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1670 NON-CANCER RELATED MORTALITY IN PARTIAL VERSUS RADICAL NEPHRECTOMY FOR T1A RENAL CELL CARCINOMA: A PROPENSITY-BASED MATCHED ANALYSIS
Vol. 185, No. 4S, Supplement, Tuesday, May 17, 2011
LR⫹MP. In 219 patients without tumor at vein margin: 84(38%) had MP and 10(3.7%) had both LR⫹MP. No patients with negative vein margins had isolated LR. Patients with positive margins were statistically more likely to have LR (p⫽0.02) and metastatic progression (p⫽0.01). There was no statistical difference in OS between the two groups (p⫽0.54). Positive margins were more likely in patients with higher level thrombus (p⬍0.001) but increase in risk was associated with higher grade (p⫽0.28). CONCLUSIONS: Positive vein margins in non-metastatic RCC patients are associated with higher rates of local recurrence and metastatic progression. Risk is increased in patients with increased height of thrombus. Preoperative identification of thrombus and liberal resection of vein margins is suggested whenever feasible.
THE JOURNAL OF UROLOGY姞
e671
CONCLUSIONS: PN-treated T1a patients have a survival noncancer related mortality advantage over RN-treated patients, even after propensity-based adjustment. Consequently, PN should be considered whenever surgically feasible. Source of Funding: None
Sexual Function/Dysfunction/Andrology: Medical and Non-Surgical Therapy Podium 43 Tuesday, May 17, 2011
10:30 AM-12:30 PM
1671 THE EFFECT OF SIMVASTATIN ON PENILE ERECTION IN PATIENTS WITH ALTERED C-REACTIVE PROTEIN: A RANDOMIZED, DOUBLE BLIND, PLACEBO CONTROLLED CLINICAL TRIAL (STED TRIAL) Eduardo Mastalir*, Gustavo Carvalhal, Vera Portal, Porto Alegre, Brazil
Source of Funding: None
1670 NON-CANCER RELATED MORTALITY IN PARTIAL VERSUS RADICAL NEPHRECTOMY FOR T1A RENAL CELL CARCINOMA: A PROPENSITY-BASED MATCHED ANALYSIS Maxine Sun*, Claudio Jeldres, Montreal, Canada; Firas Abdollah, Milan, Italy; Jan Schmitges, Hamburg, Germany; Salima Ismail, Orchid Djahangirian, Zhe Tian, Daniel Liberman, Monica Morgan, Hugues Widmer, Montreal, Canada; Shahrokh Shariat, New York, NY; Paul Perrotte, Pierre I. Karakiewicz, Montreal, Canada INTRODUCTION AND OBJECTIVES: Partial nephrectomy (PN) for treatment of small renal tumors is associated with a noncancer related mortality survival advantage relative to radical nephrectomy (RN). We sought to assess and compare non-cancer related mortality rates of patients undergoing PN relative to RN. METHODS: From the Surveillance, Epidemiology and End Results database, 19656 T1aN0M0 renal cell carcinoma patients were assessable. For proper comparison of treatment modalities, propensitybased matching was performed where respectively 5935 and 13721 PN and RN patients were matched. Cumulative incidence plots and competing-risks regression analyses were generated for evaluation of non-cancer related mortality. RESULTS: In the propensity-based matched analysis, noncancer related mortality rates at 5 and 10 years of follow-up for PN versus RN were respectively 18.6 and 23.3% vs. 34.3 vs. 47.6% (p⬍0.001). Multivariable competing-risks regression analyses revealed that PN patients were respectively 80% less likely to succumb to non-cancer related mortality relative to patients who treated with RN (p⬍0.001).
INTRODUCTION AND OBJECTIVES: Recent evidence has suggested that erectile dysfunction (ED) is strongly correlated with other correlates of endothelial dysfunction. Current knowledge about the physiopathology of ED has led to the development of clinical trials investigating the role of statins in men with ED. However, published data about the interaction of ED and statins are sparse and conflicting. The objective of this study is to evaluate the effect of simvastatin in ED secondary to endothelial dysfunction. METHODS: Double blind, randomized, clinical trial in patients with ED and endothelial dysfunction defined by ultrasensitive C-reactive protein (usCRP) levels ⱖ 1.1 mg/L (NCT00947323). Patients were randomized to receive 20 mg simvastatin (n⫽21) or placebo (n⫽20) daily, for six months. Subsequently, patients of both groups were prescribed 10mg of vardenafil on demand for four weeks. Serum cholesterol, hormone profile, usCRP, the International Index of Erectile Dysfunction (IIEF) and the ED Index of Treatment Satisfaction (EDITS) were evaluated. RESULTS: There was a significant reduction of the serum cholesterol in the treatment group. The hormonal profile remained unaltered. The reduction of the usCRP levels were of 32% (P⫽0.376) in the simvastatin group, and of 8.3% (P⫽0.266) in the placebo group. The IIEF-5 improved significantly from 13.33 ⫾ 6.33 to 22.77 ⫾ 3.68 (P⬍0.001), although without difference to placebo (from 11.16 ⫾ 7.81 to 22.22 ⫾ 4.50, P⫽0.733). At the beginning, 26% of the patients of both groups presented with mild ED and 74% with moderate to severe ED; at the end of the seventh month, all patients from the simvastatin group progressed to mild ED, compared to only 83% in the placebo group. CONCLUSIONS: Simvastatin did not determine a statistically significant improvement of erectile function compared to placebo. However, changes in the severity of ED suggest that simvastatin may be benefitial to patients with ED and endothelial dysfunction. Further studies are necessary to verify this hypothesis. Source of Funding: None
LR⫹MP. In 219 patients without tumor at vein margin: 84(38%) had MP and 10(3.7%) had both LR⫹MP. No patients with negative vein margins had isolated LR. Patients with positive margins were statistically more likely to have LR (p⫽0.02) and metastatic progression (p⫽0.01). There was no statistical difference in OS between the two groups (p⫽0.54). Positive margins were more likely in patients with higher level thrombus (p⬍0.001) but increase in risk was associated with higher grade (p⫽0.28). CONCLUSIONS: Positive vein margins in non-metastatic RCC patients are associated with higher rates of local recurrence and metastatic progression. Risk is increased in patients with increased height of thrombus. Preoperative identification of thrombus and liberal resection of vein margins is suggested whenever feasible.
THE JOURNAL OF UROLOGY姞
e671
CONCLUSIONS: PN-treated T1a patients have a survival noncancer related mortality advantage over RN-treated patients, even after propensity-based adjustment. Consequently, PN should be considered whenever surgically feasible. Source of Funding: None
Sexual Function/Dysfunction/Andrology: Medical and Non-Surgical Therapy Podium 43 Tuesday, May 17, 2011
10:30 AM-12:30 PM
1671 THE EFFECT OF SIMVASTATIN ON PENILE ERECTION IN PATIENTS WITH ALTERED C-REACTIVE PROTEIN: A RANDOMIZED, DOUBLE BLIND, PLACEBO CONTROLLED CLINICAL TRIAL (STED TRIAL) Eduardo Mastalir*, Gustavo Carvalhal, Vera Portal, Porto Alegre, Brazil
Source of Funding: None
1670 NON-CANCER RELATED MORTALITY IN PARTIAL VERSUS RADICAL NEPHRECTOMY FOR T1A RENAL CELL CARCINOMA: A PROPENSITY-BASED MATCHED ANALYSIS Maxine Sun*, Claudio Jeldres, Montreal, Canada; Firas Abdollah, Milan, Italy; Jan Schmitges, Hamburg, Germany; Salima Ismail, Orchid Djahangirian, Zhe Tian, Daniel Liberman, Monica Morgan, Hugues Widmer, Montreal, Canada; Shahrokh Shariat, New York, NY; Paul Perrotte, Pierre I. Karakiewicz, Montreal, Canada INTRODUCTION AND OBJECTIVES: Partial nephrectomy (PN) for treatment of small renal tumors is associated with a noncancer related mortality survival advantage relative to radical nephrectomy (RN). We sought to assess and compare non-cancer related mortality rates of patients undergoing PN relative to RN. METHODS: From the Surveillance, Epidemiology and End Results database, 19656 T1aN0M0 renal cell carcinoma patients were assessable. For proper comparison of treatment modalities, propensitybased matching was performed where respectively 5935 and 13721 PN and RN patients were matched. Cumulative incidence plots and competing-risks regression analyses were generated for evaluation of non-cancer related mortality. RESULTS: In the propensity-based matched analysis, noncancer related mortality rates at 5 and 10 years of follow-up for PN versus RN were respectively 18.6 and 23.3% vs. 34.3 vs. 47.6% (p⬍0.001). Multivariable competing-risks regression analyses revealed that PN patients were respectively 80% less likely to succumb to non-cancer related mortality relative to patients who treated with RN (p⬍0.001).
INTRODUCTION AND OBJECTIVES: Recent evidence has suggested that erectile dysfunction (ED) is strongly correlated with other correlates of endothelial dysfunction. Current knowledge about the physiopathology of ED has led to the development of clinical trials investigating the role of statins in men with ED. However, published data about the interaction of ED and statins are sparse and conflicting. The objective of this study is to evaluate the effect of simvastatin in ED secondary to endothelial dysfunction. METHODS: Double blind, randomized, clinical trial in patients with ED and endothelial dysfunction defined by ultrasensitive C-reactive protein (usCRP) levels ⱖ 1.1 mg/L (NCT00947323). Patients were randomized to receive 20 mg simvastatin (n⫽21) or placebo (n⫽20) daily, for six months. Subsequently, patients of both groups were prescribed 10mg of vardenafil on demand for four weeks. Serum cholesterol, hormone profile, usCRP, the International Index of Erectile Dysfunction (IIEF) and the ED Index of Treatment Satisfaction (EDITS) were evaluated. RESULTS: There was a significant reduction of the serum cholesterol in the treatment group. The hormonal profile remained unaltered. The reduction of the usCRP levels were of 32% (P⫽0.376) in the simvastatin group, and of 8.3% (P⫽0.266) in the placebo group. The IIEF-5 improved significantly from 13.33 ⫾ 6.33 to 22.77 ⫾ 3.68 (P⬍0.001), although without difference to placebo (from 11.16 ⫾ 7.81 to 22.22 ⫾ 4.50, P⫽0.733). At the beginning, 26% of the patients of both groups presented with mild ED and 74% with moderate to severe ED; at the end of the seventh month, all patients from the simvastatin group progressed to mild ED, compared to only 83% in the placebo group. CONCLUSIONS: Simvastatin did not determine a statistically significant improvement of erectile function compared to placebo. However, changes in the severity of ED suggest that simvastatin may be benefitial to patients with ED and endothelial dysfunction. Further studies are necessary to verify this hypothesis. Source of Funding: None