- Email: [email protected]
MP54-19 IMPACT OF PROSTATE INVOLVEMENT ON OUTCOMES IN PATIENTS TREATED WITH RADICAL CYSTOPROSTATECTOMY FOR BLADDER CANCER
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Sunday, May 14, 2017
cancer is a controversial issue with contradictory findings concerning ureteral FS and very few data concerning urethral FS. Moreover, previous reports aimed to assess the impact of positive FS on oncological outcomes but none have compared the impact of FS vs. no FS on oncological ouctomes. The objective of this study was to evaluate the impact of urethral and ureteral FS use on oncological outcomes after radical cystectomy for bladder cancer. METHODS: All patients who underwent a radical cystectomy for bladder cancer between 1995 and 2015 were included in a singlecenter retrospective study. The use of ureteral and urethral FS varied according to surgeons preference (routine for some, never for others) but not according to the tumors’ characteristics. Patients were divided into different groups according to the use of ureteral and/or urethral FS (FS vs. no FS). Preoperative data and the rate of positive margins were compared between groups. The prognostic factors for cancer-specific survival (CSS) and recurrence-free survival (RFS) were sought in univariate analysis using the log-rank test and in multivariate analysis using a cox regression model. RESULTS: Out of 329 patients included in this study, ureteral FS were performed in 132 (40%) and urethral FS in 183 (56%) respectivley respectively. Thirteen urethral FS were positive (7.1%) resulting in 10 additional urethrectomy. Fourteen ureteral FS (10.6%) were invaded resulting in 8 additional ureteral resections and 1 nephroureterectomy. The use of urethral FS was associated with a decrease in positive margins rate (6% vs. 23%; RR ¼ 0.27; p <0.0001). Conversely, the use of ureteral FS had no impact on the rate of positive margins (12% vs.14%; RR ¼ 0.85; p ¼ 0.58). The use of ureteral FS had no impact on survival whereas the routine use of urethral FS was a prognostic factor for RFS and CSS in univariate (5-years RFS: 51.5% vs. 32%; p <0.0001 and 5-year CSS: 65.1% vs. 50.5%) and multivariate analysis (HR ¼ 1.7; p¼ 0.003 and HR¼1.4; p¼0.04 respectively). CONCLUSIONS: This study is the first to asses the impact of urethral and ureteral FS use on oncological outcomes after radical cystectomy. The routine use of urethral FS was associated with adecreased rate of positive surgical margins and improved recurrence-free survival and cancer-specific survival. Conversely, the use of ureteral frozen section had no impact on oncological outcomes. Source of Funding: none
MP54-19 IMPACT OF PROSTATE INVOLVEMENT ON OUTCOMES IN PATIENTS TREATED WITH RADICAL CYSTOPROSTATECTOMY FOR BLADDER CANCER Marco Moschini*, Andrea Gallina, Giusy Burgio, Paolo Dell’Oglio, Emanuele Zaffuto, Milan, Italy; Agostino Mattei, Lucerne, Switzerland; Rocco Damiano, Catanzaro, Italy; Shahrokh Shariat, Vienna, Austria; Vincenzo Mirone, Naples, Italy; Andrea Salonia, Alberto Briganti, Francesco Montorsi, Renzo Colombo, Milan, Italy INTRODUCTION AND OBJECTIVES: The impact of the different types of prostate involvement by urothelial carcinoma (PUC) or prostate adenocarcinoma (PCa) at the time of radical cystoprostatectomy (RCP) has not been fully investigated. METHODS: Data from 893 male patients treated with RCP and pelvic lymph node dissection at a tertiary referral center for nonmetastatic bladder cancer between 1992 and 2012 were assessed. Significant PCa was defined as extracapsular disease and/or Gleason Score ¼ 7. Prostatic urothelial carcinoma (PUC) was stratified as stromal versus urethral/duct involvements. Multivariable Cox regression analyses were built to test the impact of the presence of incidental PCa and PUC on outcomes. RESULTS: PCa was present in 319 (35.7%) patients, of which 45 (14.1%) had significant disease. While, the proportion of significant PCa did not change significantly (p¼0.8), the rate of indolent PCa increased from 17.1%, to 29.4% to 37.9%, respectively (p<0.001). PUC
e729
was identify in 181 patients (20%): 75 (41.1%) with urethral/duct involvement and 106 (58.6%) with stromal. Within a median follow-up of 72 months, stromal PUC, but not the other forms of PUC or PCa, was associated with disease recurrence and cancer-specific mortality. In multivariable analyses adjusted for the effects of standard features, stromal PUC remained associated with recurrence (Hazard Ratio [HR]:2.01, p¼0.03) cancer-specific mortality (HR: 1.65, p¼0.01) and overall mortality (HR: 1.45, p¼0.03). CONCLUSIONS: PCa involvement does not affect outcomes in patients treated with RCP for bladder cancer. Conversely, prostatic stromal invasion with urothelial carcinoma confers a poor survival confirming its aggressiveness. Source of Funding: none
MP54-20 DO MEN WITH A HISTORY OF PROSTATE CANCER HAVE WORSE BLADDER CANCER OUTCOMES? David Golombos*, Abimbola Ayangbesan, Patrick Lewicki, LaMont Barlow, New York, NY; Padraic O’Malley, Halifax, Canada; Douglas Scherr, New York, NY INTRODUCTION AND OBJECTIVES: To review the perioperative outcomes and histopathologic features of men undergoing radical cystectomy (RC) for invasive bladder cancer with a history of prostate cancer (PCa). METHODS: IRB approved, retrospective chart review was performed on 500 patients who underwent RC at a single tertiary center between 2001-2014. After excluding females, we identified a total of 90 patients with a history of PCa prior to RC. Of those, 57 patients underwent RC as definitive treatment for bladder cancer. Clinicopathologic data of both malignancies were collected as well as details regarding prostate cancer treatment. Peri-operative RC variables were recorded, including approach (open vs. robotic), type of diversion, estimated blood loss, lymph node yields, intra-operative and post-operative complications. Complications were defined using the standardized ClavienDindo classification. A genitourinary pathologist evaluated all pathologic specimens. RESULTS: 57 patients at a median age was 77 years old underwent RC who had a history of PCa. Thirty five (61%) were treated with radiation prior to RC as either single or multimodal therapy for PCa. Compared to the non-irradiated group, patients in the irradiated group had higher stage (pT3/4) bladder disease (48.6% vs. 9.1% p¼0.021), higher rates of lymphovascular invasion (37.1% vs. 2% p¼0.006), and higher rates of variant bladder histology (42.9% vs. 13.6% p¼0.021). There was no significant difference is GFR, ASA classification, BMI, smoking history, or utilization of neoadjuvant chemotherapy between the two groups. The majority of cystectomies were approached robotically, regardless of prior radiation history (72% overall vs. 71% in irradiated group p¼0.915). History of prior radiation did not significantly change type of diversion performed, length of surgery, estimated blood loss, length of stay, or lymph node yield. Interestingly, there was a trend towards a lower rate of major complications with a robotic approach (p¼0.057). CONCLUSIONS: In men with a history of PCa, those treated with radiation had significantly higher stage disease, rates of lymphovascular invasion, and variant bladder cancer histology. Robotic assisted RC performed similarly to an open approach with respect to objective indicators of surgical quality with no increased risk of perioperative or postoperative complication across all types of diversions. Source of Funding: None
Vol. 197, No. 4S, Supplement, Sunday, May 14, 2017
cancer is a controversial issue with contradictory findings concerning ureteral FS and very few data concerning urethral FS. Moreover, previous reports aimed to assess the impact of positive FS on oncological outcomes but none have compared the impact of FS vs. no FS on oncological ouctomes. The objective of this study was to evaluate the impact of urethral and ureteral FS use on oncological outcomes after radical cystectomy for bladder cancer. METHODS: All patients who underwent a radical cystectomy for bladder cancer between 1995 and 2015 were included in a singlecenter retrospective study. The use of ureteral and urethral FS varied according to surgeons preference (routine for some, never for others) but not according to the tumors’ characteristics. Patients were divided into different groups according to the use of ureteral and/or urethral FS (FS vs. no FS). Preoperative data and the rate of positive margins were compared between groups. The prognostic factors for cancer-specific survival (CSS) and recurrence-free survival (RFS) were sought in univariate analysis using the log-rank test and in multivariate analysis using a cox regression model. RESULTS: Out of 329 patients included in this study, ureteral FS were performed in 132 (40%) and urethral FS in 183 (56%) respectivley respectively. Thirteen urethral FS were positive (7.1%) resulting in 10 additional urethrectomy. Fourteen ureteral FS (10.6%) were invaded resulting in 8 additional ureteral resections and 1 nephroureterectomy. The use of urethral FS was associated with a decrease in positive margins rate (6% vs. 23%; RR ¼ 0.27; p <0.0001). Conversely, the use of ureteral FS had no impact on the rate of positive margins (12% vs.14%; RR ¼ 0.85; p ¼ 0.58). The use of ureteral FS had no impact on survival whereas the routine use of urethral FS was a prognostic factor for RFS and CSS in univariate (5-years RFS: 51.5% vs. 32%; p <0.0001 and 5-year CSS: 65.1% vs. 50.5%) and multivariate analysis (HR ¼ 1.7; p¼ 0.003 and HR¼1.4; p¼0.04 respectively). CONCLUSIONS: This study is the first to asses the impact of urethral and ureteral FS use on oncological outcomes after radical cystectomy. The routine use of urethral FS was associated with adecreased rate of positive surgical margins and improved recurrence-free survival and cancer-specific survival. Conversely, the use of ureteral frozen section had no impact on oncological outcomes. Source of Funding: none
MP54-19 IMPACT OF PROSTATE INVOLVEMENT ON OUTCOMES IN PATIENTS TREATED WITH RADICAL CYSTOPROSTATECTOMY FOR BLADDER CANCER Marco Moschini*, Andrea Gallina, Giusy Burgio, Paolo Dell’Oglio, Emanuele Zaffuto, Milan, Italy; Agostino Mattei, Lucerne, Switzerland; Rocco Damiano, Catanzaro, Italy; Shahrokh Shariat, Vienna, Austria; Vincenzo Mirone, Naples, Italy; Andrea Salonia, Alberto Briganti, Francesco Montorsi, Renzo Colombo, Milan, Italy INTRODUCTION AND OBJECTIVES: The impact of the different types of prostate involvement by urothelial carcinoma (PUC) or prostate adenocarcinoma (PCa) at the time of radical cystoprostatectomy (RCP) has not been fully investigated. METHODS: Data from 893 male patients treated with RCP and pelvic lymph node dissection at a tertiary referral center for nonmetastatic bladder cancer between 1992 and 2012 were assessed. Significant PCa was defined as extracapsular disease and/or Gleason Score ¼ 7. Prostatic urothelial carcinoma (PUC) was stratified as stromal versus urethral/duct involvements. Multivariable Cox regression analyses were built to test the impact of the presence of incidental PCa and PUC on outcomes. RESULTS: PCa was present in 319 (35.7%) patients, of which 45 (14.1%) had significant disease. While, the proportion of significant PCa did not change significantly (p¼0.8), the rate of indolent PCa increased from 17.1%, to 29.4% to 37.9%, respectively (p<0.001). PUC
e729
was identify in 181 patients (20%): 75 (41.1%) with urethral/duct involvement and 106 (58.6%) with stromal. Within a median follow-up of 72 months, stromal PUC, but not the other forms of PUC or PCa, was associated with disease recurrence and cancer-specific mortality. In multivariable analyses adjusted for the effects of standard features, stromal PUC remained associated with recurrence (Hazard Ratio [HR]:2.01, p¼0.03) cancer-specific mortality (HR: 1.65, p¼0.01) and overall mortality (HR: 1.45, p¼0.03). CONCLUSIONS: PCa involvement does not affect outcomes in patients treated with RCP for bladder cancer. Conversely, prostatic stromal invasion with urothelial carcinoma confers a poor survival confirming its aggressiveness. Source of Funding: none
MP54-20 DO MEN WITH A HISTORY OF PROSTATE CANCER HAVE WORSE BLADDER CANCER OUTCOMES? David Golombos*, Abimbola Ayangbesan, Patrick Lewicki, LaMont Barlow, New York, NY; Padraic O’Malley, Halifax, Canada; Douglas Scherr, New York, NY INTRODUCTION AND OBJECTIVES: To review the perioperative outcomes and histopathologic features of men undergoing radical cystectomy (RC) for invasive bladder cancer with a history of prostate cancer (PCa). METHODS: IRB approved, retrospective chart review was performed on 500 patients who underwent RC at a single tertiary center between 2001-2014. After excluding females, we identified a total of 90 patients with a history of PCa prior to RC. Of those, 57 patients underwent RC as definitive treatment for bladder cancer. Clinicopathologic data of both malignancies were collected as well as details regarding prostate cancer treatment. Peri-operative RC variables were recorded, including approach (open vs. robotic), type of diversion, estimated blood loss, lymph node yields, intra-operative and post-operative complications. Complications were defined using the standardized ClavienDindo classification. A genitourinary pathologist evaluated all pathologic specimens. RESULTS: 57 patients at a median age was 77 years old underwent RC who had a history of PCa. Thirty five (61%) were treated with radiation prior to RC as either single or multimodal therapy for PCa. Compared to the non-irradiated group, patients in the irradiated group had higher stage (pT3/4) bladder disease (48.6% vs. 9.1% p¼0.021), higher rates of lymphovascular invasion (37.1% vs. 2% p¼0.006), and higher rates of variant bladder histology (42.9% vs. 13.6% p¼0.021). There was no significant difference is GFR, ASA classification, BMI, smoking history, or utilization of neoadjuvant chemotherapy between the two groups. The majority of cystectomies were approached robotically, regardless of prior radiation history (72% overall vs. 71% in irradiated group p¼0.915). History of prior radiation did not significantly change type of diversion performed, length of surgery, estimated blood loss, length of stay, or lymph node yield. Interestingly, there was a trend towards a lower rate of major complications with a robotic approach (p¼0.057). CONCLUSIONS: In men with a history of PCa, those treated with radiation had significantly higher stage disease, rates of lymphovascular invasion, and variant bladder cancer histology. Robotic assisted RC performed similarly to an open approach with respect to objective indicators of surgical quality with no increased risk of perioperative or postoperative complication across all types of diversions. Source of Funding: None