AUA 2018: Predictors of Pheochromocytoma Surgery Outcomes Using a Pre-Operative Severity Classification Scale

San Francisco, CA (UroToday.com) Pheochromocytoma is an adrenal pathology (benign or malignant) that may be referred to urologist for management. Surgical resection is often warranted, particularly if a patient is symptomatic or the mass is enlarged. However, adrenalectomy is not a commonly performed operation (as prior abstracts in this session have noted). Hence, the authors attempt to generate a pre-operative severity scale to help predict surgical outcomes of adrenalectomy for pheochromocytoma – based on clinical manifestations of the pheochromocytoma. Patients were treated over a 10-year period (2000-2017).

The classification scheme of the pheochromocytomas was as follows: (presumably on pre-operative manifestations)

Class I- incidentaloma
Class II: asymptomatic + controlled hypertension
Class III: symptomatic + controlled hypertension
Class IV: uncontrolled hypertension or hemodynamic crisis

156 patients were included in the study. Basic demographic data: mean age 48 ± 18 yrs, 54% were female, mean BMI was 26 ± 3, 57% of masses were right sided and 6% were bilateral, and 34% of patients had a familial disorder (VHL 29%, NF1 19%). Based on the above classification, the proportion of patients in each group was: Class 1 (25%), Class 2 (20.5%), Class 3 (37%), and Class 4 (16%).

In terms of surgical approach, 18% were open, 56% laparoscopic and 26% robotic.

The primary outcomes were post-operative complications according to the Clavien-Dindo classification. A total of 5% sustained a ≥Clavien 3a complication (30% had any degree of complication). While not in their original abstract, the authors provided a copy of their manuscript – in this, the risk of complications clearly increased with increasing PCSS score. Class 4 patients had a 21% rate of ≥Clavien 3a complications while patients with Class 1 pheo had only a 5% risk (p = 0.05).

On univariate analysis, PCSS, BMI, history of hypertension, and number of hypertensives prescribed were associated with risk of complications; however, on MV analysis, only BMI was significant (OR 1.1, p < 0.01) – though not a strong predictor based on its OR.

The authors do note that adding PCSS to BMI was able to increase the predictive ability of the model – final AUC was 0.752.

Unfortunately, the title of this study is quite misleading. Rather than looking at whether this scale predicted surgical outcomes, despite accounting for other variables, it seems the authors focused on the predictors of pre-operative clinical manifestations. The analysis appears to be a little backward!

Presented By: Joel Hillelsohn, MD New York Medical College
Co-Authors: Joel Hillelsohn, Valhalla, NY, Soroush Rais-Bahrami, Vidhush Yarlagadda, Luciana Schwartz, Jennifer Gordetsky, Birmingham, AL, Victor Srougi, Sao Paulo, Brazil, John Phillips, Valhalla, NY

Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, | twitter: @tchandra_uromd at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA

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