Adverse Pathologic Features Research Articles

Quality-of-Life Outcomes and Toxicity Profile Among Patients With Localized Prostate Cancer After Radical Prostatectomy Treated With Stereotactic Body Radiation: The SCIMITAR Multicenter Phase 2 Trial

Postoperative radiation therapy (RT) is an underused standard-of-care intervention for patients with prostate cancer and recurrence/adverse pathologic features after radical prostatectomy. Although stereotactic body RT (SBRT) is a well-studied and convenient option for definitive treatment, data on the postprostatectomy setting are extremely limited. The purpose of this study was to evaluate short-term physician-scored genitourinary (GU) and gastrointestinal (GI) toxicities and patient-reported outcomes after postprostatectomy SBRT. The SCIMITAR trial was a phase 2, dual-center, open-label, single-arm trial that enrolled patients with postoperative prostate-specific antigen >0.03 ng/mL or adverse pathologic features. Coprimary endpoints were 4-year biochemical recurrence-free survival, physician-scored acute and late GU and GI toxicities by the Common Terminology Criteria for Adverse Events (version 4.03) scale, and patient-reported quality-of-life (QOL) outcomes, as represented by the Expanded Prostate Cancer Index-26 and the International Prostate Symptom Score. Patients received SBRT 30 to 34 Gy/5 fractions to the prostate bed ± bed boost ± pelvic nodes with computed tomography (CTgRT) or magnetic resonance imaging guidance (MRgRT) in a nonrandomized fashion. Physician-scored toxicities and patient-reported QOL outcomes were collected at baseline and at 1, 3, and 6 months of follow-up. Univariable and multivariable analyses were performed to evaluate predictors of toxicities and QOL outcomes. One hundred participants were enrolled (CTgRT, n=69; MRgRT, n=31). The median follow-up was 29.5 months (CTgRT: 33.3 months, MRgRT: 22.6 months). The median (range) prostate bed dose was 32 (30-34) Gy. Acute and late grade 2 GU toxicities were both 9% while acute and late grade 2 GI toxicities were 5% and 0%, respectively. Three patients had grade 3 toxicity (n=1 GU, n=2 GI). No patient receiving MRgRT had grade 3 GU or grade ≥2 GI toxicity. Compared with CTgRT, MRgRT was associated with a 30.5% (95% confidence interval, 11.6%-49.5%) reduction in any-grade acute GI toxicity (P=.006). MRgRT was independently associated with improved any-grade GI toxicity and improved bowel QOL. Postprostatectomy SBRT was well tolerated at short-term follow-up. MRgRT may decrease GI toxicity. Longer toxicity and/or efficacy follow-up and randomized studies are needed.

Conditional cause-specific survival after chemotherapy and local treatment for primary stage IV breast cancer: A population-based study.

BackgroundConditional survival (CS) represents the probability of surviving for additional years after the patient has survived for several years, dynamically describing the survival rate of the patient with the varying time of survival. The aim of this study was to evaluate the conditional cause-specific survival (CCSS) after chemotherapy and local treatment for metastatic breast cancer, and to identify the prognostic factors affecting the CCSS.MethodsPatients diagnosed with primary stage IV breast cancer in the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015 were included. CS is defined as the probability of additional survival for y years after the patient had survived x years with the calculation formula CCSS (x | y) = CSS (x + y)/CSS (x), where CSS(x) indicates the patient’s cause-specific survival rate at the time of x years. Cox proportional hazard models were used to evaluate predictors of CCSS.ResultsA total of 3,194 patients were included. The 5-year CSS was 39%, whereas the 5-year CCSS increased to 46%, 57%, 71%, and 85% after the diagnosis of 1, 2, 3, and 4 years. For patients with adverse clinical pathological features, CCSS had more pronounced increase with survival time and is more different from the CSS at diagnosis. No matter at the time of diagnosis or 1 year or 3 years after diagnosis, HER2 status, local treatment, and multisite metastasis were independent prognostic factors that affect the long-term survival of patients (all P < 0.05).ConclusionThe 5-year CCSS of patients with stage IV breast cancer was extended as the survival years increased. HER2 status, multisite metastasis, and local treatment were independent prognostic factors even 3 years after diagnosis.

Analysis of separate training and validation radical prostatectomy cohorts identifies 0.25 mm diameter as an optimal definition for “large” cribriform prostatic adenocarcinoma

AbstractCribriform growth pattern is well-established as an adverse pathologic feature in prostate cancer. The literature suggests “large” cribriform glands associate with aggressive behavior; however, published studies use varying definitions for “large”. We aimed to identify an outcome-based quantitative cut-off for “large” vs “small” cribriform glands. We conducted an initial training phase using the tissue microarray based Canary retrospective radical prostatectomy cohort. Of 1287 patients analyzed, cribriform growth was observed in 307 (24%). Using Kaplan–Meier estimates of recurrence-free survival curves (RFS) that were stratified by cribriform gland size, we identified 0.25 mm as the optimal cutoff to identify more aggressive disease. In univariable and multivariable Cox proportional hazard analyses, size >0.25 mm was a significant predictor of worse RFS compared to patients with cribriform glands ≤0.25 mm, independent of pre-operative PSA, grade, stage and margin status (p < 0.001). In addition, two different subset analyses of low-intermediate risk cases (cases with Gleason score ≤ 3 + 4 = 7; and cases with Gleason score = 3 + 4 = 7/4 + 3 = 7) likewise demonstrated patients with largest cribriform diameter >0.25 mm had a significantly lower RFS relative to patients with cribriform glands ≤0.25 mm (each subset p = 0.004). Furthermore, there was no significant difference in outcomes between patients with cribriform glands ≤ 0.25 mm and patients without cribriform glands. The >0.25 mm cut-off was validated as statistically significant in a separate 419 patient, completely embedded whole-section radical prostatectomy cohort by biochemical recurrence, metastasis-free survival, and disease specific death, even when cases with admixed Gleason pattern 5 carcinoma were excluded. In summary, our findings support reporting cribriform gland size and identify 0.25 mm as an optimal outcome-based quantitative measure for defining “large” cribriform glands. Moreover, cribriform glands >0.25 mm are associated with potential for metastatic disease independent of Gleason pattern 5 adenocarcinoma.

Microfocal prostate cancer: a clinicopathological analysis of 206 cases

Objective: To investigate the clinical and pathological features and prognosis of patients with microfocal prostate adenocarcinoma. Methods: Clinical and pathological data of the patients diagnosed with microfocal adenocarcinoma on prostate biopsy at the West China Hospital from 2013 to 2019 were collected. Microfocal adenocarcinoma was defined as follows: Gleason score of 3+3=6, total number of the cores ≥10, number of the positive cores ≤2, and proportion of the tumor in each positive core<50%. Clinicopathological parameters, treatment plans and follow-up data were collected. Pathological information of the biopsy and radical resection specimens was used to analyze the correlation between pathological parameters in the biopsy report and adverse pathological features of radical resection specimens, including increased Gleason score, capsule invasion, positive surgical margin and perineural invasion. Results: A total of 206 cases of microfocal adenocarcinoma were diagnosed on prostate biopsies from 2013 to 2019, accounting for 6.7% of all adenocarcinoma cases. There were 139 cases of 1 positive core and 67 cases of 2 positive cores. Patients with microfocal adenocarcinoma were younger than those with non-microfocal adenocarcinoma (69 years versus 71 years, P<0.001). Compared with patients with non-microfocal adenocarcinoma, the pre-biopsy total prostate specific antigen (tPSA) and free prostate specific antigen (fPSA) levels in patients with microfocal adenocarcinoma were both lower (11.2 μg/L2 versus 23.7 μg/L2; 1.4 μg/L2 versus 3.0 μg/L2, P<0.001), the fPSA/tPSA level was higher (12.9% versus 10.7%, P<0.05), the prostate volume was larger (38.9 mL versus 34.3 mL, P<0.05), and the PSA density was lower (0.3 μg/L2 versus 0.8 μg/L2, P<0.001). 130 patients underwent radical prostatectomy, 30 patients chose active monitoring, 31 patients chose endocrine or radiation therapy, and 15 patients were lost to follow-up. Three patients in the active surveillance group underwent radical prostatectomy for disease progression after 21-39 months observation. Biochemical relapses occurred in two patients in the radical prostatectomy group. The remaining patients have no disease progression or recurrence at present. Compared with radical prostatectomy specimens, Gleason score in the biopsy material was increased in 64/115 patients (55.7%). Among resection excision specimens, 14 cases (12.2%) had extraprostatic extension (EPE), 35 cases (30.4%) had perineural invasion, and 16 cases (13.9%) had a positive margin. Univariate and multivariate analyses showed that low fPSA/tPSA ratio and 2 positive cores were independent risk factors for Gleason score increase in the radical prostatectomy specimens. A low fPSA/tPSA ratio was an independent risk factor for perineural invasion. Low fPSA/tPSA ratio and low prostate volume were associated with a positive margin in radical prostatectomy specimens. Conclusions: In this study, patients diagnosed with microfocal adenocarcinoma on prostate biopsy account for a high proportion of the patients with increased Gleason score in the radical prostatectomy specimens, and there is a certain proportion of adverse pathological features in the radical specimens. Therefore, for the patients with only a small amount of low-grade adenocarcinoma found in biopsy, PSA levels and PSA density should be taken into consideration in treatment selection.

Risk Stratification in Oral Cancer: A Novel Approach.

BackgroundOral squamous cell carcinoma (OSCC) is a common head and neck cancer with high morbidity and mortality. Currently, treatment decisions are guided by TNM staging, which omits important negative prognosticators such as lymphovascular invasion, perineural invasion (PNI), and histologic differentiation. We proposed nomogram models based on adverse pathological features to identify candidates suitable for treatment escalation within each risk group according to the National Comprehensive Cancer Network (NCCN) guidelines.MethodsAnonymized clinicopathologic data of OSCC patients from 5 tertiary healthcare institutions in Asia were divided into 3 risk groups according to the NCCN guidelines. Within each risk group, nomograms were built to predict overall survival based on histologic differentiation, histologic margin involvement, depth of invasion (DOI), extranodal extension, PNI, lymphovascular, and bone invasion. Nomograms were internally validated with precision–recall analysis and the Kaplan–Meier survival analysis.ResultsLow-risk patients with positive pathological nodal involvement and/or positive PNI should be considered for adjuvant radiotherapy. Intermediate-risk patients with gross bone invasion may benefit from concurrent chemotherapy. High-risk patients with positive margins, high DOI, and a high composite score of histologic differentiation, PNI, and the American Joint Committee on Cancer (AJCC) 8th edition T staging should be considered for treatment escalation to experimental therapies in clinical trials.ConclusionNomograms built based on prognostic adverse pathological features can be used within each NCCN risk group to fine-tune treatment decisions for OSCC patients.

Not All Adverse Pathology Features Are Equal: Identifying Optimal Candidates for Adjuvant Radiotherapy Among Patients With Adverse Pathology at Radical Prostatectomy.

Recent studies reported a potential benefit associated with adjuvant radiotherapy for patients with adverse pathology features of prostate cancer. We hypothesized that not all the patients with adverse features may benefit from adjuvant radiotherapy and, therefore, observation ± early salvage radiotherapy may still be considered in a subgroup of these patients. Among 8,362 patients treated with radical prostatectomy at a single center between 1987 and 2020, 926 eligible patients with adverse pathology features (ie, grade group 4-5 with ≥pT3a stage and/or lymph node invasion) were identified. Cox models were used to assign a score to each feature. Patients were then stratified in low-, intermediate-, and high-risk groups, and interaction term analyses tested the impact of adjuvant radiotherapy for each risk subgroup after adjusting for inverse probability of treatment weighting. Overall, 538 (58%) vs 89 (10%) vs 299 (32%) patients received adjuvant radiotherapy vs early salvage radiotherapy vs observation. The 10-year overall survival rate was 90%. A significant interaction between adjuvant radiotherapy and high-risk group was recorded (HR 0.21, P = .04). After risk stratification and propensity-score weighting, survival analyses depicted comparable 10-year overall survival in low- and intermediate-risk patients treated with adjuvant radiotherapy or observation ± early salvage radiotherapy. Conversely, in high-risk patients, adjuvant radiotherapy was associated with significant improvement in 10-year overall survival compared to observation ± early salvage radiotherapy (76% vs 63%, P = .038). Among patients with adverse pathology features, we identified 3 subclassifications of risk. When testing the effect of adjuvant radiotherapy vs observation with or without early salvage radiotherapy on survival, only patients included in the high-risk group seemed to benefit from adjuvant radiotherapy.

Clinicopathologic association and prognostic impact of microcystic, elongated and fragmented pattern invasion, combined with tumor budding in endometrioid endometrial cancer.

As a special invasive pattern seen in low-grade endometrial carcinoma, microcystic, elongated and fragmented (MELF) pattern is related to lymph node metastasis. Tumor budding (TB) is another histological marker in many cancers associated with tumor aggressiveness. Herein, we evaluated the impact of MELF pattern combined with TB about clinicopathological features and prognosis in endometrioid endometrial cancer (EEC). To verify the relationship between the two morphological markers and microsatellite status in EEC, the primary mismatch repair (MMR) proteins were detected by immunohistochemistry. One hundred and seventy-two cases of ECC diagnosed between 2011 and 2016 were reviewed with a median follow up of 47.5months. MELF pattern and TB were examined on all H&E-stained slides. Primary MMR proteins (MLH1, MSH2, MSH6, and PMS2) were also detected. Based on MELF pattern and TB, 172 patients were divided into the following four groups: MELF(-)/TB(+) (n=41), MELF(+)/TB(-) (n=15), MELF(+)/TB(+) (n=20), and MELF(-)/TB(-) (n=96). Adverse pathological features were observed in the MELF(+)/TB(+) group: 70% presented deep muscular infiltration, 65% were lymphovascular space invasion, and 25% suffered lymph node metastasis. The proportion of MMR deficient in MELF(+)/TB(-) group was the highest (66.7%). The progression-free survival (PFS) and overall survival (OS) among the four groups were significantly different. MELF(+)/TB(+) group showed the worst PFS and OS. As univariate and multivariate survival analyses revealed, the combination of MELF pattern and TB was confirmed as an independent predictor of poor prognosis. Our research demonstrates that MELF pattern combined with TB, as an independent predictor of adverse outcome, is associated with adverse pathological features, which facilitates better understanding of EEC tumor behavior and more precise prognosis without additional medical expense.

Whole genome duplication in oral squamous cell carcinoma in patients younger than 50 years: implications for prognosis and adverse clinicopathological factors.

IntroductionOral squamous cell carcinoma (OSCC) in the young (<50 years), without known carcinogenic risk factors, is on the rise globally. Whole genome duplication (WGD) has been shown to occur at higher rates in cancers without an identifiable carcinogenic agent. We aimed to evaluate the prevalence of WGD in a cohort of OSCC patients under the age of 50 years.MethodsWhole genome sequencing (WGS) was performed on 28 OSCC patients from the Sydney Head and Neck Cancer Institute (SHNCI) biobank. An additional nine cases were obtained from The Cancer Genome Atlas (TCGA).ResultsWGD was seen in 27 of 37 (73%) cases. Non‐synonymous, somatic TP53 mutations occurred in 25 of 27 (93%) cases of WGD and were predicted to precede WGD in 21 (77%). WGD was significantly associated with larger tumor size (p = 0.01) and was frequent in patients with recurrences (87%, p = 0.36). Overall survival was significantly worse in those with WGD (p = 0.05).ConclusionsOur data, based on one of the largest WGS datasets of young patients with OSCC, demonstrates a high frequency of WGD and its association with adverse pathologic characteristics and clinical outcomes. TP53 mutations also preceded WGD, as has been described in other tumors without a clear mutagenic driver.

Elevated IsoPSA Selects for Clinically Significant Prostate Cancer Without a Preference for Any Particular Adverse Histopathologic or Radiographic Feature

OBJECTIVETo explore if elevated IsoPSA selects for particular adverse radiographic or histopathologic features among men destined to undergo radical prostatectomy (RP) because of clinically significant prostate cancer identified at biopsy. MATERIALS AND METHODSSingle center, retrospective review of patients who had undergone IsoPSA testing, prostate biopsy and RP at our institution from 2019-2021. A consecutive cohort of patients whom had undergone RP within the same period without pre-operative IsoPSA served as controls. Pre-operative prostate Magnetic Resonance Imaging (MRI) was included in our analysis. Adverse histopathologic and MRI features were compared between both groups. Concordance, downstaging, and upstaging grade group rates (GG) was evaluated. Pearson Chi-Square test was used to compare categorical variables, Wilcoxon-Rank sum test for quantitative variables, and binary logistic regression to identify predictors of upstaging at RP. RESULTSEighty-three patients underwent IsoPSA and RP while 44 patients were controls. The IsoPSA group had significantly higher pre-operative PSA (IsoPSA group: 7.8 ng/mL vs Control group: 5.2 ng/mL, P<.001 ). Elevated IsoPSA index (>6.0) did not select for any specific adverse histopathologic features at RP. Excluding PSA density, elevated IsoPSA was not selective for adverse MRI features. There were no differences in concordance, downstaging, and upstaging GG rates from biopsy to RP. IsoPSA testing was not a predictor of GG upstaging (Odds Ratio: 0.63, P .58). CONCLUSIONElevated IsoPSA is a diagnostic tool that can detect clinically significant prostate at the time of biopsy. In doing so, it does not select for any particular adverse prostate MRI or pathologic feature at RP.

Low baseline vitamin D levels correlate with adverse pathological features and clinical outcomes among patients with breast cancer.

552 Background: Serum vitamin D levels have been linked to breast cancer development; however, the impact on breast cancer features and outcomes remains unclear. The present study aimed at investigating the prognostic value of baseline vitamin D level among non-metastatic breast cancer patients. Methods: In this study; we prospectively assessed female patients presenting to our department with non-metastatic breast cancer during the period from October 2018 to December 2019 for their baseline serum vitamin D levels measured by ELISA test before starting systemic therapy, in addition to other clinicopathological factors. Low Vit-D was defined as Vit-D level less than 30 ng /l. Chi-square test (Fisher’s exact test) was used to examine the relation between qualitative variables. Survival analysis was done using Kaplan-Meier method and comparison between two survival curves was done using log-rank test. Multivariate analysis was done using Cox-regression hazard model for the significant factors affecting survival on univariate analysis. Results: We enrolled 221 patients with non-metastatic breast cancer as they matched our eligibility criteria. Median age at diagnosis was (50.7± 10.9). About two thirds of the patients (64.7%) were post menopause. Median vitamin D level was (23.1 ng/l) with a range of (4-62.46 ng/liter). Around half of the patients (56.5%) had vitamin D level lower than 30 ng/liter, with higher numbers of low vitamin D levels among HER2 positive and triple negative (TNBC) patients compared to hormonal receptor positive (HR+ve) patients (P=&lt;0.001). There was a significant negative correlation between vitamin D levels and tumor size, lymph node positivity and stage at diagnosis (the lower the vitamin D level, the larger the tumor size, and the higher the number of positive lymph nodes and the stage; r= -0.414, r= -0.586, r= -0.674; respectively; p&lt;0.001). On follow up, the number of local recurrences, bone metastases and liver metastases were significantly higher among the low vitamin D level group, however; there was no significant difference between the two groups in terms of development of brain and lung metastases. Disease free survival (DFS) and overall survival (OS) was significantly worse among the low vitamin D level group (p&lt;0.001). Conclusions: Low serum vitamin D in breast cancer patients negatively correlates with tumor size, lymph node positivity and stage at diagnosis. It is linked to HER-2 positive and TNBC, and is significantly associated with worse DFS and OS.

Is Young Age an Independent Prognostic Factor in Carcinoma Breast? A Single-Institution Retrospective Comparative Study from South India.

Breast cancer is the most common cancer in women globally(1). It is usually a disease of old age. The incidence of breast cancer in females younger than 40years is as low as 0.5%. Disease in patients with age less than or equal to 40years at diagnosis is usually considered a young breast cancer(2). Occurrence of more adverse pathological features like triple negative and Her2 positive breast cancer as well as lacking reliable screening methods in young women leads to the poor prognosis in this group of patients(3). In the present study we aim to find the clinical and pathological characteristics of breast cancer in young women and their survival outcome for 5years comparing the same with those characteristics of the older patients. Patients with nonmetastatic carcinoma breast who had registered at Regional Cancer Centre, Trivandrum, during the year 2012 were selected for the study. Patient's details including the clinicopathological features, treatment details, oncologic outcomes including recurrence, and survival data until 31 July 2019 were collected from treatment files kept in the hospital and via telephonic interview. Kaplan-Meier method was employed for survival analysis. Survival comparison was done using the log-rank test. Cox proportional hazards regression analysis was done for assessing the risk. Out of 1611 curatively treated patients with carcinoma breast, 281 (17.44%) were young breast cancer (equal to or less than 40years). The median follow-up period was 82months. Median age of diagnosis was 51.3years. Young patients presented with larger tumour size, but nodal stage and composite stage, were not different. They had more TNBC status, 35% vs. 24%, p = 0.001. Young patient group had a drop in 5-year OS but statistically insignificant (75.9% vs. 82.5%, p = 0.179) and marginally significant drop in DFS (68.1% vs. 73.8%, p = 0.064). The proportion of young breast cancer is very high in the Indian population. Age is not an independent risk factor for worse prognosis. T and N stage, Her2nue status, and adequacy of nodal clearance are the most important independent risk factors deciding the 5-year OS.

Abstract No. 110 Intraductal carcinoma of the prostate in the era of mpMRI-targeted prostate biopsies: clinical, pathologic and radiologic characteristics

Since 2018, there is increasing adoption of mpMRI to detect prostate cancer, particularly in the pre-biopsy setting. Recent studies showed that mpMRI is a sensitive tool for detecting cancers harboring intraductal carcinoma of the prostate (IDC-P). The presence of IDC-P has been associated with adverse pathological features and worse clinical outcomes. The goals of this study were to 1) determine frequency of IDC-P detected on biopsy in the mpMRI era and 2) assess the MRI and pathologic characteristics of biopsy proven IDC-P.

Do we need repeat transurethral resection after en bloc resection for pathological T1 bladder cancer?

To assess the clinical significance of repeat transurethral resection (reTUR) and surgical margin status after en bloc resection of bladder tumour (ERBT) for pathological T1 (pT1) bladder cancer. We retrospectively analysed the record of 106 patients with pT1 high-grade bladder cancer who underwent ERBT between April 2013 and February 2021 at multiple institutions. All specimens were reviewed by a genitourinary pathologist. The primary outcome measures were recurrence-free survival (RFS) and progression-free survival (PFS) between patients with and those without reTUR. We also analysed the predictive value of surgical margin on the likelihood of residual tumour on reTUR. A reTUR was performed in 50 of the 106 patients. The 2-year RFS and 3-year PFS were comparable between patients who underwent reTUR and those who did not (55.1% vs 59.9%, P = 0.6, 80.6% vs 82.6%, P = 0.6, respectively). No patient was upstaged to pT2 on reTUR. Regarding the surgical margin status, there were no recurrences at the original site in 51 patients with negative horizontal margins. Cox proportional hazard analysis revealed that a positive vertical margin was an independent prognostic factor of worse PFS. On reTUR, six pTa/is residues were detected in patients with a positive horizontal margin, and three pT1 residues were detected in one patient with a positive vertical margin or other adverse pathological features. A reTUR after ERBT for pT1 bladder cancer appears not to improve either recurrence or progression. Surgical margin status affects prognosis and reTUR outcomes. A reTUR can be omitted after ERBT in patients with pT1 bladder cancer and negative margins; for those with positive horizontal or vertical margins, reTUR should remain the standard until proven otherwise.

Asociación entre la invasión perineural en la biopsia de próstata dirigida por RMmp y/o sistemática y los resultados patológicos adversos en la prostatectomía radical asistida por robot

Introduction and objectivesThis study aims to investigate the relationship between perineural invasion (PNI) in targeted (TBx) and/or systematic (SBx) prostate needle biopsy and adverse pathological features of prostate cancer (PCa) in prostatectomy specimens. Materials and methodsA total of 95 male patients who underwent transperineal TBx and/or concomitant SBx subsequently treated with robot-assisted radical prostatectomy for PCa between October 2015 and June 2020 were included. The performance of PNI as a classification test (sensitivity, specificity, positive and negative predictive values) and its correlation with clinically significant PCa, surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy were computed. ResultsThe median age of the patients was 65 (60-70) years. TBx and concomitant SBx were performed in 78 (82.1%) patients, while 16 (16.8%) patients underwent SBx alone and one (1.1%) patient underwent TBx alone. The frequency of PNI in TBx and SBx was 17 (21.5%) and 32 (34.0%), respectively. The specificity/negative predictive values of PNI for surgical margin positivity, extraprostatic extension, and seminal vesicle invasion were 79.7/88.7%, 92.5/79.0%, and 83.3/96.8%, in TBx, and 71.1/87.1%, 80.7/74.2%, and 69.5/91.9%, in SBx, respectively. There was also a statistically significant correlation between PNI in biopsy and surgical margin positivity, extraprostatic extension, and seminal vesicle invasion in prostatectomy as well as the ISUP grade group and pT stage. ConclusionsThe absence of PNI in prostate needle biopsy may predict localized PCa with a pT stage≤2c and negative surgical margins in contrast to its presence which appears to be an indicator of unfavorable factors in final pathology.

MP27-02 NOT ALL ADVERSE PATHOLOGY FEATURES ARE EQUAL: IDENTIFYING OPTIMAL CANDIDATES FOR ADJUVANT RADIOTHERAPY AMONG PATIENTS WITH ADVERSE PATHOLOGY AT RADICAL PROSTATECTOMY

MP27-02 NOT ALL ADVERSE PATHOLOGY FEATURES ARE EQUAL: IDENTIFYING OPTIMAL CANDIDATES FOR ADJUVANT RADIOTHERAPY AMONG PATIENTS WITH ADVERSE PATHOLOGY AT RADICAL PROSTATECTOMY

MP24-07 ADVERSE RADIOLOGIC AND PATHOLOGIC FEATURES IMPACT SURVIVAL OUTCOMES FOR SMALL RENAL MASSES FOLLOWING NEPHRECTOMY

You have accessJournal of UrologyCME1 May 2022MP24-07 ADVERSE RADIOLOGIC AND PATHOLOGIC FEATURES IMPACT SURVIVAL OUTCOMES FOR SMALL RENAL MASSES FOLLOWING NEPHRECTOMY Sari Khaleel, Hong Truong, Song Jiang, Benjamin Davelman, Jonathan Coleman, Ari Hakimi, and Paul Russo Sari KhaleelSari Khaleel More articles by this author , Hong TruongHong Truong More articles by this author , Song JiangSong Jiang More articles by this author , Benjamin DavelmanBenjamin Davelman More articles by this author , Jonathan ColemanJonathan Coleman More articles by this author , Ari HakimiAri Hakimi More articles by this author , and Paul RussoPaul Russo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002563.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While most small renal masses (SRMs, <4 cm) have excellent prognosis following extirpative treatment, the impact of finding adverse preoperative radiologic and/or postoperative pathologic T3 features in SRMs that undergo partial (PN) or radical nephrectomy (RN) remains unclear. We sought to review clinical outcomes for SRMs that underwent RN/PN at our institution, comparing pT3 SRMs that presented with adverse (T3) preoperative radiologic features (cT3/pT3) to SRMs that had no adverse preoperative radiologic features, with/without subsequent upstaging to pT3 disease (cT1a/pT3 and cT1a/non-pT3, respectively). METHODS: We retrospectively reviewed SRM cases that underwent RN/PN at our institution between 2010-2020, classifying them into one of the three above groups, excluding cases with known advanced (pT4, M1) disease preoperatively. Continuous and categorical variables were compared using ANOVA and Kruskal-Wallis (K-W) tests, respectively. Cox proportional hazard regression (CPHR) analysis was used to model survival outcomes against the presence of adverse pathologic and radiologic features. Analyses were performed using R Statistical Package (v4.04). RESULTS: Of 2146 cases, 8.4% were pT3 post-operatively, of which 45.9% had adverse preoperative cT3 radiologic features (Table 1). Median follow-up was 3.3 years (IQR 1.5–6.1). pT3-SRMs had higher rates of radical nephrectomy, positive margins, overall and cancer-specific mortality, and metastases than their non-pT3 counterparts, particularly in the cT3/pT3 subgroup (K-W p <0.05; Table 1). On multivariate CPHR analysis, only the combined presence of adverse radiologic and pathologic features (cT3/pT3 group) was significantly associated with higher risk for overall- and cancer-specific survival (p <0.05), adjusting for patient age, BMI, mass size, histology, and Charlson comorbidity index. Unexpected upstaging (cT1a/pT3) was not associated with higher risk of any of the outcomes of interest (p >0.05). CONCLUSIONS: Adverse pathologic T3 features portend worse outcomes for SRMs, particularly in those with adverse preoperative radiologic features. This study highlights the importance of SRM substratification by these features, which may aid in surgical planning and potential multimodal treatment. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e395 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sari Khaleel More articles by this author Hong Truong More articles by this author Song Jiang More articles by this author Benjamin Davelman More articles by this author Jonathan Coleman More articles by this author Ari Hakimi More articles by this author Paul Russo More articles by this author Expand All Advertisement PDF downloadLoading ...

MP48-10 ANDROGEN DEPRIVATION THERAPY FOR NODE-POSITIVE PROSTATE CANCER AT RADICAL PROSTATECTOMY AND PELVIC LYMPH NODE DISSECTION: CONTEMPORARY PRACTICE PATTERNS AND ASSOCIATED FACTORS

You have accessJournal of UrologyCME1 May 2022MP48-10 ANDROGEN DEPRIVATION THERAPY FOR NODE-POSITIVE PROSTATE CANCER AT RADICAL PROSTATECTOMY AND PELVIC LYMPH NODE DISSECTION: CONTEMPORARY PRACTICE PATTERNS AND ASSOCIATED FACTORS Leilei Xia, Ruchika Talwar, Raju Chelluri, Daniel Lee, and Thomas Guzzo Leilei XiaLeilei Xia More articles by this author , Ruchika TalwarRuchika Talwar More articles by this author , Raju ChelluriRaju Chelluri More articles by this author , Daniel LeeDaniel Lee More articles by this author , and Thomas GuzzoThomas Guzzo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002619.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current guidelines recommend observation or adjuvant androgen deprivation therapy (ADT) with or without external beam radiation therapy (EBRT) for node-positive prostate cancer at radical prostatectomy (RP) and pelvic lymph node dissection (PLND). There is limited data on contemporary practice patterns and factors associated with the usage of ADT at the national level. METHODS: Patients with cT1-2N0M0 prostate cancer diagnosed between 2006 and 2015 who underwent RP and PLND and then were found to have pathologically positive lymph node (LN) were identified from National Cancer Database (NCDB). Patients were stratified into 3 cohorts based on the number of positive LNs (1 LN vs. 2 LNs vs. ≥3 LNs). Some of the covariables included hospital volume of RP (low vs. medium vs. high), more extended PLND (≥11 nodes vs. <11 nodes removed), positive surgical margin (PSM), and pT stage (pT3-4 vs. pT2). Primary outcome was ADT usage (with or without the EBRT). RESULTS: A total of 4,641 patients were included: 2,998 patients with 1 positive LN, 837 with 2 positive LNs, and 806 with ≥3 positive LNs. In the overall cohort, 56.4% did not receive ADT, 24.3% received ADT only, and 19.2% received ADT+EBRT. The distributions of observation vs. ADT vs. ADT+EBRT stratified by positive LNs, PSM, and pT stage are shown in the Figure. Multivariable logistic regressions showed that compared with 1 LN, 2 LNs (odds ratio [OR]=1.49, P <0.001) and ≥3 LNs (OR=1.83, P <0.001) were associated with higher odds of receiving ADT. Patients with PSM (OR=1.81, P <0.001) and pT3-4 cancer (OR=1.65, P <0.001) were significantly more likely to receive ADT. More extended PLND was associated with lower odds of receiving ADT (OR=0.76, P <0.001). Compared with low RP volume, patients who had RP at medium volume (OR=0.80, P=0.005) and high volume (OR=0.66, P <0.001) hospitals were less likely to receive ADT. CONCLUSIONS: This NCDB study suggests that clinicians have been selectively offering ADT based on adverse pathological features and extension of PLND. Variations of ADT usage among hospitals may be related to RP surgical volumes. These findings have implications for patient counseling, policymaking, and further trial design for these groups of aggressive and heterogeneous cancers. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e824 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leilei Xia More articles by this author Ruchika Talwar More articles by this author Raju Chelluri More articles by this author Daniel Lee More articles by this author Thomas Guzzo More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP48-13 THE KEY ROLE OF CONCOMITANT ANDROGEN-DEPRIVATION THERAPY ON THE EFFICACY OF IMAGING GUIDED TREATMENTS IN MEN WITH BIOCHEMICAL RECURRENT PROSTATE CANCER AFTER RADICAL PROSTATECTOMY AND POSITIVE 68GA-PSMA PET/CT SCAN

MP48-13 THE KEY ROLE OF CONCOMITANT ANDROGEN-DEPRIVATION THERAPY ON THE EFFICACY OF IMAGING GUIDED TREATMENTS IN MEN WITH BIOCHEMICAL RECURRENT PROSTATE CANCER AFTER RADICAL PROSTATECTOMY AND POSITIVE 68GA-PSMA PET/CT SCAN

MP48-09 TOXICITY PROFILE OF IMMEDIATE POST-PROSTATECTOMY RADIATION THERAPY: RESULTS FROM A LARGE MULTI-INSTITUTIONAL SERIES

MP48-09 TOXICITY PROFILE OF IMMEDIATE POST-PROSTATECTOMY RADIATION THERAPY: RESULTS FROM A LARGE MULTI-INSTITUTIONAL SERIES

PD15-11 TRANSLOCATION RCC: PROGRESSION-FREE AND OVERALL SURVIVAL BY TUMOR STAGE AND SURGICAL PROCEDURE AT A HIGH-VOLUME ACADEMIC CENTER

You have accessJournal of UrologyCME1 May 2022PD15-11 TRANSLOCATION RCC: PROGRESSION-FREE AND OVERALL SURVIVAL BY TUMOR STAGE AND SURGICAL PROCEDURE AT A HIGH-VOLUME ACADEMIC CENTER Jason Farrow, Nate Hollowell, Connor Drake, Leo Song, Clint Cary, Clinton Bahler, Ronald Boris, and Chandru Sundaram Jason FarrowJason Farrow More articles by this author , Nate HollowellNate Hollowell More articles by this author , Connor DrakeConnor Drake More articles by this author , Leo SongLeo Song More articles by this author , Clint CaryClint Cary More articles by this author , Clinton BahlerClinton Bahler More articles by this author , Ronald BorisRonald Boris More articles by this author , and Chandru SundaramChandru Sundaram More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002547.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Translocation Renal Cell Carcinoma (RCC) is a rare variant and is estimated to represent 2-5% of RCC diagnoses. Prior studies characterizing the clinical behavior of translocation RCC are limited and stage-by-stage prognostication for adult patients remains uncertain. METHODS: Patients diagnosed with localized translocation RCC that underwent either partial or radical nephrectomy between 2004 and 2021 were reviewed. Standard clinico-pathologic characteristics were included. Both progression-free and overall survival were estimated using Kaplan Meier curves. Non-parametric tests in SAS were used with statistical significance set at 0.05. RESULTS: A total of 59 patients were identified. Age at surgery and Body Mass Index were balanced across pathological stage. Tumor complexity increased with stage, as did adverse pathological features (Fuhrman Grade 3-4, lymphovascular invasion, and margin positivity). Both progression-free and overall survival was worse for higher stage disease. Of note, low stage disease had favorable long-term survival approaching 90%; there was no difference in overall survival between partial or radical nephrectomy for low-stage disease. CONCLUSIONS: Translocation tumors predictably demonstrate worse pathological features with stage progression. Interestingly, those patients with low-stage disease had durable treatment responses with either partial or radical nephrectomy, suggesting minimally invasive approaches may be preferred to limit perioperative morbidity without sacrificing oncologic outcomes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e267 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason Farrow More articles by this author Nate Hollowell More articles by this author Connor Drake More articles by this author Leo Song More articles by this author Clint Cary More articles by this author Clinton Bahler More articles by this author Ronald Boris More articles by this author Chandru Sundaram More articles by this author Expand All Advertisement PDF DownloadLoading ...