Evaluating the role of microvascular invasion as a prognosticator in renal cell cancer

1. Aim In this cohort study we aim to evaluate the role of microvascular invasion (MVI) on disease-specific survival in comparison to macrovascular disease and absence of vascular invasion. Secondarily, a study of the relationship between several other clincopathological factors and their role in outcome is examined. These include: Age Gender Size and Histopathological type of tumour Introduction The role of macrovascular invasion in prognostication of renal cell cancer has been well shown, and features within the AJCC TNM staging system. Microvascular invasion (MVI) is commonly reported, yet a link between this phenomenon and disease-specific survival is less well established. • Conclusions • Microvascular invasion is an independent prognostic factor. Our finding is consistent result repeated in previous studies (1,2). MVI should be considered for incorporation into future staging systems for RCC, and has the capacity to potentially change future treatment decisions. Macrovascular invasion and tumour size are other important independent prognosticators. Results • Methods • Case selection: • Data on 959 nephrectomies undertaken at Princess Alexandra Hospital, Brisbane, Australia between January 1990 and December 2010.All relevant data was extracted, and more recent admissions, indicating survival, noted. • Inclusion criteria: • T1-4NxM0 disease • Exclusion criteria: • Known metastatic disease • Non RCC histopathology • Multiple tumours within resected specimen • Total of 650 eligible cases included • Statistical analysis: • Risk factors for death due to RCC were examined using a Cox proportional hazards regression model. • Kaplan Meier survival plots were used to observe trends within factors eg. degree of vascular invasion, size of tumour and type of tumour • Multivariate analysis was conducted utilising a forward step-wise Cox proportional hazards model Acknowledgements Dr Malcolm Lawson, Department of Urology, Princess Alexandra Hospital, Brisbane Ian Wilson, Research Assistant, Department of Urology, Princess Alexandra Hospital, Brisbane References 1. Dall'Oglio MF, Ribeiro-Filho LA, Antunes AA, Crippa A, Nesrallah L, Gonçalves PD, Leite KR, Srougi M. Microvascular tumor invasion, tumor size and Fuhrman grade: a pathological triad for prognostic evaluation of renal cell carcinoma. J Urol Aug 2007; 178:425-8 2. Van Poppel H, Vandendriessche H, Boel K, Mertens V, Goethuys H, Haustermans K, Van Damme B, Baert L. Microscopic vascular invasion is the most relevant prognosticator after radical nephrectomy for clinically nonmetastatic renal cell carcinoma. J Urol Jul 1997; 158: 45-9 • 5 year disease-specific survival (statistically different) • No vascular invasion: 90.5% • MVI: 71.5% • Macrovascular: 56.5% Three factors were found to be independent risk factors at multivariate analysis when compared to absence of vascular invasion over 10 years: Macrovascular invasion: HR 4.14; 95% CI, 2.7-6.3; p < 0.001 Microvascular invasion HR 2.55; CI, 1.5-4.4; p < 0.001 Size of Tumour ( > 7cm) HR 2.93; CI, 2.0-4.3; p < 0.001 No. 065 Evaluating the role of microvascular invasion as a prognosticator in renal cell cancer G. EVANS1, M. RANAWEERA1, H. SRINATH2, I. WILSON1, M. LAWSON1 1Princess Alexandra Hospital, Woolloongabba, Australia; 2University of Queensland, St Lucia, Australia Captions to be set in Arial font italic and no smaller than 6 points, to the length of the column in case when a figure takes more than 2/3 of column width. Poster presentation sponsor