Rate Of Lymph Node Invasion Research Articles

Assessing risk of lymph node invasion in complete responders to neoadjuvant chemotherapy for muscle-invasive bladder cancer.

To investigate the lymph node invasion (LNI) rate in patients exhibiting complete pathological response (CR) to neoadjuvant chemotherapy (NAC) and to test the association of CR status with lower LNI and better survival outcomes. We included patients with bladder cancer (BCa; cT2-4a; cN0; cM0) treated with NAC and radical cystectomy (RC) + pelvic lymph node dissection (PLND) at our institution between 2012 and 2022 (N = 157). CR (ypT0) and LNI (ypN+) were defined at final pathology. Univariable and multivariable logistic regression analysis was performed to test the association between CR and LNI after adjusting for number of lymph nodes removed (NLR). Kaplan-Meier and Cox regression analyses were used to assess overall survival (OS), metastasis-free survival (MFS) and disease free-survival (DFS) according to CR status. Overall CR and LNI rates were 40.1% and 19%, respectively. The median (interquartile range [IQR]) NLR was 26 (19-36). The LNI rate was lower in patients with CR vs those without CR (2 [3.2%] vs 61 [29.8%]; P < 0.001). After adjusting for NLR, CR reduced the LNI risk by 93% (odds ratio 0.07, 95% confidence interval [CI] 0.01-0.25; P < 0.001). Kaplan-Meier plots depicted better 5-year OS (69.7 vs 52.2%), MFS (68.3 vs 45.5%) and DFS (66.6 vs 43.5%) in patients with CR vs those without CR. After multivariable adjustments, CR independently reduced the risk of death (hazard ratio [HR] 0.44, 95% CI 0.24-0.81; P = 0.008), metastatic progression (HR 0.41, 95% CI 0.23-0.71; P = 0.002) and disease progression (HR 0.41, 95% CI 0.24-0.70; P = 0.001). Based on these findings, we postulate that PLND could potentially be omitted in patients exhibiting CR after NAC, due to negligible risk of LNI. Prospective Phase II trials are needed to explore this challenging hypothesis.

Impact of the time elapsed between prostate biopsy and surgery on the accuracy of nomograms predicting lymph node invasion in patients with clinically localized prostate cancer.

We aimed to investigate whether the performance characteristics of available nomograms predicting lymph node invasion (LNI) in prostate cancer patients undergoing radical prostatectomy (RP) change according to the time elapsed between diagnosis and surgery. We identified 816 patients who underwent RP with extended pelvic lymph node dissection (ePLND) after combined prostate biopsy at 6 referral centers. We plotted the accuracy (ROC-derived area under the curve [AUC]) of each Briganti nomogram according to the time elapsed between biopsy ad RP. We then tested whether discrimination of the nomograms improved after accounting for the time elapsed between biopsy ad RP. The median time between biopsy and RP was 3 months. The LNI rate was 13%. The discrimination of each nomogram decreased with increasing time elapsed between biopsy and surgery, where the AUC of the 2019 Briganti nomogram was 88% vs. 70% for men undergoing surgery <2 vs. >6 months from the biopsy. The addition of the time elapsed between biopsy ad RP improved the accuracy of all available nomograms (P < 0.003), with the Briganti 2019 nomogram showing the highest discrimination. Clinicians should be aware that the discrimination of available nomograms decreases according to the time elapsed between diagnosis and surgery. The indication of ePLND should be carefully evaluated in men below the LNI cut-off who had a diagnosis more than 6 months before RP. This has important implications when considering the longer waiting lists related to the impact of COVID-19 on healthcare systems.

PD10-07 CAN WE RELY ON AVAILABLE MODELS TO IDENTIFY CANDIDATES FOR EXTENDED PELVIC LYMPH NODE DISSECTION (EPLND) IN MEN STAGED WITH PSMA-PET? EXTERNAL VALIDATION OF THE BRIGANTI NOMOGRAMS AND DEVELOPMENT OF A NOVEL TOOL TO IDENTIFY OPTIMAL CANDIDATES FOR EPLND

PD10-07 CAN WE RELY ON AVAILABLE MODELS TO IDENTIFY CANDIDATES FOR EXTENDED PELVIC LYMPH NODE DISSECTION (EPLND) IN MEN STAGED WITH PSMA-PET? EXTERNAL VALIDATION OF THE BRIGANTI NOMOGRAMS AND DEVELOPMENT OF A NOVEL TOOL TO IDENTIFY OPTIMAL CANDIDATES FOR EPLND

MP67-03 IDENTIFYING THE OPTIMAL CANDIDATES FOR A SUPER-EXTENDED STAGING PELVIC LYMPH-NODE DISSECTION IN PROSTATE CANCER PATIENTS TREATED IN THE PET-PSMA ERA. RESULTS FROM A MULTI-INSTITUTIONAL SERIES

MP67-03 IDENTIFYING THE OPTIMAL CANDIDATES FOR A SUPER-EXTENDED STAGING PELVIC LYMPH-NODE DISSECTION IN PROSTATE CANCER PATIENTS TREATED IN THE PET-PSMA ERA. RESULTS FROM A MULTI-INSTITUTIONAL SERIES

Micropapillary thyroid carcinoma: not so harmless as it seems. A 5-year follow-up cohort retrospective study.

Introduction: Differentiated thyroid cancer is becoming increasingly prevalentmostly due to the increasing incidence of micropapillary carcinoma. For low-risktumors, hemithyroidectomy does not reduce survival and may be associated withhigher local recurrence. This study aimed to compare Micropapillary versusPapillary thyroid carcinomas regarding overall survival and disease-free survival.Methods: A retrospective, unicentric, cohort study was carried between 2012 and2016. Consecutive cases with (micro)papillary thyroid carcinoma were enrolledand divided in microcarcinoma group and control group. Exclusion criteria wereloss to follow-up, previous thyroid surgery and non-operative treatment. Acomparison of several clinical and pathological parameters, recurrence rate andcumulative survival was performed between groups. Results: Patients withmicropapillary carcinomas were younger and frequently asymptomatic. 6.5% ofthese carcinomas presented a benign cytology (Bethesda II) in this study. 18.9% ofthese patients were submitted to hemithyroidectomy but 71.4% were thereaftertotalized. Micropapillary carcinomas presented higher rate of multifocality butsimilar lymph node invasion rate, lymph node dissection rate and adjuvant iodinetherapy. Patients with micropapillary carcinomas presented less advanced stagingbut similar recurrence rate and time to recurrence; moreover, higher stage wasonly related with (older) age of presentation. Conclusions: In this studymicropapillary carcinomas presented better staging but similar recurrence ratecomparing with papillary carcinomas. Moreover, most of these patients weresubmitted to totalization. These results question if hemithyroidectomy is still agood option for micropapillary carcinomas and if this staging system is adequate.Larger studies with longer follow-up are needed to confirm or refute these results.

Cancer specific mortality in patients with collecting duct vs. clear cell renal carcinoma

BackgroundCollecting duct carcinoma (CDC) is biologically more aggressive than clear cell renal cell carcinoma (ccRCC). We tested for differences in cancer specific mortality (CSM) rates according to CDC vs. ISUP (International Society of Urological Pathology) 4 ccRCC histological subtype. We hypothesized that the survival disadvantage still applies, even after most detailed adjustments. MethodsWithin Surveillance, Epidemiology, and End Results database (2004–2018), we identified 380 CDC vs. 6273 ISUP 4 ccRCC patients of all stages. Propensity score matching (age, sex, race/ethnicity, T, N, and M stages, nephrectomy, and systemic therapy status), Kaplan-Meier plots and multivariable Cox regression models were used. ResultsAll 380 CDC were matched (1:2) with 760 ISUP4 ccRCC patients. Prior to matching CDC patients exhibited higher rates of lymph node invasion (37.6 % vs. 14.7 %, p < 0.001), and of distant metastases (40.8 % vs. 30.4 %, p < 0.001). Systemic therapy rates were higher in CDC (29.5 % vs. 20.5 %, p < 0.001). However, nephrectomy rates were higher in ISUP4 ccRCC patients (97.5 % vs. 84.7 %, p < 0.001). After matching, in multivariable Cox regression models addressing CSM, CDC was associated with a HR of 1.5 (p < 0.001) in the overall population vs. 1.9 (p = 0.014) in stage I-II vs. 1.4 (p = 0.022) in stage III vs. 1.6 in stage IV (p < 0.001), relative to ISUP4 ccRCC. ConclusionCDC patients exhibited 40–90 % higher CSM than their ISUP4 ccRCC counterparts in the overall analysis, as well as in stage specific analyses. The CSM disadvantage applies despite higher rates of systemic therapy in CDC patients.

Factors predicting biochemical recurrence following robot-assisted radical prostatectomy: single-center experience

Objective: In this study, we aimed to investigate factors predicting the development of biochemical recurrence (BCR) in our clinical experience with patients over a long follow-up.Material and Methods: The data of 758 patients who underwent robot-assisted radical prostatectomy (RARP) were retrospectively reviewed. In the postoperative period, the prostate-specific antigen (PSA) value is measured as 0.2 ng/mL and above, regarded as biochemical recurrence (BCR). The non-BCR group was regarded as Group 1, and the BCR group as Group 2.Results: The mean age was similar between the two groups. The PSA values ​​were significantly higher in the group that developed BCR (p&amp;lt;0.001). The biopsy Gleason score (GS), risk classification, and specimen GS were significantly higher in this group (p=0.02, p&amp;lt;0.001, and p&amp;lt;0.001, respectively). The BCR group also had statistically significantly higher positive surgical margin (PSM), extraprostatic extension (EPE), seminal vesicle invasion (SVI), and lymph node invasion rates. According to the multivariate analyses, PSA, risk classification, specimen GS, PSM, SVI, and T stage were significant parameters in the prediction of BCR.Conclusion: The parameters ​​that predict the development were determined as the PSA value, risk classification, specimen GS, PSM, SVI, and T stage. The widespread adoption of commonly accepted methods will help achieve better patient management and optimize patient expectations.

PD54-04 CHALLENGING THE DOGMA: SHOULD UNILATERAL PELVIC LYMPH NODE DISSECTION BE ENVISIONED IN THE MULTIPARAMETRIC PROSTATE MRI ERA?

PD54-04 CHALLENGING THE DOGMA: SHOULD UNILATERAL PELVIC LYMPH NODE DISSECTION BE ENVISIONED IN THE MULTIPARAMETRIC PROSTATE MRI ERA?

Contemporary Trends and Efficacy of Pelvic Lymph Node Dissection at Radical Cystectomy for Urothelial and Variant Histology Carcinoma of the Urinary Bladder.

To test 1) contemporary pelvic lymph node dissection (PLND) trends at radical cystectomy (RC) in variant histology bladder cancer (VHBC) patients and urothelial carcinoma of the urinary bladder (UCUB), as well as 2) to test the effect of PLND extent on cancer specific mortality (CSM) after RC. Within the Surveillance, Epidemiology and End Results Registry (SEER, 2004-2016), we identified non-metastatic stage T1-2 or T3-4 VHBC and UCUB patients, who underwent RC. CSM and lymph node invasion (LNI) rates were stratified according to PLND extent, as well as coded continuously in multivariate Cox and logistic regression models. Of 19,020 patients, 1736 (9.1%) were coded as having VHBC (46.9% squamous cell carcinoma, 22.5% adenocarcinoma, 18.9% neuroendocrine carcinoma, 11.7% not otherwise specified) vs 17,284 (90.9%) UCUB. PLND was performed in 80.1 of VHBC vs. 83.5% UCUB patients. In both histological groups, PLND rates increased over time (70.9-89.6% and 76.2%-90.1%, both P < .01). PLND extent did not significantly affect CSM in stage T1-2 or T3-4 VHBC patients. Conversely, PLND extent was associated with lower CSM in T1-2, as well as in T3-4 UCUB patients, which was confirmed in multivariate Cox analyses (Hazard ratio [HR] 0.99, P < .001). Rates of LNI increased with extent of PLND in logistic regression analyses in stage T3-4 VHBC (Odds ratio [OR] 1.01, P=.001), stage T1-2 UCUB (OR 1.01, P < .001) and T3-4 UCUB (OR 1.01, P < .001), but not in stage T1-2 VHBC (OR 1.01, P = .3). PLND rates do not differ between VHBC and UCUB patients. A potential survival benefit related to more extensive PLND is operational in UCUB patients, but not in VHBC patients.

MP15-15 WHO ARE THE PATIENTS WHO BENEFIT THE MOST FROM EXTENDED PELVIC LYMPH NODE DISSECTION IN LOCALIZED PROSTATE CANCER? IDENTIFICATION OF THE OPTIMAL CANDIDATES TO BE INCLUDED IN A RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP15)1 Sep 2021MP15-15 WHO ARE THE PATIENTS WHO BENEFIT THE MOST FROM EXTENDED PELVIC LYMPH NODE DISSECTION IN LOCALIZED PROSTATE CANCER? IDENTIFICATION OF THE OPTIMAL CANDIDATES TO BE INCLUDED IN A RANDOMIZED CONTROLLED TRIAL Giorgio Gandaglia, Giuseppe Rosiello, Simone Scuderi, Nicola Fossati, Armando Stabile, Andrea Necchi, Vito Cucchiara, Riccardo Leni, Donato Cannoletta, Andrea Gallina, Emanuele Zaffuto, Marco Moschini, Andrea Salonia, Federico Dehò, Francesco Montorsi, and Alberto Briganti Giorgio GandagliaGiorgio Gandaglia More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Armando StabileArmando Stabile More articles by this author , Andrea NecchiAndrea Necchi More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Riccardo LeniRiccardo Leni More articles by this author , Donato CannolettaDonato Cannoletta More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Federico DehòFederico Dehò More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001996.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A Phase III RCT (NCT01812902) failed to show a benefit of limited vs extended pelvic lymph node dissection (ePLND) in intermediate and high-risk prostate cancer (PCa) patients undergoing RP. We aimed at assessing the generalizability of this trial and the outcomes of ePLND according to different selection criteria to identify the candidate for inclusion in a RCT METHODS: 3,421 PCa patients treated with RP and PLND were included. We identified men who fulfilled the NCT01812902 criteria for inclusion. Kaplan-Meier analyses assessed time to biochemical recurrence (BCR). An interaction test assessed whether the impact of the number of nodes removed on BCR-free survival varied according to the risk of lymph node invasion (LNI) according to different risk strata calculated with the Briganti nomogram RESULTS: The criteria proposed by the NCT01812902 trial would have resulted in 1,076 (72.7%) and 405 (27.3%) eligible intermediate- and high-risk patients. The number of nodes removed was 18 (vs. 17 in the ePLND group of the trial) and the rate of LNI was 15.6% (vs. 17%). If the 5% Briganti nomogram cut-off to select PLND candidates had been used, only 758 (51.2%) patients would have been included in the trial with a rate of LNI of 27.3% and a 55% 5-year BCR-free survival (n=171), lower than 67.5% (n=228) corresponding to intermediate and high risk patients. The impact of the PLND extent (i.e., number of nodes removed) on BCR varied according to the risk of LNI according to the Briganti nomogram (p=0.04 by interaction test). A more extensive PLND was associated with a decreased BCR if the risk of LNI was between 10-20% but not in men with a lower or higher risk (Figure). The use of this range of the estimated risk of LNI for patient selection would have resulted in only 258 (34%) eligible men CONCLUSIONS: The use of a 5% Briganti nomogram cut-off as eligibility criteria for a RCT would have resulted into the inclusion of only 50% of intermediate and high-risk patients. The NCT01812902 trial cannot be generalized to patients selected for PLND according to guidelines. A more extended PLND was beneficial in men with a 10-20% LNI risk, who should theoretically be considered for the inclusion in RCTs Source of Funding: © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e269-e269 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giorgio Gandaglia More articles by this author Giuseppe Rosiello More articles by this author Simone Scuderi More articles by this author Nicola Fossati More articles by this author Armando Stabile More articles by this author Andrea Necchi More articles by this author Vito Cucchiara More articles by this author Riccardo Leni More articles by this author Donato Cannoletta More articles by this author Andrea Gallina More articles by this author Emanuele Zaffuto More articles by this author Marco Moschini More articles by this author Andrea Salonia More articles by this author Federico Dehò More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Loading ...

A novel nomogram predicting lymph node invasion among patients with prostate cancer: The importance of extracapsular extension at multiparametric magnetic resonance imaging

PurposeTo develop a novel risk tool that allows the prediction of lymph node invasion (LNI) among patients with prostate cancer (PCa) treated with robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND). MethodsWe retrospectively identified 742 patients treated with RARP + ePLND at a single center between 2012 and 2018. All patients underwent multiparametric magnetic resonance imaging (mpMRI) and were diagnosed with targeted biopsies. First, the nomogram published by Briganti et al. was validated in our cohort. Second, three novel multivariable logistic regression models predicting LNI were developed: (1) a complete model fitted with PSA, ISUP grade groups, percentage of positive cores (PCP), extracapsular extension (ECE), and Prostate Imaging Reporting and Data System (PI-RADS) score; (2) a simplified model where ECE score was not included (model 1); and (3) a simplified model where PI-RADS score was not included (model 2). The predictive accuracy of the models was assessed with the receiver operating characteristic-derived area under the curve (AUC). Calibration plots and decision curve analyses were used. ResultsOverall, 149 patients (20%) had LNI. In multivariable logistic regression models, PSA (OR: 1.03; P= 0.001), ISUP grade groups (OR: 1.33; P= 0.001), PCP (OR: 1.01; P= 0.01), and ECE score (ECE 4 vs. 3 OR: 2.99; ECE 5 vs. 3 OR: 6.97; P< 0.001) were associated with higher rates of LNI. The AUC of the Briganti et al. model was 74%. Conversely, the AUC of model 1 vs. model 2 vs. complete model was, respectively, 78% vs. 81% vs. 81%. Simplified model 1 (ECE score only) was then chosen as the best performing model. A nomogram to calculate the individual probability of LNI, based on model 1 was created. Setting our cut-off at 5% we missed only 2.6% of LNI patients. ConclusionsWe developed a novel nomogram that combines PSA, ISUP grade groups, PCP, and mpMRI-derived ECE score to predict the probability of LNI at final pathology in RARP candidates. The application of a nomogram derived cut-off of 5% allows to avoid a consistent number of ePLND procedures, missing only 2.6% of LNI patients. External validation of our model is needed.

Prediction of the Need for an Extended Lymphadenectomy at the Time of Radical Cystectomy in Patients with Bladder Cancer

BackgroundA prospective randomized trial (LEA AUO AB 25/02) found no survival benefit in extended compared with limited pelvic lymph node dissection (PLND) templates in bladder cancer (BCa) patients treated with radical cystectomy (RC). However, the rate of lymph node invasion (LNI) in the standard and extended templates was lower than estimated. ObjectiveTo assess the accuracy of preoperative clinical and pathological parameters to predict LNI and to develop a model to preoperatively select candidates for the extended PLND templates. Design, setting, and participantsA total of 903 BCa patients treated at a single institution were retrospectively identified. The primary outcome was to identify preoperatively the risk of LNI to tailor the type of PLND. The extended PLND templates consisted in the removal of pelvic lymph nodes together with the common iliac, presacral, para-aortocaval, interaortocaval, and paracaval sites up to the inferior mesenteric artery. InterventionA total of 903 BCa patients were treated with RC and bilateral extended PLND templates. Outcome measurements and statistical analysisSeveral models predicting LNI were evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots and decision curve analyses. A nomogram predicting LNI in the extended pattern was developed and validated internally. Results and limitationsOverall, 55 patients (6.1%) had LNI in the extended PLND templates at RC. The median number of nodes removed was 19 (interquartile range: 13–26). A model including age, clinical T stage, clinical node stage, lymphovascular invasion, and presence of carcinoma in situ at the last transurethral resection before RC was developed. The AUC of this model is 73%. Using a cutoff of 3%, 108 extended PLNDs (12%) would be spared and only two LNIs (3%) would be missed. The main limitations of our model are the retrospective nature of the data, lack of external validation, and low rate of LNI. ConclusionsThis is the first proposed model to predict LNI in the extended PLND templates. This model might help urologists identify which patients might benefit from an extended PLND at the time of RC, reserving a standard PLND for all the others. Patient summaryWe developed the first nomogram to predict lymph node invasion (LNI) in the extended pelvic lymph node dissection templates in bladder cancer patients treated with radical cystectomy. The adoption of our model to identify candidates for the extended pelvic lymph node dissection templates could avoid up to 12% of these procedures at the cost of missing only 3% of patients with LNI.

The role of 18F-FAZA PET/CT in detecting lymph node metastases in renal cell carcinoma patients: a prospective pilot trial.

The accurate detection of nodal invasion is an unmet need in the clinical staging of renal cancer. Positron emission tomography (PET) with 18F-fluoroazomycin arabinoside (18F-FAZA), a hypoxia specific tracer, is a non-invasive imaging method that detects tumour hypoxia. The aim of this work was to evaluate the role of 18F-FAZA PET/CT in the identification of lymph node metastases in renal cancer. A proof-of-concept phase 2 study including 20 kidney cancer patients ( ClinicalTrials.gov Identifier: NCT03955393) was conducted. Inclusion criteria were one or more of the following three criteria: (1) clinical tumour size > 10cm, (2) evidence of clinical lymphadenopathies at preoperative CT scan and (3) clinical T4 cancer. Before surgery, 18F-FAZA PET/CT was performed, 2h after the intravenous injection of the radiotracer. An experienced nuclear medicine physician, aware of patient's history and of all available diagnostic imaging, performed a qualitative and semi-quantitative analysis on 18F-FAZA images. Histopathological analysis was obtained in all patients on surgical specimen. Fourteen/19 (74%) patients had a non-organ confined renal cell carcinoma (RCC) at final pathology (either pT3 or pT4). Median number of nodes removed was 12 (IQR 7-15). The rate of lymph node invasion was 16%. No patient with pN1 disease showed positive 18F-FAZA PET, thus suggesting the non-hypoxic behaviour of the lesions. In addition, neither primary tumour nor distant metastases presented a pathological 18F-FAZA uptake. No adverse events were recorded during the study. 18F-FAZA PET/CT scan did not detect RCC lymph neither nodal nor distant metastases and did not show any uptake in the primary renal tumour.

Histotype predicts the rate of lymph node invasion at nephrectomy in patients with nonmetastatic renal cell carcinoma

BackgroundLymph node invasion (LNI) at nephrectomy is one of the most important predictors of mortality in patients with nonmetastatic renal cell carcinoma (RCC). We analyzed the effect of histology on lymph node metastases at nephrectomy and its effect on survival in a contemporary cohort of patients with nonmetastatic RCC. MethodsWithin the Surveillance, Epidemiology, and End Results database (2004-2015), we identified 100,060 patients with clear-cell, papillary, chromophobe, sarcomatoid, and collecting duct RCC, who underwent nephrectomy with or without lymph node dissection for nonmetastatic RCC. Logistic regression models, cumulative incidence plots, and competing-risks regression models were performed. ResultsOverall, 10,590 patients underwent lymph node dissection for nonmetastatic RCC. Of these, LNI was recorded in 52 (7.0%), 615 (8.7%), 282 (13.9%), 316 (25.1%), 129 (38.3%), 45 (71.4%) patients with chromophobe, clear-cell, nonotherwise specified RCC, papillary, sarcomatoid, and collecting duct RCC histological subtypes, respectively. In logistic regression models, relative to clear-cell, papillary Odds ratio (OR 3.9), sarcomatoid (OR 6.3), collecting duct (OR 14.6) but not chromophobe RCC (OR 0.9; P = 0.5) independently predicted LNI at surgery. Moreover, in competing-risks regression models, LNI increased the risk of CSM 1.8-fold for sarcomatoid, 3.6-fold for clear-cell, 4.1-fold for papillary, and 6.7-fold for chromophobe histological subtype. ConclusionsHistology is an independent predictor of increased risk of LNI at nephrectomy. Moreover, the effect of pathological nodal stage on survival differs according to different histology.

The platelet-to-lymphocyte ratio as a significant prognostic factor to predict survival outcomes in patients with synchronous metastatic renal cell carcinoma.

PurposeThe clinical impact of the platelet-to-lymphocyte ratio (PLR) on the prognosis of patients with metastatic renal cell carcinoma (mRCC) remains controversial. We investigated the associations between elevation of the PLR and disease prognosis in patients with synchronous mRCC.Materials and MethodsThe data of 1,505 patients with synchronous mRCC were retrospectively analyzed. The entire cohort was stratified into two subgroups according to PLR. Kaplan–Meier and Cox proportional analyses were performed to investigate the possible associations between the PLR and disease prognosis.ResultsThere were 921 patients with a high PLR and 584 patients with a low PLR by use of the cutoff of 146. The patients with a high PLR had worse clinical characteristics in terms of advanced clinical stage (p<0.001) and rate of lymph node invasion (p=0.036). The Kaplan–Meier analysis showed that patients with a high PLR had significantly shorter overall survival (OS) (p<0.001) and cancer-specific survival (CSS) (p<0.001). The multivariate Cox analysis revealed that the PLR was an independent predictor for shorter OS (hazard ratio [HR], 1.345; 95% confidence interval [CI], 1.183–1.530; p<0.001) and CSS (HR, 1.318; 95% CI, 1.156–1.502; p<0.001). In the subgroup analyses, the PLR showed a significant association with survival outcomes in the subgroup with clear cell type (all p<0.05) but not in the subgroup with the non–clear cell type.ConclusionsThe PLR was an independent prognostic factor for survival outcomes in patients with mRCC. However, the association was statistically significant only in patients with clear cell type mRCC.

Rates of lymph node invasion and their impact on cancer specific mortality in upper urinary tract urothelial carcinoma

PurposeTo analyze lymph node invasion (LNI) rates according to tumor characteristics and to test the impact of LNI and its extent on cancer specific mortality (CSM) in surgically-treated non metastatic urothelial upper urinary tract carcinoma (UTUC) patients. Materials and methodsWithin the SEER database (2004–2014), we identified 2098 patients with histologically confirmed non-metastatic urothelial carcinoma of renal pelvis or ureter who underwent NU with LND. LNI rates stratified according to tumor location and stage were described. Kaplan-Meier plots illustrated CSM rates according to LNI and its extent. Multivariable Cox regression models (MCRMs) tested the effect of LNI and its extent on CSM. ResultsOf 2098 UTUC patients, who underwent nephroureterectomy with lymph node dissection, 646 (33%) had LNI. The median number of removed lymph nodes was 3 [Interquartile range (IQR): 1–7]. The median number of positive lymph nodes in patients, who harbored LNI was 1 (IQR:1–3). LNI rates according to tumor location were, respectively, 23.6% for ureteral and 36.5% for renal pelvis tumors. LNI rates according to tumor stage were 9.6, 18.0, 38.7 and 63.9%, for respectively, T1, T2, T3 and T4 UTUC. In MCRMs, LNI achieved independent predictor status for higher CSM (HR 3.00; p < 0.001). Finally, in MCRMs, number of positive lymph nodes defined as the 75th percentile (n ≥ 3) achieved independent predictor status for higher CSM (HR 1.37; p = 0.04). ConclusionsLNI in non-metastatic UTUC patients is the most important determinant of CSM. Number of positive lymph node is independently associated with higher CSM. In consequence, lymph node dissection can provide extensive prognostic information.

The side and the location of the primary tumor does not affect the probability of lymph node invasion in patients with renal cell carcinoma.

To evaluate the role of side and location of the primary renal cell carcinoma (RCC) on the risk of lymph node invasion (LNI) and/or nodal progression (NP) during follow-up. We evaluated 2485 patients with unilateral RCC, surgically treated in a single tertiary care referral center. Outcomes were LNI at surgery and/or NP during follow-up. We studied if RCC side (left vs. right) and location (upper vs. middle vs. hilar vs. lower area vs. more than one area) affected the probability of LNI and/or NP at follow-up. Overall, 43 and 15% of patients underwent lymph node dissection and had LNI at surgery, respectively. During follow-up, 2.2% of patients had NP. Higher rates of LNI and NP were observed for patients with primary tumor located in more than one anatomical kidney area relative to patients with tumor in a single area (upper 11% vs. middle 10% vs. hilar 0%, vs. lower 12% vs. more than one area 26%, p < 0.01). cM1, cN1, pT2/pT3/pT4 disease and Fuhrman grade 3/4 were independent predictors of the study outcome (all p ≤ 0.01). Neither the RCC side nor the location reached the independent predictor status (all p > 0.1). Patients with single-side and more than one anatomical kidney area affected by RCC have higher rate of LNI at surgery and/or NP at follow-up. Neither side nor location of primary RCC tumor is related to the risk of harboring LNI at surgery and/or developing NP at follow-up.

Racial disparities in lymph node dissection at radical prostatectomy: A Surveillance, Epidemiology and End Results database analysis.

To test for racial disparities in lymph node dissection rates, lymph node dissection extent, lymph node invasion rates and cancer-specific mortality in North American African Americans versus non-Hispanic whites, at radical prostatectomy for clinically localized prostate cancer. Within the Surveillance, Epidemiology and End Results database (2010-2014), we identified 58 974 African Americans or non-Hispanic whites with prostate cancer, who underwent radical prostatectomy with available clinical stage, prostate-specific antigen and biopsy Gleason score. Annual trends were examined. Logistic regression models focused on lymph node dissection rates, lymph node dissection extent (number of removed lymph nodes) and lymph node invasion. Cox regression models tested for differences in cancer-specific mortality. Multivariable models were adjusted for D'Amico risk groups, age and year. Models predicting lymph node invasion and cancer-specific mortality were additionally adjusted for lymph node dissection extent. Among all patients, 14.5% were African Americans. Lymph node dissection was carried out in 60.0% of African Americans versus 59.5% of non-Hispanic whites (P = 0.4). The median number of removed lymph nodes was five in African Americans versus six in non-Hispanic whites (P < 0.001). Furthermore, 3.1% versus 3.3% of African Americans and non-Hispanic whites, respectively, harbored lymph node invasion (P = 0.3). In multivariable logistic regression models African American race did not affect lymph node dissection or lymph node invasion rates, but lymph node dissection extent was lower in African Americans (hazard ratio 0.9; P < 0.001). No statistical differences in cancer-specific mortality were identified according to race. Contemporary North American African American patients treated with radical prostatectomy have equal access to lymph node dissection, the same lymph node invasion rates and the same cancer-specific mortality rates as non-Hispanic whites. However, the extent of lymph node dissection is lower in African Americans. The results regarding lymph node dissection rates are encouraging. However, improvements are required regarding lymph node dissection extent in African Americans.

Increasing rate of lymph node invasion in patients with prostate cancer treated with radical prostatectomy and lymph node dissection

ObjectivesTo investigate lymph node invasion (LNI) rates in prostate cancer (PCa) patients. Recent studies demonstrated an inverse stage migration in PCa patients toward more advanced and unfavorable diseases. We hypothesized that this trend is also evident in LNI rates, in PCa patients treated with radical prostatectomy (RP) and pelvic lymph node dissection (PLND). Patients and methodsWithin the Surveillance, Epidemiology, and End Results database (2004–2014), we identified patients who underwent RP and PLND. Annual trends of LNI rates and PLND extent were plotted. Univariable and multivariable logistic regression models tested the hypothesis that LNI rates are increasing annually, even after adjustment for clinical or pathological characteristics. ResultsOf 96,874 patients treated with RP and PLND, 4.1% (n = 4,002) exhibited LNI. The rate of LNI (2.5%–6.6%.), the mean (6.5–8.4) and median (5–6) number of removed lymph nodes increased during the study period. In multivariable logistic regression models, more contemporary year of diagnosis was associated with higher LNI rate, when year of diagnosis was modeled as a continuous, categorized or cubic spline variable, with adjustment for either clinical (prostate specific antigen, clinical tumor stage, and biopsy Gleason group) or pathological characteristics (pathologic tumor stage and Gleason group), as well as PLND extent (number of removed lymph nodes). ConclusionWe confirmed the hypothesis about increasing LNI rate over time in RP patients. This observation implies an increasing rate of unfavorable PCa defined as LNI. This finding is novel for contemporary epidemiological North American or European databases.

MP34-09 PREVALENCE AND PROGNOSTIC IMPACT OF PROSTATE CANCER HISTOLOGICAL VARIANTS AT RADICAL PROSTATECTOMY: A LONG-TERM, SINGLE CENTER ANALYSIS

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History II1 Apr 2018MP34-09 PREVALENCE AND PROGNOSTIC IMPACT OF PROSTATE CANCER HISTOLOGICAL VARIANTS AT RADICAL PROSTATECTOMY: A LONG-TERM, SINGLE CENTER ANALYSIS Carlo Andrea Bravi, Giorgio Gandaglia, Nicola Fossati, Roberta Lucianò, Emanuele Zaffuto, Vincenzo Scattoni, Andrea Gallina, Roberto Bertini, Massimo Freschi, Shahrokh F. Shariat, Vincenzo Mirone, Pierre I. Karakiewicz, Rodolfo Montironi, Claudio Doglioni, Francesco Montorsi, and Alberto Briganti Carlo Andrea BraviCarlo Andrea Bravi More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Roberta LucianòRoberta Lucianò More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Vincenzo ScattoniVincenzo Scattoni More articles by this author , Andrea GallinaAndrea Gallina More articles by this author , Roberto BertiniRoberto Bertini More articles by this author , Massimo FreschiMassimo Freschi More articles by this author , Shahrokh F. ShariatShahrokh F. Shariat More articles by this author , Vincenzo MironeVincenzo Mirone More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Rodolfo MontironiRodolfo Montironi More articles by this author , Claudio DoglioniClaudio Doglioni More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1101AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although variant histological subtypes in prostate cancer (PCa) are rare, recent studies reported conflicting results regarding their aggressiveness. We sought to assess the incidence of variant histological subtypes in patients treated with radical prostatectomy (RP). We then focused on the impact of variant histology on disease features and outcomes METHODS Overall, 8,723 PCa patients treated with RP ± ePLND between 1997 and 2017 at a single center were identified. All prostatectomy specimens were evaluated by four high- volume uro-pathologists. Individuals with variant histologic subtypes at final pathology (namely, ductal and mucinous adenocarcinoma) were identified. The Mann-Whitney and chi-square tests assessed differences in medians and proportions between acinar adenocarcinoma vs. variant histologic subtype. We focused on age, preoperative PSA, clinical stage, pathologic stage, positive surgical margins (PSM) and lymph node invasion (LNI). Biochemical recurrence (BCR) was defined as two consecutive PSA ≥0.2 ng/ml. Clinical recurrence (CR) was defined as positive imaging during follow-up. Kaplan-Meier analyses assessed time to BCR, CR and cancer-specific mortality (CSM) according to the histologic subtype RESULTS Overall, 8,659 (99.3%), 44 (0.5%) and 20 (0.2%) patients had acinar adenocarcinoma, ductal adenocarcinoma and mucinous carcinoma of the prostate. Median age and preoperative PSA were 65.3 vs 66.8 vs 63.1 years and 6.7 vs 7.7 vs 8.9 ng/ml for acinar, ductal and mucous carcinoma (all P≥0.2). Clinical stage was T3 in 733 (8.4%), 6 (13.6%) and 3 (15%) in acinar, ductal and mucinous carcinoma (P=0.1). Overall, 1,267 (14.6%), 16 (36.4%) and 7 (35%) acinar, ductal and mucinous carcinoma had pT3b/4 disease (P<0.001). The PSM and LNI rates were 24.8 vs 34.1 vs 35% and 11.4 vs 27.3 vs 35% in acinar vs ductal vs mucinous carcinoma (all P<0.001). Median follow-up for survivors was 66 months. When patients were stratified according to the histologic subtype, the 10-year BCR-, CR-, and CSM-free survival rates were 67.2 vs 31.7 vs 58.9%, 91.3 vs 70.9 vs 99% and 96.4 vs 79.5 vs 99% for acinar vs ductal vs mucous carcinoma (all P<0.001) CONCLUSIONS Although baseline characteristics of patients with variant histologic subtypes do not differ compared to acinar adenocarcinoma, men with ductal or mucinous carcinoma have a higher rate of pT3b/4, PSM and LNI. Only the presence of ductal adenocarcinoma was associated with an increased risk of CR and CSM. These patients should be considered for more aggressive postoperative therapies © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e441 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Carlo Andrea Bravi More articles by this author Giorgio Gandaglia More articles by this author Nicola Fossati More articles by this author Roberta Lucianò More articles by this author Emanuele Zaffuto More articles by this author Vincenzo Scattoni More articles by this author Andrea Gallina More articles by this author Roberto Bertini More articles by this author Massimo Freschi More articles by this author Shahrokh F. Shariat More articles by this author Vincenzo Mirone More articles by this author Pierre I. Karakiewicz More articles by this author Rodolfo Montironi More articles by this author Claudio Doglioni More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...