCDB), we abstracted patients with Stage III and IV RCC from 2004-2014 and evaluated PC utilization amongst this cohort. Socioeconomic and clinical factors were compared for patient receiving and not receiving PC for advanced RCC. Multivariable logistic regression identified factors that were associated with receipt of PC among the overall cohort and treatment-based cohorts. Results: Among 20,122 and 42,014 patients with Stage III and IV RCC, 329 and 9,317 patients received PC, respectively. From 2004 to 2014, PC utilization was stable at ̃1% for Stage III RCC and minimally increased from 17% to 20% for Stage IV RCC. Multivariable analysis demonstrated that increased comorbidities, insurance status, higher education status, facility location, care at a comprehensive cancer program or integrated network, sarcomatoid histology, and prior treatments significantly increased likelihood of palliative care utilization. We uncover socioeconomic and clinical factors that are associated with receipt of palliative care use in a treatment-specific manner. Conclusions: While PC utilization has minimally increased for Stage IV RCC, there are several demographic, socioeconomic, and clinical factors that predict PC use, especially in a treatment-specific manner, among patients with advanced RCC. Taken together, this suggests the need for more equitable and systematic use of PC among patients with advanced RCC.

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MP66-05 CLINICOPATHOLOGICAL AND SURVIVAL ANALYSIS OF STAGE III/IV PAPILLARY AND CHROMOPHOBE RENAL CELL CARCINOMA: IMPLICATIONS FOR FUTURE CLINICAL TRIALS

The Journal of Urology ◽

10.1016/j.juro.2018.02.1877 ◽

2018 ◽

Vol 199 (4S) ◽

Author(s):

Alain Kaldany ◽

David Paulucci ◽

Harry Anastos ◽

Alp Tuna Beksac ◽

John Sfakianos ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Clinical Trials ◽

Survival Analysis ◽

Cell Carcinoma ◽

Renal Cell ◽

Chromophobe Renal Cell Carcinoma ◽

Stage Iii

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Patients with metastatic chromophobe renal cell carcinoma treated with sunitinib therapy: Analysis of an international database regarding outcome and comparison to clear cell histology (mccRCC).

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.429 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 429-429

Author(s):

Daniel Keizman ◽

David Sarid ◽

Jae-Lyun Lee ◽

Maya Gottfried ◽

Natalie Maimon ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Clinical Benefit ◽

Renal Cell ◽

Smoking Status ◽

Progression Free Survival ◽

Chromophobe Renal Cell Carcinoma ◽

P Value ◽

First Line ◽

Factors Associated

429 Background: Sunitinib (Su) is a standard therapy (tx) for mccRCC. Data on its activity in the rare variant of metastatic chromophobe renal cell carcinoma (mchRCC) are limited by very small or heterogeneous (mixed histology with papillary type, or mixed targeted therapies) studies. We analyzed the activity of Su in a relatively large and homogenous international cohort of mchRCC pts, in terms of outcome and comparison to mccRCC. Methods: Records from mchRCC pts treated with first-line Su in 9 centers across 4 countries were retrospectively reviewed. Univariate and multivariate analyses of association between clinicopathologic factors and outcome were performed. Subsequently, mchRCC pts were individually matched to mccRCC pts. We compared the response rate (RR), progression free survival (PFS), and overall survival (OS) between the groups. Results: Between 2004-2014, 33 pts (median age 64, 45% male) with mchRCC were treated with Su as first-line tx. 76% had a prior nephrectomy. HENG risk was good 27%, intermediate 55%, and poor 18%. 33% were active smokers, and 30% users of angiotensin system inhibitors (ASIs). 55%, 27%, and 33% had lung, liver, and bone metastases, respectively. 48% had a pre-tx neutrophil to lymphocyte ratio (NLR) >3. 42% had dose reduction/tx interruption (DR/TI). Su-induced hypertension (HTN) occurred in 48%. 75% achieved a clinical benefit (partial response + stable disease), while 25% had disease progression within the first 3 months of tx. Median PFS and OS were 10 and 26 months, respectively. Factors associated with PFS were the HENG risk (HR 3.8, p=0.025) and pre-tx NLR >3 (HR 0.6, p=0.012). Factors associated with OS were the HENG risk (HR 4.27, p=0.027), liver metastases (HR 4.6, p=0.029), and pre-treatment NLR <3 (HR 0.5, p=0.04). Tx outcome was not significantly different between mchRCC pts and mccRCC pts, who were individually matched by HENG risk, nephrectomy/smoking status, pre-tx NLR, use of ASIs, DR/TI, and Su induced HTN. In mccRCC pts (p value versus mchRCC), 70% achieved a clinical benefit (p=0.58), and median PFS and OS were 9 (p=0.7) and 24 (p=0.6) months, respectively. Conclusions: In mchRCC pts, Su tx may have similar outcome to mccRCC pts.

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