29: Mayo Adhesive Probability Score is Associated with Worse Overall Survival in Patients Undergoing Surgery for Clinical Stage T1 Renal Cell Carcinoma

Background: The Mayo Adhesive Probability (MAP) score is predictive of adherent perinephric fat in patients undergoing surgery for renal cell carcinoma (RCC). Higher MAP scores are associated with worse perioperative outcomes and progression-free survival in surgically-treated localized RCC. Here, we examine the ability of MAP score to predict overall survival (OS) in our large, diverse cohort.

Methods: Retrospective review of our nephrectomy database was conducted for patients with cT1 renal masses and RCC histology. Exclusion criteria included nodal or metastatic disease, multiple masses, history of nephrectomy, estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73m2, unavailable preoperative imaging/laboratory data, and missing follow-up. 457 patients underwent MAP scoring and were dichotomized as low (1-3) or high (4-5). ANOVA for numerical and generalized chi-square tests for categorical variables were used to test for differences between scores. Multivariable Cox proportional hazards models and Kaplan-Meier curves estimated the relationship with 10-year OS.

Results: 136 (29.8%) patients with high MAP scores were associated with older age (63.6 vs 56.8 years; p< 0.001), increased BMI (31.9 vs 30.4kg/m2; p=0.032), diabetes (37.5% vs 25.5%; p=0.010), hypertension (81.6% vs 60.1%; p< 0.001), and worse eGFR (73.4 vs 83.4; p< 0.001). Increased operating time (276 vs 258 minutes; p=0.002), and 30-day complications (4.1% vs 0.6%; p=0.003) were also observed. Aggressive features on pathology were associated with high MAP, including tumor necrosis (22.8% vs 13.4%; p=0.013) and renal vein invasion (2.9% vs 0.3%; p=0.013), although no difference in perinephric fat invasion (10.3% vs 5.9%; p=0.099) or pathologic upstaging (14% vs 10.6%; p=0.302) was seen. High MAP displayed worse OS for RCC and clear-cell RCC (ccRCC, Figure 1), which persisted on multivariable analysis (All RCC: HR 1.89; p=0.046; ccRCC: HR 3.88; p< 0.001).

Conclusions: High MAP scores were associated with aggressive pathological features and predicted worse 10-year overall survival following surgery in patients with cT1 RCC.