pT3 Disease Research Articles

Association of lymph node count and survival after primary retroperitoneal lymph node dissection (RPLND) for testicular nonseminomatous germ cell tumor (NSGCT).

e17052 Background: RPLND for clinical stage (CS) I & IIA/B NSGCT has both staging and therapeutic implications. Single center studies have reported on the impact of lymph node count on outcome after 1° RPLND for men with NSGCT. However, this has yet to be corroborated in a nationally representative dataset. Methods: Using the National Cancer Database, patients who received a 1° RPLND from 2004-2014 for CS I & IIA/B NSGCT were identified. The analytic cohort was stratified according to LN count (≤20, 21-40, and > 40 LNs). Sociodemographic characteristics were compared among groups. The Kaplan-Meier method was calculated and pairwise comparisons performed. Based on sensitivity analyses to determine LN cutoff that impacts survival, subsequent analysis compared patients with ≤20 and > 20 LNs resected. Multivariate analysis using stepwise regression was used to determine factors associated with receipt of an RPLND with > 20 LNs resected. Results: Of 1,376 men who received 1° RPLND for Stage I or IIA/B NSGCT, 35.6%, 27.4%, and 14% had ≤20, 21-40, and > 40 LNs resected, respectively. LN count was associated with overall survival (OS), with 95%, 97%, and 98% 8-year OS for men with LN count ≤20, 21-40, and > 40 LNs, respectively. OS in men with ≤20 vs 21-40 (p = 0.018) and > 40 LNs (p = 0.042) resected differed significantly. However, no significant difference was observed when 21-40 vs > 40 LNs were resected (p = 0.677). Therefore, subsequent analysis compared those who had ≤20 and > 20 LN resected, and OS between these two groups differed significantly (Figure). Multivariate analysis demonstrated that patients with private insurance, surgery having been performed at an academic center or in the Northeast, and those with pT2 disease were more likely to have > 20 LNs resected at the time of RPLND. Conclusions: Lymph node count after 1° RPLND for NSGCT is significantly associated with overall survival, with more favorable survival seen in those who receive an RPLND with > 20 LNs resected when compared to ≤20 LNs.

Pembrolizumab (pembro) for the treatment of patients with Bacillus Calmette-Guérin (BCG) unresponsive, high-risk (HR) non–muscle-invasive bladder cancer (NMIBC): Over two years follow-up of KEYNOTE-057.

5041 Background: Pembro was recently approved for the treatment of HR NMIBC based on results from the phase 2 KEYNOTE-057 (NCT02625961) study. Herein we present safety, efficacy, and posttreatment outcomes with > 2 y follow-up from KEYNOTE-057 cohort A. Methods: Patients with histologically confirmed HR BCG-unresponsive carcinoma in situ (CIS) with or without papillary tumors who received adequate BCG therapy and were ineligible for or opted out of radical cystectomy (RC) received pembro 200 mg Q3W for up to 2 y or until disease recurrence, progression, or unacceptable toxicity. The primary end point was complete response rate (CRR). Key secondary end points were duration of response (DOR) and safety. Results: Overall, 102 patients were initially enrolled, and 96 were included in the efficacy analysis. Median time from enrollment to data cut off was 28.4 months (range, 18.2-40.5). CRR was 40.6% (95% CI, 30.7-51.1), and median DOR was 16.2 months (range, 0+ to 30.4+). Among 39 patients with CR, 18 (46.2%) had a DOR ≥12 months. No patient’s disease progressed to muscle-invasive or metastatic bladder cancer while on study treatment. Median PFS and OS were not reached. At 12 months, PFS was 82.7% and OS was 97.9%. A total of 36 patients (37.5%) underwent RC after discontinuation from study treatment, which included 9 of 22 patients (40.9%) who had recurrence after initial CR and 27 of 57 (47.4%) nonresponders. Of the 36 who underwent RC, 33 (91.6%) had no pathological upstaging to MIBC and 3 (8.3%) had at least pT2 disease at time of RC. For subsequent treatments other than RC, 27 of 96 (28.1%) patients received additional intravesical therapy (eg, BCG, gemcitabine, or mitomycin), 21 of 96 (21.9%) underwent local procedures (eg, TURBT), and 3 of 96 (3.1%) received systemic therapy (eg, pembro). In 102 patients treated with pembro, treatment-related AEs (TRAEs) occurred in 67 (65.7%) patients; most frequently reported TRAEs were fatigue, pruritus, and diarrhea (10.8% each). Grade 3/4 TRAEs occurred in 13 patients (12.7%), and 21 patients (20.6%) experienced immune-mediated AEs. There were no grade 5 TRAEs. Conclusions: After > 2 y of follow-up, durable and clinically meaningful activity of pembro was observed in patients who had HR BCG-unresponsive CIS with or without papillary tumors and who were ineligible for or opted out of RC. Pembro did not seem to limit the opportunity for subsequent therapies, including RC. The safety profile was consistent with what is reported in the literature. Clinical trial information: NCT02625961 .

Factors impacting use of adjuvant therapy in lip and oral cavity squamous cell carcinoma: A NCDB analysis.

e18556 Background: Two trials followed by a combined analysis of the trials in head and neck squamous cell carcinoma (SCC) established that the benefit of adjuvant chemotherapy concurrent with radiation (CRT) was only noted in patients with extracapsular extension of nodal disease (ECE) and positive resection margins (PM). Despite this recommendation, other high-risk pathological features including pT3 or pT4 disease, positive lymph nodes, perineural involvement, vascular tumor embolism and level IV or V lymph node involvement have been noted to increase the risk of recurrence and adjuvant chemotherapy has been utilized for these patients. We report an observational study to evaluate the factors impacting use of CRT in patients with oral cavity and lip SCC. Methods: We conducted a retrospective study of patients with oral cavity and lip SCC who underwent resection of primary tumor with or without neck dissection in the reporting hospital in the NCDB database. We compared demographic, clinical and pathological characteristics of patients who received adjuvant CRT versus radiation alone. Multivariate analysis was performed using logistic regression model. Results: Out of the 58,481 patients reported to have surgery in NCDB from 2004 to 2016, 11,413 patients received adjuvant therapy. In univariate analysis, patients who received CRT were most likely less than 65 years of age, males, patients with no insurance or private insurance, lower Charlson Deyo score, Stage IVA, pT4, grade 2 or higher, tumor size > 4cm, positive lymph nodes, involvement of level IV and V nodes, lymphovascular invasion, ECE and PM. In multivariate analysis, factors which influenced receiving CRT were age between 40 and 65 years, males, Stage IVA (compared to Stage I to III), positive nodes, ECE and PM. A total of 984 patients received CRT without having ECE or PM. Conclusions: In addition to ECE and PM, positive lymph nodes was the major pathological factor in patients receiving CRT compared to RT alone.

Minimal Residual Disease Defines the Risk and Time to Biochemical Failure in Patients with Pt2 and Pt3a Prostate Cancer Treated With Radical Prostatectomy: An Observational Prospective Study.

To compare Gleason score (GS), pathological stage, minimal residual disease (MRD) and outcome after prostatectomy radical for prostate cancer. 290/357 men with GS 6 or 7 and pT2 or pT3a disease treated with radical prostatectomy participated. Blood and bone marrow were obtained one month after surgery. Circulating prostate cells (CPCs) were detected using differential gel centrifugation and immunocytochemistry with anti PSA, micro-metastasis weas detected using immunocytochemistry with anti-PSA. Biochemical failure free survival (BFFS) and restricted mean survival times (RMST) were calculated according to GS and stage. MRD was classified as negative, patients only positive for micro-metastasis and patients positive for CPCs; BFFS and RMST were calculated according to MRD sub-type. GS7 (HR 3.03) and pT3a (HR 3.68) cancers were associated with a higher failure rate, shorter time to failure and associated with CPC positive MRD (p < 0.001), while G6 and pT2 with MRD negative disease (p<0.001). Men with CPC (+) MRD were at high risk of early treatment failure; 15% BFFS at 10 years, RMST 3.0 years. Men positive for only micro-metastasis were at risk of late failure, 50% BFFS at 10 years, RMST 8.0 years compared with MRD negative patients; 80% BFFS at 10 years, RMST 9.0 years. The sub-type of MRD identifies Gleason 6 pT2 patients with a poor prognosis and Gleason 7 pT3a patients with a good prognosis and could be used to classify men according to personal risk characteristics for the use of adjuvant treatment.

Risk factors analysis and stratification for microscopically positive resection margin in gastric cancer patients

BackgroundCancer cells are often found postoperatively at surgical resection margins (RM) in patients with gastric cancer because of submucosal infiltration or hesitation to secure adequate RM. This study was designed to evaluate risk factors for microscopic positive RM and to clarify which patients should undergo intraoperative frozen section diagnosis (IFSD).MethodsPatients who underwent R0/1 gastrectomy for gastric adenocarcinoma between 2000 and 2018 in a single cancer center in Japan were studied. We divided the patients into a positive RM group and negative RM group according to the results of definitive histopathological examinations. We performed multivariate analysis to analyze risk factors for positive RM by and used the identified risk factors to risk stratify the patients.ResultsA total of 2757 patients were studied, including 49 (1.8%) in the positive RM group. The risk factors significantly associated with positive RM were remnant gastric cancer (odds ratio [OR] 4.7), esophageal invasion (OR 6.3), tumor size ≥80 mm (OR 3.9), and a histopathological diagnosis of undifferentiated type (OR 3.6), macroscopic type 4 (OR 3.7), or pT4 disease (OR 4.6). On risk stratification analysis, the incidence of positive RM was 0.1% without any risk factors, increasing to 0.4% with one risk factor, 3.1% with two risk factors, 5.3% with three risk factors, 21.3% with four risk factors, and 85.7% with five risk factors.ConclusionsThe risk of macroscopically positive RM increased in patients who have risk factors. IFSD should be performed in patients who have four or more risk factors.

Pathological features of prostate cancer in men treated with robot-assisted radical prostatectomy in the Middle East

Little is known about the pathological features of radical prostatectomy among men living in the Middle East. Although prostate cancer became the most common malignancy among males in some countries in the Middle East, the incidence is much lower compared to western populations. The aim of this study is to analyze pathological features and biochemical recurrence in men who underwentrobotic-assisted radicalprostatectomy(RARP) in Kuwait. The data on all RARP cases performed by a uro-oncologist (SA) were recorded. A comprehensive database was collected, including demographic, clinical, and pathological data. Between February 2014 and November 2019, 65 RARP cases were performed out of a total of 200 robotic urological procedures. The median follow-up was 41.5months [inter quartile range (IQR) 27.6-52.7]. Eleven (17%) complications occurred in 7 patients, 64% were early (< 30days post-operatively) and minor (Clavien I-II). Thirty-five (54%) patients had ≥ pT3 disease. Overall, 12 (18%) patients had a positive surgical margin (PSM), and all had ≥ pT3 disease. Potency and continence rates at 12months were 82% and 97%, respectively. The mean and SD of the hospital stay were 2.7 ± 1.1days. Biochemical recurrence (BCR) rate was 10%. Men with prostatic adenocarcinoma treated with RARP in Kuwait show a high incidence of pT3 disease. PSM and BCR rates were similar to multiple reports in the literature. To our knowledge, this is the first report of RARP pathological outcomes in the gulf cooperation council (GCC) region of the Middle East.

Perioperative Chemotherapy on Survival in Patients With Upper Urinary Tract Urothelial Carcinoma Undergoing Nephroureterectomy: A Population-Based Study.

Objectives: To estimate the stage-specific impact of perioperative chemotherapy on survival for upper urinary tract urothelial carcinoma (UTUC) patients treated with nephroureterectomy (NU).Methods: Overall, 7,278 UTUC patients treated with NU from 2004 to 2015 were identified within the SEER database. Kaplan–Meier plots were used to elucidate overall survival (OS) and cancer-specific survival (CSS) rates. Multivariable Cox regression analyses were used to test the impact of chemotherapy on survival rates, after stratifying according to pathological stage.Results: Chemotherapy was performed in 17.3% of patients and in 5.7, 11.5, 25.4, and 51.3% of patients with, respectively, pT1, pT2, pT3, and pT4 disease (P < 0.001). In multivariable analyses, perioperative chemotherapy was associated with a lower OS in pT2 patients and a lower CSS in pT1 disease (both P < 0.05), while predisposed to a higher OS in pT3 and pT4 patients (both P < 0.01). Moreover, perioperative chemotherapy was prone to a higher OS or CSS in pN+ disease compared to no chemotherapy (both P < 0.01).Conclusion: Perioperative chemotherapy was more frequently performed in locally advanced UTUC patients. The beneficial effect of chemotherapy on OS was evident in pT3/pT4 and pN+ patients. In addition, a clear CSS benefit was observed in patients who received chemotherapy for pN+ UTUC, while perioperative chemotherapy may reduce CSS for pT1 and OS for pT2 patients following NU.

MRI cT1-2 rectal cancer staging accuracy: a population-based study.

BackgroundAdequate MRI‐based staging of early rectal cancers is essential for decision‐making in an era of organ‐conserving treatment approaches. The aim of this population‐based study was to determine the accuracy of routine daily MRI staging of early rectal cancer, whether or not combined with endorectal ultrasonography (ERUS).MethodsPatients with cT1–2 rectal cancer who underwent local excision or total mesorectal excision (TME) without downsizing (chemo)radiotherapy between 1 January 2011 and 31 December 2018 were selected from the Dutch ColoRectal Audit. The accuracy of imaging was expressed as sensitivity, specificity, and positive predictive value (PPV) and negative predictive value.ResultsOf 7382 registered patients with cT1–2 rectal cancer, 5539 were included (5288 MRI alone, 251 MRI and ERUS; 1059 cT1 and 4480 cT2). Among patients with pT1 tumours, 54·7 per cent (792 of 1448) were overstaged by MRI alone, and 31·0 per cent (36 of 116) by MRI and ERUS. Understaging of pT2 disease occurred in 8·2 per cent (197 of 2388) and 27·9 per cent (31 of 111) respectively. MRI alone overstaged pN0 in 17·3 per cent (570 of 3303) and the PPV for assignment of cN0 category was 76·3 per cent (2733 of 3583). Of 834 patients with pT1 N0 disease, potentially suitable for local excision, tumours in 253 patients (30·3 per cent) were staged correctly as cT1 N0, whereas 484 (58·0 per cent) and 97 (11·6 per cent) were overstaged as cT2 N0 and cT1–2 N1 respectively.ConclusionThis Dutch population‐based analysis of patients who underwent local excision or TME surgery for cT1–2 rectal cancer based on preoperative MRI staging revealed substantial overstaging, indicating the weaknesses of MRI and missed opportunities for organ preservation strategies.

PT1 high-grade bladder cancer: histologic criteria, pitfalls in the assessment of invasion, and substaging.

Most patients with bladder carcinoma are diagnosed with non-muscle-invasive disease, stage Ta, and pT1. Stage remains as the single most important prognostic indicator in urothelial carcinoma. Among the pT1 bladder cancer patients, recurrence and progression of disease occur in 50% and 10%, respectively. The identification of high-risk patients within the pT1 subgroup remains an important clinical goal and an active field of research. Substaging of pT1 disease has been claimed as important histologic discriminator by the 2016 World Health Organization (WHO) classification of the genitourinary tract tumors and by the 8th edition of the American Joint Committee on Cancer (AJCC) staging manual supporting its implementation in clinical practice. Interobserver variation in pT1 diagnosis and the associated pitfalls in pT1 assessment are the critical pathological issues. The aim of this review paper is to provide the practicing pathologist with the state of the art of morphological and immunohistochemical features useful for the diagnosis of early invasive bladder carcinomas, including practical clues on how to avoid relevant interpretative pitfalls, and to summarize the current status of pT1 substaging.

Trends in clinical and oncological outcomes of robot-assisted radical prostatectomy before and after the 2012 US Preventive Services Task Force recommendation against PSA screening: a decade of experience.

To assess the influence of the 2012 US Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen (PSA)-based screening on oncological and functional outcomes following robot-assisted laparoscopic prostatectomy (RALP). We retrospectively analysed patients who underwent RALP between 2008 and 2018 with a minimum of 12-month follow-up from a prospectively collected institutional review board-approved database. The impact of the USPSTF recommendation against PSA screening on our surgical outcomes was assessed using a logistic regression model using two groups comprising patients treated before/after the USPSTF statement and indicating time trends for each successive year. The mean preoperative PSA increased from 6.0 to 7.4ng/mL after the USPSTF recommendation. We detected statistically significant time-trend changes after 2012, including an increase in the positive slope of Gleason ≥3 + 4 or ≥pT3 disease. We detected a fall in bilateral full nerve-sparing and an increase in partial nerve-sparing. The total positive surgical margin (PSM) rate increased after the USPSTF recommendation; however, PSM rates pertinent to each pathological stage did not change significantly after 2012. There was a significant negative trend change in the postoperative 12-month continence and potency rates, indicating a breakpoint in functional outcomes after 2012. We detected a 1.7-fold increase in 12-month biochemical recurrence (BCR) rates. The 12-month BCR, potency and continence rates were maintained in young (<55years) patients with a Sexual Health Inventory for Men score >22 and low-volume disease. Since the USPSTF's recommendation in 2012, we have seen a significant increase in the incidence of high-risk disease that has forced us to modify our approach to the procedure and the grade of nerve-sparing used, leading to a wider resection, in order to reduce PSMs. This has led to a decrease in postoperative functional recovery. Patients with favourable characteristics had good outcomes before and after the USPSTF's recommendation, implying that the quality of surgery did not change over time.

MP62-03 IMPACT OF LYMPHOVASCULAR INVASION ON OVERALL SURVIVAL IN PATIENTS WITH PROSTATE CANCER FOLLOWING RADICAL PROSTATECTOMY STRATIFIED BY PATHOLOGICAL TUMOR STAGE

You have accessJournal of UrologyProstate Cancer: Staging I (MP62)1 Apr 2020MP62-03 IMPACT OF LYMPHOVASCULAR INVASION ON OVERALL SURVIVAL IN PATIENTS WITH PROSTATE CANCER FOLLOWING RADICAL PROSTATECTOMY STRATIFIED BY PATHOLOGICAL TUMOR STAGE Marcus Jamil*, Jacob Keeley, Akshay Sood, Deepansh Dalela, Sohrab Arora, Isaac Palma-Zamora, Natalija Kovacevic, Chandler Bronkema, Nikola Rakic, Alyssa Danno, James Peabody, Mani Menon, Craig Rogers, and Firas Abdollah Marcus Jamil*Marcus Jamil* More articles by this author , Jacob KeeleyJacob Keeley More articles by this author , Akshay SoodAkshay Sood More articles by this author , Deepansh DalelaDeepansh Dalela More articles by this author , Sohrab AroraSohrab Arora More articles by this author , Isaac Palma-ZamoraIsaac Palma-Zamora More articles by this author , Natalija KovacevicNatalija Kovacevic More articles by this author , Chandler BronkemaChandler Bronkema More articles by this author , Nikola RakicNikola Rakic More articles by this author , Alyssa DannoAlyssa Danno More articles by this author , James PeabodyJames Peabody More articles by this author , Mani MenonMani Menon More articles by this author , Craig RogersCraig Rogers More articles by this author , and Firas AbdollahFiras Abdollah More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000937.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The detrimental impact of lymphovascular invasion (LVI) in prostate cancer (PCa) on the risk of biochemical recurrence has been previously described. However, the impact of LVI on overall survival (OS) is not clear. The aim of this study was to evaluate the prognostic ability of LVI as a predictor of OS stratified by pathological tumor stage. METHODS: We examined all men with non-metastatic PCa who were treated with radical prostatectomy between 2004 and 2015 years within the National Cancer Database. Only those with information on the presence LVI on final pathological analysis were included (n=232,704). Patients were stratified according to final pathological T stage (pT2, pT3a and pT3b). Kaplan-Meier curves estimated survival in each individual sub-group based on LVI status. Moreover, Cox proportional hazards assessed the relationship between LVI and OS after adjusting for all available covariates. RESULTS: Median (IQR) age and PSA were 62 (56 – 67) years and 5.6 (4.3 - 8.2) ng/ml, respectively. Overall, 174,838 (75.1%), 40,281 (17.3%) and 17,585 (7.6%) of patients had pT2, pT3a and pT3b disease, respectively. Median follow-up was 42.7 months (27.1 – 58.7). At 10-years, the OS in LVI vs. non-LVI patients was 93.9% vs 95.0% in pT2 (0.0004), 92.7% vs 94.8% in pT3a (<0.0001), and 86.1% vs 91.6% in pT3b (<0.0001). On multivariable analysis, LVI status was not an independent predictor of OS in pT2 disease (hazard ratio [HR]: 1.11, 95% confidence interval [CI] 0.92 – 1.35, p = 0.2). Conversely, in pT3a and pT3b disease, presence of LVI had 1.2-fold (95%CI: 1.03–1.44, p=0.02) and 1.4-fold (95%CI: 1.22–1.61, p=<0.001) higher overall mortality than their counterparts without LVI. CONCLUSIONS: Our report is the first to demonstrate the detrimental impact of LVI on OS in locally advanced disease (pT3a and higher). This information may prove valuable when risk stratifying based on final pathology and in counseling patients regarding outcomes in addition to determining the necessity of further treatment. Source of Funding: HFHS © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e946-e946 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcus Jamil* More articles by this author Jacob Keeley More articles by this author Akshay Sood More articles by this author Deepansh Dalela More articles by this author Sohrab Arora More articles by this author Isaac Palma-Zamora More articles by this author Natalija Kovacevic More articles by this author Chandler Bronkema More articles by this author Nikola Rakic More articles by this author Alyssa Danno More articles by this author James Peabody More articles by this author Mani Menon More articles by this author Craig Rogers More articles by this author Firas Abdollah More articles by this author Expand All Advertisement PDF downloadLoading ...

PD50-07 SYSTEMATIC ENDOSCOPIC EVALUATION FALLS SHORT IN PREDICTING PT0 BLADDER CANCER

INTRODUCTION AND OBJECTIVE: Concern for discordance between endoscopic evaluation and final pathology drives current clinical management of patients deemed appropriate candidates for radical cystectomy (RC). Yet, > 30% of patients (pts) who undergo neoadjuvant chemotherapy (NAC) prior to RC do not harbor detectable malignancy within the bladder at the time of extirpative surgery. Our objective was to prospectively assess the reliability of cystoscopic evaluation in RC candidates. METHODS: Pts undergoing RC for urothelial carcinoma (UC) at our institution were enrolled in a prospective single-arm study to evaluate reliability of Systematic Endoscopic Evaluation (SEE) in predicting pT0 UC. SEE consisted of rigid cystoscopy with targeted biopsy (and transurethral resection with loop after protocol amendment) of visible tumor and/or tumor bed/scar, plus two additional random biopsies performed at the time of RC. A standardized bladder map was used to index cystoscopic findings. SEE and biopsy results were compared to RC pathology. Comparisons were considered congruent if both SEE and RC were T0, or if any level of disease seen at both SEE and RC (exception, cT0 with pTis at RC called congruent). This trial design included early stopping rules for futility based on the primary endpoint of a negative predictive value (NPV) less than 70%. RESULTS: In total, 61 pts underwent SEE and RC as part of this trial. The final population included MIBC in 41 pts (67%) and high-risk NMIBC in 20 pts (33%). 38 pts (62%) received platinum-based neoadjuvant chemotherapy. Based on RC final pathology, 16 pts (26%) were pT0 and 28 pts (46%) harbored residual ≥pT2 disease. For detecting any disease, the positive predictive value was 96.7%, but the NPV was 48.4%, necessitating study closure based on pre-specified boundaries for futility. The sensitivity for detecting pT2 at RC disease was 71%. CONCLUSIONS: To our knowledge, this was the first prospective study exploring whether a standardized SEE could sufficiently predict the presence of residual malignancy. The NPV was below the pre-specified threshold, triggering study closure. pT2 or higher disease was missed nearly 30% of the time. This study definitively demonstrates that current cystoscopic techniques are inadequate to guide decisions on bladder preservation.Source of Funding: None

MP67-03 IMPROVEMENT IN FUNCTIONAL AND ONCOLOGICAL OUTCOME IN LOCALLY ADVANCED PROSTATE CANCER BY ROBOT-ASSISTED RADICAL PROSTATECTOMY WITH 3D-CANCER MAPPING GUIDANCE

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP67)1 Apr 2020MP67-03 IMPROVEMENT IN FUNCTIONAL AND ONCOLOGICAL OUTCOME IN LOCALLY ADVANCED PROSTATE CANCER BY ROBOT-ASSISTED RADICAL PROSTATECTOMY WITH 3D-CANCER MAPPING GUIDANCE Kazumi Kamoi*, Keita Takimoto, Masato Baba, Wataru Satoh, and Tsuneharu Miki Kazumi Kamoi*Kazumi Kamoi* More articles by this author , Keita TakimotoKeita Takimoto More articles by this author , Masato BabaMasato Baba More articles by this author , Wataru SatohWataru Satoh More articles by this author , and Tsuneharu MikiTsuneharu Miki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000947.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: MRI/US fusion biopsy has shown to improve the localization of index lesion and 3D-Cancer mapping can be created to display index lesions in the prostate whether they are attaching or bulging to the prostatic capsule. 3D-Cancer mapping navigation during robot-assisted radical prostatectomy (RARP) has shown to improve oncological outcome in pT3 disease (Kamoi et al, EAU 2017). The aim of this study was to evaluate the functional and histological outcomes in patients who are suspected to have T3 lesions treated by RARP. METHODS: 3D-Cancer mapping was constructed using Trinity™ (Koelis, France), which was applied to diagnose prostate cancer by MR/US fusion technique. Histological data was added to the 3D-Cancer mapping to display index lesions of the prostate whether they are attaching or bulging to the prostatic capsule and was shown in the “Tile-pro display” during RARP. The information of index tumor was applied to RARP by selection of dissection layer especially near the neurovascular and apical area. A total of 76 patients (38 with pT3 and 38 with pT2) were enrolled to this study to compare postoperative early continence and surgical margin status. RESULTS: All patients were applied nerve-sparing procedure in the side without index lesion attaching to the prostatic capsule. Bilateral, hemi-lateral, and non nerve sparing approach were applied to 56, 18 and 2 case, respectively. Among 38 patients with pT3 disease, 3 patients had positive surgical margin (8%) and all 38 patients with pT2 disease had negative surgical margin. An early continence just after catheter removal (0-1 pad per day) was achieved 23/38 (61%) patients with pT3 disease and 30/38 (79%) patients with pT2 disease (p=0.133). CONCLUSIONS: 3D-Cancer mapping correctly provided location and risk of extra-prostatic extension during dissection of the prostate. 3D-Cancer mapping navigation during RARP could secure a safety margin while maintaining an early continence after surgery in pT3 disease. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1026-e1026 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kazumi Kamoi* More articles by this author Keita Takimoto More articles by this author Masato Baba More articles by this author Wataru Satoh More articles by this author Tsuneharu Miki More articles by this author Expand All Advertisement PDF downloadLoading ...

MP55-15 SHOULD WE CONSIDER ALL AJCC STAGE IIIB BCA EQUAL? THE IMPACT OF LOCAL T STAGING IN N2 AND N3 PATIENTS AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Invasive II (MP55)1 Apr 2020MP55-15 SHOULD WE CONSIDER ALL AJCC STAGE IIIB BCA EQUAL? THE IMPACT OF LOCAL T STAGING IN N2 AND N3 PATIENTS AFTER RADICAL CYSTECTOMY Emanuele Zaffuto*, Marco Bandini, Simone Scuderi, Marco Moschini, Giusy Burgio, Andrea Salonia, Giorgio Gandaglia, Nicola Fossati, Roberto Bertini, Vincenzo Scattoni, Federico Dehò, Alberto Briganti, Francesco Montorsi, Renzo Colombo, Andrea Necchi, and Andrea Gallina Emanuele Zaffuto*Emanuele Zaffuto* More articles by this author , Marco BandiniMarco Bandini More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Giusy BurgioGiusy Burgio More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Roberto BertiniRoberto Bertini More articles by this author , Vincenzo ScattoniVincenzo Scattoni More articles by this author , Federico DehòFederico Dehò More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Renzo ColomboRenzo Colombo More articles by this author , Andrea NecchiAndrea Necchi More articles by this author , and Andrea GallinaAndrea Gallina More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000924.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current AJCC staging defines stage IIIB disease in bladder cancer (BCa) as patients with pN2 or pN3 disease, regardless of local staging (T stage). However, long term survival in this cohort of patients is not invariably unfavorable. We tested the prognostic impact of T stage in AJCC Stage IIIB BCa in patients treated with radical cystectomy (RC) METHODS: We identified a total of 499 patients with pathological N2 or N3 disease at RC, treated at a single tertiary care center. Descriptive statistics showed the differences in clinical features of patients included in the study. Kaplan-Meier plots described the recurrence and survival figures of the study population after stratification according to local T stage (pT0-T2 vs. pT3 vs. pT4a) and according to pN2 and pN3 disease. A novel risk stratification was defined according to different combination of T and N stages and was tested in Kaplan-Meier as well as after univariable and multivariable Cox regression analyses assessing disease recurrence and cancer-specific mortality after RC RESULTS: A total of 50 (10%), 236 (47.3%) and 213 (42.7%) patients were identified with pT0-pT2, pT3 and pT4a disease, respectively. The proportion of individuals with pN3 disease was 15.6% (n=78). At 3 years, recurrence-free survival rates were 57.4%, 27.6% and 13.2% in patients with pT0-pT2, pT3 and pT4a disease, respectively (p<0.001), while CSS rates were 72.8%, 52.4% and 31.5%, respectively (p<0.001). After stratification according to pN2 vs pN3 disease, 3-years recurrence-free survival rates were 58%, 29.5% and 13.2%, respectively, among patients with pN2 disease (p<0.01), and 66.7%, 20.7% and 10.4%, respectively, for pN3 individuals (p=0.03). We stratified patients in 3 risk groups according to: Low risk pT0-pT2 disease in pN2 individuals; Intermediate risk pT3 disease among pN2 individuals; High risk pT4a or pN3. Our stratification showed a significant difference in recurrence and CSS rates across the 3 groups. Specifically, in multivariable Cox regression analyses, intermediate and high-risk conferred a 2.37- and 4.06-fold increased risk of disease recurrence, compared to low-risk disease, and 11- and 17-fold increased risk of cancer-specific mortality, compared to low-risk patients (all p<0.05) CONCLUSIONS: Our results should suggest that a substaging of AJCC stage IIIB treated with RC, accounting for local tumor staging offers a higher discrimination on both recurrence and survival. In light of our results, a re-stratification of stage IIIB BCa should be advocated Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e843-e844 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emanuele Zaffuto* More articles by this author Marco Bandini More articles by this author Simone Scuderi More articles by this author Marco Moschini More articles by this author Giusy Burgio More articles by this author Andrea Salonia More articles by this author Giorgio Gandaglia More articles by this author Nicola Fossati More articles by this author Roberto Bertini More articles by this author Vincenzo Scattoni More articles by this author Federico Dehò More articles by this author Alberto Briganti More articles by this author Francesco Montorsi More articles by this author Renzo Colombo More articles by this author Andrea Necchi More articles by this author Andrea Gallina More articles by this author Expand All Advertisement PDF downloadLoading ...

Metastasis to para-aortic lymph nodes cephalad to the renal veins in patients with ovarian cancer

BackgroundIn patients with epithelial ovarian cancer, whether metastasis to para-aortic lymph nodes located cephalad to the renal veins (supra-renal PAN) should be classified as regional lymph node metastasis or distant metastasis remains controversial. This study was a preliminary retrospective evaluation of the pattern of supra-renal PAN metastasis in patients with epithelial ovarian cancer.MethodsThe subjects were 25 patients with epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer who underwent systematic dissection of the para-aortic nodes, including the supra-renal PAN, and pelvic lymph nodes (PLN). Patient factors, perioperative factors, the number of dissected lymph nodes, and pathological lymph node metastasis were investigated.ResultsSupra-renal PAN metastasis was found in 4/25 patients (16.0%). None of the 14 patients with pT1 or pT2 disease had supra-renal PAN metastasis, while 4/11 patients (36.4%) with pT3 or ypT3 disease had such metastases. None of the patients had isolated supra-renal PAN metastasis, while patients with supra-renal PAN metastasis also had multiple metastases to the infra-renal PAN and PLN.ConclusionsIn patients with epithelial ovarian cancer, supra-renal PAN metastases might be considered to be distant rather than regional metastases. Further studies are needed to better define the clinical significance of supra-renal PAN metastasis.

MP11-12 ASSOCIATION OF LYMPH NODE COUNT AND SURVIVAL AFTER PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION (RPLND) FOR TESTICULAR NONSEMINOMATOUS GERM CELL TUMOR (NSGCT)

You have accessJournal of UrologyPenile & Testicular Cancer: Penile & Testicular Cancer I (MP11)1 Apr 2020MP11-12 ASSOCIATION OF LYMPH NODE COUNT AND SURVIVAL AFTER PRIMARY RETROPERITONEAL LYMPH NODE DISSECTION (RPLND) FOR TESTICULAR NONSEMINOMATOUS GERM CELL TUMOR (NSGCT) Hiren Patel*, Arnav Srivastava, Sinae Kim, Isaac Kim, Eric Singer, and Thomas Jang Hiren Patel*Hiren Patel* More articles by this author , Arnav SrivastavaArnav Srivastava More articles by this author , Sinae KimSinae Kim More articles by this author , Isaac KimIsaac Kim More articles by this author , Eric SingerEric Singer More articles by this author , and Thomas JangThomas Jang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000831.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: RPLND for clinical stage (CS) I & IIA/B NSGCT has both staging and therapeutic implications. Single center studies have reported on the impact of lymph node count on outcome after 1° RPLND for men with NSGCT. However, this has yet to be corroborated in a nationally representative dataset. METHODS: Using the National Cancer Database, patients who received a 1° RPLND from 2004-2014 for CS I & IIA/B NSGCT were identified. The analytic cohort was stratified according to LN count (≤20, 21-40, and >40 LNs). Sociodemographic characteristics were compared among groups. The Kaplan-Meier method was calculated and pairwise comparisons performed. Based on sensitivity analyses to determine LN cutoff that impacts survival, subsequent analysis compared patients with ≤20 and >20 LNs resected. Multivariate analysis using stepwise regression was used to determine factors associated with receipt of an RPLND with >20 LNs resected. RESULTS: Of 1,376 men who received 1° RPLND for Stage I or IIA/B NSGCT, 35.6%, 27.4%, and 14% had ≤20, 21-40, and >40 LNs resected, respectively. LN count was associated with overall survival (OS), with 95%, 97%, and 98% 8-year OS for men with LN count ≤20, 21-40, and >40 LNs, respectively. OS in men with ≤20 vs 21-40 (p=0.018) and >40 LNs (p=0.042) resected differed significantly. However, no significant difference was observed when 21-40 vs >40 LNs were resected (p=0.677). Therefore, subsequent analysis compared those who had ≤20 and >20 LN resected, and OS between these two groups differed significantly (Figure). Multivariate analysis demonstrated that patients with private insurance, surgery having been performed at an academic center or in the Northeast, and those with pT2 disease were more likely to have >20 LNs resected at the time of RPLND. CONCLUSIONS: Lymph node count after 1° RPLND for NSGCT is significantly associated with overall survival, with more favorable survival seen in those who receive an RPLND with >20 LNs resected when compared to ≤20 LNs. Source of Funding: This work is supported by a grant from the National Cancer Institute (P30CA072720). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e139-e140 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiren Patel* More articles by this author Arnav Srivastava More articles by this author Sinae Kim More articles by this author Isaac Kim More articles by this author Eric Singer More articles by this author Thomas Jang More articles by this author Expand All Advertisement PDF downloadLoading ...

PD03-08 THE NECESSITY OF A SECOND TRANSURETHRAL RESECTION FOR PATIENTS DIAGNOSED WITH PTAHG TUMOR AT FIRST TUR: A MULTICENTER COLLABORATION OF EAU YOUNG ACADEMIC UROLOGISTS UROTHELIAL CARCINOMA GROUP

PD03-08 THE NECESSITY OF A SECOND TRANSURETHRAL RESECTION FOR PATIENTS DIAGNOSED WITH PTAHG TUMOR AT FIRST TUR: A MULTICENTER COLLABORATION OF EAU YOUNG ACADEMIC UROLOGISTS UROTHELIAL CARCINOMA GROUP

MP55-05 SURVIVAL OF PATIENTS WITH MUSCLE-INVASIVE UROTHELIAL CANCER OF THE BLADDER WITH RESIDUAL DISEASE AT THE TIME OF CYSTECTOMY FOLLOWING NEOADJUVANT CHEMOTHERAPY

INTRODUCTION AND OBJECTIVE: Approximately, 30-40% of bladder cancer patients treated with neoadjuvant chemotherapy (NAC) will have a pathologic complete response. The aim of our study was to compare overall survival (OS) between patients responsive and nonresponsive to NAC at time of RC to those who underwent RC alone or RC + adjuvant chemotherapy (AC). METHODS: The National Cancer Database was queried for patients who underwent RC alone, NAC+RC, or RC+AC treatment for muscle-invasive bladder cancer (MIBC) from 2004-2015. Covariates including age, sex, race, insurance, income, education, county, facility type, Charlson-Deyo comorbidity index, and clinical size (cT) were balanced using propensity score (PS) matching. Time to death was evaluated from diagnosis. A weighted cox proportional hazards model and Kaplan-Meier survival curves were created to analyze differences in OS. RESULTS: 8,288 patients were included in our analysis, 1,899 (23%) received NAC+RC, 860 (10%) received RC+AC, and 5,529 (67%) received RC alone. The 5-year PS-adjusted rates of OS was 47.7% (95% CI: 46.3-49.1, p<0.001) for NAC+RC vs 45.7% (95% CI: 44.5-46.9, p<0.001) for RC alone vs 41.5% (95% CI: 37.2-39.7, p<0.001) for RC+AC. Patients were sub-stratified based on pathological staging (≤pT2 or >pT2) and compared against treatment with RC alone. In the ≤pT2 cohort, NAC+RC was associated with a decreased risk of death (HR: 0.85, 95% CI: 0.79-0.91) and RC+AC was associated with an increased risk of death (HR: 1.46, 95% CI: 1.34-1.59, both p<0.001). In the >pT2 cohort, these associations reverse, with an increased risk of death seen in the NAC+RC treatment group (HR: 1.46, 95% CI: 1.05-1.18) and a decreased risk of death in the RC+AC treatment group (HR: 0.74, 95% CI: 0.7-0.77, both p<0.001). A similar trend was observed when sub-stratifying the NAC+RC group based on pathological response (pT<cT) (Figure 1). A landmark analysis fitted to 6 months after diagnosis confirmed our findings. CONCLUSIONS: Patients with >pT2 disease after NAC experienced a significant increased risk of death when compared to pathological stage-matched patients who underwent RC alone. Further research is warranted to accurately determine patient selection for NAC.Source of Funding: NA

Postoperative risk stratification in oral squamous cell carcinoma.

Postoperative prognostic stratification using the Union for International Cancer Control (UICC) TNM 8th edition staging rules (UICC 8) may identify additional groups of patients who could benefit from adjuvant radiotherapy. Currently, selection for such treatment is not based on all known prognostic factors, and their relative importance may vary depending on the overall risk category. The objective of this study therefore was to evaluate these possibilities. We retrospectively studied 644 patients who had surgery with curative intent for oral squamous cell carcinoma (OSCC) between March 2006 and February 2017. The outcomes of interest were disease-specific survival (DSS) and locoregional recurrence (LRR). Patients were re-staged according to the UICC 8 staging rules. Putative clinical and pathological prognostic variables were evaluated and hazard ratios estimated. Regression analysis was done to identify independent prognostic factors, and iterative analyses identified clinically-relevant risk categories with a minimum of residual prognostic variables. The significance of recognised pathological prognostic factors differed according to the overall risk category. An intermediate risk group comprising patients with pN1 disease as well those with pT3 disease solely on the basis of a depth of invasion (DOI) of more than 10 mm, was identified. A trial to evaluate the benefit or otherwise of adjuvant radiotherapy in this group is now required. Individual prognostic risk factors should be considered within the context of the overall risk category in patients with OSCC.

Outcomes of surgical treatment for patients with distal rectal cancer: A retrospective review from a single university hospital

Introduction and aimSurgery for distal rectal cancer (DRC) can be performed with or without sphincter preservation. The aim of the present study was to analyze the outcomes of two surgical techniques in the treatment of DRC patients: low anterior resection (LAR) and abdominoperineal resection (APR). MethodsPatients with advanced DRC that underwent surgical treatment between 2002 and 2012 were evaluated. We compared the outcomes of the type of surgery (APR vs LAR) and analyzed the associations of survival and recurrence with the following factors: age, sex, tumor location, lymph nodes obtained, lymph node involvement, and rectal wall involvement. Patients with distant metastases were excluded. ResultsA total of 148 patients were included, 78 of whom were females (52.7%). The mean patient age was 61.2 years. Neoadjuvant chemoradiation therapy was performed in 86.5% of the patients. APR was performed on 86 (58.1%) patients, and LAR on 62 (41.9%) patients. No differences were observed between the two groups regarding clinical and oncologic characteristics. Eighty-seven (62%) patients had pT3-4 disease, and 41 patients (27.7%) had lymph node involvement. In the multivariate analysis, only poorly differentiated tumors (P=.026) and APR (P=.009) correlated with higher recurrence rates. Mean follow-up time was 32 (16-59.9) months. Overall 5-year survival was 58.1%. The 5-year survival rate was worse in patients that underwent APR (46.5%) than in the patients that underwent LAR (74.2%) (P=.009). ConclusionsPatients with locally advanced DRC that underwent APR presented with a lower survival rate and a higher local recurrence rate than patients that underwent LAR. In addition, advanced T/stage, lymph node involvement, and poor tumor differentiation were associated with recurrence and a lower survival rate, regardless of the procedure.