(UroToday.com) The 2023 American Urological Association Annual Meeting hosted a session on kidney cancer, featuring the work of Dr. Ameeta Nayak and colleagues on renal tumors. Although most kidney tumors are characterized as benign, there are some malignant tumors that develop slowly and are difficult to assess properly. As such, their team sought to create a point-of-care prediction tool to determine kidney tumor malignancy and high-grade malignancy. Pre-existing models that have been developed are limited due to their small sample size and inclusion of surgically treated patients only. Thus, developing these predictive models for a wider population of patients is integral to determining the optimal management plan and being prepared to treat malignancy early on.
5,517 patients with solitary renal masses were identified from the Canadian Kidney Cancer information system (CKCis), consisting of patient data from 14 Academic sites between January 2011 to October 2022. Additionally, patients were only identified for the study if they were specifically at clinical stage T1 and T2 disease. The patients’ demographics, clinical data, and imaging were compared to their pathologic diagnosis, done via surgery or biopsy. Tumors were then stratified as being malignant or benign, as well as aggressive (i.e. high-grade malignancy) or indolent (i.e. low-grade malignancy, benign). Logistic regression models were developed in order to determine disease predictors within each category. Prediction models included age, sex, and tumor size on imaging. Furthermore, nomograms were created with statistically significant risk factors, where p < 0.05. Bootstrap methods were performed to internally validate discrimination and calibration.
Their team found that of the 5,517 CKCis solitary tumor patients, 92% had malignant histology and 40% had high-grade disease. Of note, male sex and tumor size were factors associated with malignancy and high-grade malignancy. Furthermore, there was a correlation between age and sex identified for malignancy, such that malignancy risk statistically decreased as men grew older but increased (but not statistically) as women aged. Older age was concluded to be a predictor for high-grade malignancy. Nomograms could be developed with excellent calibration that could distinguish between benign versus malignant tumors, as well as aggressive versus indolent tumors.
Dr. Nayak concluded that the patient’s age, sex, and tumor size on imaging were independent risk factors for malignancy and high-grade malignancy. It is additionally necessary for other factors, such as Radiomics, to be considered to create a highly accurate prediction. As her takeaway for the audience, she stated, “These prediction tools can be used by patients and physicians to help guide treatment decisions.” Although there were no follow-up questions, one of the moderators did comment on the “elegant work being done.” He further expressed how renal cell cancer is a hematologic malignancy and he would want to see more data towards what is going on at the level of the chest. Regardless, Dr. Nayak’s presentation on her team’s prediction tool has offered great insight into how renal mass malignancy can be managed based on surgery and biopsy histology with these predictive models.
Figure 1. The relationship between tumor size and cancer.
Figure 2. The calibration curves of the prediction models.
Presented by: Ameeta Nayak, Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ontario, ON, Canada
Written by: Thao Vu, Department of Urology, University of California Irvine, @thaonvu_ on Twitter during the 2023 American Urological Association (AUA) Annual Meeting, Chicago, IL, April 27 – May 1, 2023
References:
- Ameeta Nayak, Luke Lavallee, Ranjeeta Mallick, Simon Tanguay, Frederic Pouliot, Antonio Finelli, Anil Kapoor, Ricardo Rendon, Alan So, Darrel Drachenberg, Birnal Bhindi, Jean-Baptiste Lattouf, Lucas Dean, Aly-Khan Lalani, Lori Wood, Daniel Heng, Rodney Breau. Is a Renal Tumour Benign or Malignant? A Prediction Tool Including Patients Managed with Surgery, Ablation, or Surveillance [abstract]. In: American Urological Association Annual Meeting. April 28 – May 1, 2023, Chicago, Illinois