- Email: [email protected]
MP77-13 DIFFERENCE AMONG CANCER-RELATED FACTORS BY SMOKING STATUS IN PATIENTS WITH UROTHELIAL CANCER OF THE UPPER URINARY TRACT: THEIR IMPACT ON METASTASIS AFTER RADICAL NEPHROURETERECTOMY.
THE JOURNAL OF UROLOGYâ
e916
TGF-beta receptor. Endoglin is highly expressed on endothelial cells during tumor angiogenesis and inflammation. Endoglin levels in serum or urine have been reported as biomarkers in several cancers. Antiendoglin therapy was also developed and now under the clinical trial. In the current study, we evaluated the expression status and prognostic significance of endoglin in upper urinary tract urothelial carcinoma (UTUC). METHODS: Archival fomain-fixed and paraffin-embedded tissues from 99 primary UTUCs were retrieved. Tissued microarrays were constructed with triplicate tumor samples and paired nonneoplastic urothelium. Tissue microarrays were analyzed using immunohistochemistry for endoglin; association with clinicopathological parameters and outcome was studied. RESULTS: We found that endoglin was expressed in the endothelium and significantly highly in UTUC compared with paired benign urothelium (P<0.05). Endoglin expression was not associated with pathological T stage or tumor grade. Whereas endoglin expression was not associated with increased hazard ratios for cancer-specific mortality or tumr recurrence in lymph node or distant metastasis, endolign expression was associated with intravesical recurrence, when adjusting for relevant clinicopathologic variables (P <0.05). CONCLUSIONS: Upregulation of endolglin was observed in the endothelium of UTUC compared with normal urothelium, and associated with intravesical recurrence. The endoglin could be a biomarker to predict the intravesical recurrence as well as the therapeutic target.
Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014
METHODS: Immunohistochemistry was performed using formalin-fixed and paraffin-embedded specimens, which were all from the same 117 patients with N0M0 UUT-UC. The determination of negative/weakly positive, moderately positive, or strongly positive staining was based on the intensity of staining and the percentage of cells stained. Correlation of the positivity of RAC1 or PAK1 or both with clinicopathological parameters, including shortened disease-specific or extravesical-recurrence-free survival time, was evaluated. RESULTS: A hazard model showed that extravesical recurrence, strong positivity of PAK1, and strong positivity of both RAC1 and PAK1 were independent factors for shortened disease-specific survival time (p < 0.0001, p ¼ 0.0223, p ¼ 0.0258, respectively). Another hazard model revealed that there was no significant factor for extravesical recurrence, which we speculated would be the most significant factor for shortened disease-specific survival time among clinicopathological parameters; however, multiple logistic regression analysis showed that strong positivity of both RAC1 and PAK1 was the only independent factor for shortened extravesical-recurrence-free survival time (p ¼ 0.0200). Neither RAC1 positivity alone nor PAK1 positivity alone was an independent factor for a worse extravesical-recurrence-free survival rate in multivariate analysis. CONCLUSIONS: We conclude that N0M0 UUT-UC patients with strongly positive expression of both RAC1 and PAK1 should be carefully followed up after surgery. Source of Funding: none
MP77-13 DIFFERENCE AMONG CANCER-RELATED FACTORS BY SMOKING STATUS IN PATIENTS WITH UROTHELIAL CANCER OF THE UPPER URINARY TRACT: THEIR IMPACT ON METASTASIS AFTER RADICAL NEPHROURETERECTOMY. Yasuyoshi Miyata*, Katsura Kakoki, Akihiro Asai, Kensuke Mitsunari, Tomohiro Matsuo, Kojiro Ohba, Hideki Sakai, Nagasaki, Japan
Source of Funding: none
MP77-12 IMPACT OF INCREASED EXPRESSION OF BOTH RAS-RELATED C3 BOTULINUM TOXIN SUBSTRATE 1 AND P21-ACTIVATED KINASE 1 IN PATIENTS WITH N0M0 UPPER URINARY TRACT UROTHELIAL CARCINOMA Kenji Kuroda*, Junichi Asakuma, Takako Asano, Akio Horiguchi, Makoto Isono, Yujiro Tsujita, Akinori Sato, Kenji Seguchi, Keiichi Ito, Tomohiko Asano, Tokorozawa, Saitama, Japan INTRODUCTION AND OBJECTIVES: As one of the members of the Rho small GTPases family, RAC1 (ras-related C3 botulinum toxin substrate 1) interacts with various specific effectors to coordinate the activation of a multitude of signaling cascades that affect diverse physiological outcomes. PAK1 (p21-activated kinase 1), which has a role in both carcinogenesis and cellular invasion, binds to RAC1 after which activated PAK1 regulates cellular functions. Some reports have indicated that RAC1 and PAK1 may be potential molecular targets for the treatment of cancer. However, there have been few reports about the simultaneous analysis of RAC1 and its downstream effector PAK1 in upper urinary tract urothelial carcinoma (UUT-UC). To better understand the impact of RAC1 and PAK1 on tumor progression and prognosis of UUT-UC, we assessed their expressions by using primary tumor sections from patients with N0M0 UUT-UC and then associated our findings with clinicopathological parameters.
INTRODUCTION AND OBJECTIVES: Cigarette smoking is a common and strong risk factor for carcinogenesis, tumor development, and prognosis of urothelial cancer (UC). In recent years, several reports showed that smoker have a higher risk of advanced disease and recurrence in UC of the upper urinary tract (UC-UUT). On the other hand, there is a little information regarding detailed changes of pathological characteristics by smoking in UC-UUT patients. The aim of this study is to clarify the differences of cancer-related factors according to smoking status in these patients. METHODS: A total of 134 UC-UUT patients who underwent radical nephroureterectomy were investigated retrospectively. Patients with metastasis and/or neo-adjuvant therapy were excluded from this study. We evaluated cancer cell proliferation (PI, measured by using anti-Ki-67 antibody), apoptosis (AI, by TUNEL method), angiogenesis (MVD, by using anti-CD105 antibody), and lymph-angiogenesis (LVD, by using anti-D2-40 antibody). In addition, expressions of invasionrelated molecules, including vascular endothelial growth factor (VEGF)A and -C, matrix metalloproteinase (MMP)-2 and -9, urokinase-type plasminogen activator (uPA), and cyclooxygenase (COX)-2 are also investigated by immunohistochemical techniques in formalinfixed specimens. RESULTS: Patients were divided into 3 groups according to smoking status; never-smoker (n¼54, 40.3%), former smoker (46, 34.3%), and current smoker (34, 25.4%). Mean/SD LVD in current smoker (40.9/12.9%) was significantly higher than that in never-smoker (34.4/10.6%; P¼0.034). In addition, smoking status was positively correlated with presence of intra-tumoral lymphvessel (iLV) (P¼0.010) and expressions of COX-2 (P¼0.040) and MMP-9 (P¼0.036), but not with other factors. When we investigated the influence of smoking status on these factors in a multi-variate analysis model including pathological features, presence of iLV, LVD, and COX-2 expression were identified to be independent factors. Similar multivariate analyses also showed that presence of iLVD and COX-2 expression were independent factors for metastasis after radical operation.
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014
CONCLUSIONS: Our study showed lymph-angiogenesis and COX-2 expression are strongly influenced by smoking status in UCUUT patients, and that these factors may play important roles for tumor metastasis after radical nephroureterectomy. Our results are important to discuss observation strategy and pathological changes by smoking in these patients. Source of Funding: None.
MP77-14 CAN PRE-OPERATIVE CT IDENTIFY POSITIVE LYMPH NODES IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA? Alyssa Yee*, Eugene Cha, John Sfakianos, Philip Kim, Fara Friedman, Itay Sternberg, Jonathan Coleman, New York, NY INTRODUCTION AND OBJECTIVES: There is no consensus regarding the indications for lymph node dissection (LND) for upper tract urothelial carcinoma (UTUC) or the extent of LND necessary for adequate staging. We sought to evaluate the performance of CT scan in identifying positive LNs in UTUC patients undergoing radical nephroureterectomy (RNU). METHODS: We queried a prospectively maintained institutional database and identified 411 consecutive patients who underwent RNU from 1995-2013. The location of suspicious LNs identified on preoperative axial imaging was categorized as para-caval (PC), interaortocaval (IAC), para-aortic (PA), hilar, and pelvic. This categorization was applied to the location of positive LNs on pathology and inclusion of regions in LND templates. The performance of pre-operative imaging in LN-positive patients was assessed. RESULTS: Of 411 UTUC patients treated with RNU, 279 (68%) underwent LND, with a median of 8 LNs removed (IQR 3-14). There were 52 (18.6%) LN-positive patients with a median of two positive LNs (IQR 1-4). For 24 LN-positive patients with right-sided tumors, involved LNs were located in the PC (16), IAC (4), hilar (8), and pelvic (1) regions. For 28 LN-positive patients with left-sided tumors, involved LNs were located in the PA (18), IAC (3), hilar (8), and pelvic (3) regions. Pre-operative axial imaging (CT 46, MRI 4) was available for 50/52 LNpositive patients. The sensitivity of imaging for detecting LN-positive patients was, at best, 48%, as 26/50 of the LN-positive patients (52%) had normal imaging. Sixty-two patients had preoperative imaging identifying suspicious LNs in 92 regions; 63 of these regions were included in LND. The positive predictive value of imaging was approximately 41%, as 26 of 63 suspicious LN regions included in LND were positive on pathology. CONCLUSIONS: Axial imaging prior to RNU has poor sensitivity for identifying UTUC patients with positive LNs and should not be used as a screening criterion for performance of LND. However, in patients with suspicious LNs identified on imaging, LND templates should be extended to include those regions. Prospective studies are needed to assess the distribution of positive LNs in patients with UTUC, stratified by laterality and tumor location, so that LND templates can be standardized.
MP77-15 DEGREE OF HYDRONEPHROSIS PREDICTS ADVERSE PATHOLOGICAL FEATURES AND WORSE ONCOLOGIC OUTCOMES IN HIGH-GRADE UPPER TRACT UROTHELIAL CARCINOMA Paul Chung*, Laura-Maria Krabbe, Oussama Darwish, Mary Westerman, Aditya Bagrodia, Bishoy Gayed, Ahmed Haddad, Payal Kapur, Arthur Sagalowsky, Yair Lotan, Vitaly Margulis, Dallas, TX INTRODUCTION AND OBJECTIVES: To evaluate whether degree of hydronephrosis (HN) is predictive of worse oncologic outcomes and can be used as a surrogate for presence of adverse pathologic features and oncological outcomes in patients with high-grade (HG), but not low-grade (LG) upper tract urothelial carcinoma (UTUC). METHODS: We retrospectively reviewed 141 patients with localized UTUC that underwent extirpative surgery. Pre-operative imaging was used to evaluate ipsilateral HN. We evaluated the association between degree of HN (none/mild vs. moderate/severe), pathological findings and oncological outcomes in patients with HG vs. LG tumors. RESULTS: HG UTUC was present in 113 (80%) patients, muscle-invasive disease (pT2) in 49 (35%) and non-organ-confined disease in 41 (29%). At a median follow-up of 34 months (range 1149), 49 (35%) patients experienced intravesical recurrence, 28 (20%) developed local/systemic recurrence and 24 (17%) died of UTUC. HN was graded as none/mild in 77 (55%) patients and moderate/severe in 64 (45%). In patients with HG, but not LG UTUC, degree of HN was associated with advanced pathologic stage (p<0.001), positive lymph nodes (p¼0.01), local/systemic recurrence-free survival (RFS) (HR 5.5, p¼0.019) and cancer-specific survival (CSS) (HR 5.2, p¼0.022). On multivariable analysis of pre-operative factors, degree of HN in patients with HG was associated with muscle invasion (HR 5.0, 95% CI 2.16-11.46, p<0.001), non-organ-confined disease (HR 3.3, 95% CI 1.42-7.52, p¼0.005), local/systemic RFS (HR 2.5, 95% CI 1.08-5.74, p¼0.032) and CSS (HR 2.5, 95% CI 1.036.09, p¼0.044). CONCLUSIONS: Degree of HN can serve as a surrogate of advanced disease and predict worse oncological outcomes in patients with HG UTUC.
Patients with suspicious LNs identified on preoperative axial imaging Right-Sided
Left-Sided
Tumors
Tumors
(n¼31) Suspicious
Pathology
in LND
Positive
17
5/17 (29%)
15
6
3/6 (50%)
3
0
Imaging Para-caval LN
22
Interaortocaval
All Patients
(n¼31) Included
Suspicious Imaging 3
(n¼62) Included
Pathology
in LND
Positive
1
1/3 (33%)
Pathology Positive 6/20 (30%)
5
5
0/5 (0%)
3/11 (27%)
24
20
12/20 (60%)
12/20 (60%)
LN Para-aortic LN
0/0 (0%)
Hilar LN
3
3
1/3 (33%)
5
3
1/3 (33%)
2/6 (33%)
Pelvic LN
7
6
1/6 (17%)
5
2
2/2 (100%)
3/8 (38%)
50
32
10/32 (31%)
42
31
16/31 (52%)
26/63 (41%)
All LN Regions
Source of Funding: none
e917
Source of Funding: None
e916
TGF-beta receptor. Endoglin is highly expressed on endothelial cells during tumor angiogenesis and inflammation. Endoglin levels in serum or urine have been reported as biomarkers in several cancers. Antiendoglin therapy was also developed and now under the clinical trial. In the current study, we evaluated the expression status and prognostic significance of endoglin in upper urinary tract urothelial carcinoma (UTUC). METHODS: Archival fomain-fixed and paraffin-embedded tissues from 99 primary UTUCs were retrieved. Tissued microarrays were constructed with triplicate tumor samples and paired nonneoplastic urothelium. Tissue microarrays were analyzed using immunohistochemistry for endoglin; association with clinicopathological parameters and outcome was studied. RESULTS: We found that endoglin was expressed in the endothelium and significantly highly in UTUC compared with paired benign urothelium (P<0.05). Endoglin expression was not associated with pathological T stage or tumor grade. Whereas endoglin expression was not associated with increased hazard ratios for cancer-specific mortality or tumr recurrence in lymph node or distant metastasis, endolign expression was associated with intravesical recurrence, when adjusting for relevant clinicopathologic variables (P <0.05). CONCLUSIONS: Upregulation of endolglin was observed in the endothelium of UTUC compared with normal urothelium, and associated with intravesical recurrence. The endoglin could be a biomarker to predict the intravesical recurrence as well as the therapeutic target.
Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014
METHODS: Immunohistochemistry was performed using formalin-fixed and paraffin-embedded specimens, which were all from the same 117 patients with N0M0 UUT-UC. The determination of negative/weakly positive, moderately positive, or strongly positive staining was based on the intensity of staining and the percentage of cells stained. Correlation of the positivity of RAC1 or PAK1 or both with clinicopathological parameters, including shortened disease-specific or extravesical-recurrence-free survival time, was evaluated. RESULTS: A hazard model showed that extravesical recurrence, strong positivity of PAK1, and strong positivity of both RAC1 and PAK1 were independent factors for shortened disease-specific survival time (p < 0.0001, p ¼ 0.0223, p ¼ 0.0258, respectively). Another hazard model revealed that there was no significant factor for extravesical recurrence, which we speculated would be the most significant factor for shortened disease-specific survival time among clinicopathological parameters; however, multiple logistic regression analysis showed that strong positivity of both RAC1 and PAK1 was the only independent factor for shortened extravesical-recurrence-free survival time (p ¼ 0.0200). Neither RAC1 positivity alone nor PAK1 positivity alone was an independent factor for a worse extravesical-recurrence-free survival rate in multivariate analysis. CONCLUSIONS: We conclude that N0M0 UUT-UC patients with strongly positive expression of both RAC1 and PAK1 should be carefully followed up after surgery. Source of Funding: none
MP77-13 DIFFERENCE AMONG CANCER-RELATED FACTORS BY SMOKING STATUS IN PATIENTS WITH UROTHELIAL CANCER OF THE UPPER URINARY TRACT: THEIR IMPACT ON METASTASIS AFTER RADICAL NEPHROURETERECTOMY. Yasuyoshi Miyata*, Katsura Kakoki, Akihiro Asai, Kensuke Mitsunari, Tomohiro Matsuo, Kojiro Ohba, Hideki Sakai, Nagasaki, Japan
Source of Funding: none
MP77-12 IMPACT OF INCREASED EXPRESSION OF BOTH RAS-RELATED C3 BOTULINUM TOXIN SUBSTRATE 1 AND P21-ACTIVATED KINASE 1 IN PATIENTS WITH N0M0 UPPER URINARY TRACT UROTHELIAL CARCINOMA Kenji Kuroda*, Junichi Asakuma, Takako Asano, Akio Horiguchi, Makoto Isono, Yujiro Tsujita, Akinori Sato, Kenji Seguchi, Keiichi Ito, Tomohiko Asano, Tokorozawa, Saitama, Japan INTRODUCTION AND OBJECTIVES: As one of the members of the Rho small GTPases family, RAC1 (ras-related C3 botulinum toxin substrate 1) interacts with various specific effectors to coordinate the activation of a multitude of signaling cascades that affect diverse physiological outcomes. PAK1 (p21-activated kinase 1), which has a role in both carcinogenesis and cellular invasion, binds to RAC1 after which activated PAK1 regulates cellular functions. Some reports have indicated that RAC1 and PAK1 may be potential molecular targets for the treatment of cancer. However, there have been few reports about the simultaneous analysis of RAC1 and its downstream effector PAK1 in upper urinary tract urothelial carcinoma (UUT-UC). To better understand the impact of RAC1 and PAK1 on tumor progression and prognosis of UUT-UC, we assessed their expressions by using primary tumor sections from patients with N0M0 UUT-UC and then associated our findings with clinicopathological parameters.
INTRODUCTION AND OBJECTIVES: Cigarette smoking is a common and strong risk factor for carcinogenesis, tumor development, and prognosis of urothelial cancer (UC). In recent years, several reports showed that smoker have a higher risk of advanced disease and recurrence in UC of the upper urinary tract (UC-UUT). On the other hand, there is a little information regarding detailed changes of pathological characteristics by smoking in UC-UUT patients. The aim of this study is to clarify the differences of cancer-related factors according to smoking status in these patients. METHODS: A total of 134 UC-UUT patients who underwent radical nephroureterectomy were investigated retrospectively. Patients with metastasis and/or neo-adjuvant therapy were excluded from this study. We evaluated cancer cell proliferation (PI, measured by using anti-Ki-67 antibody), apoptosis (AI, by TUNEL method), angiogenesis (MVD, by using anti-CD105 antibody), and lymph-angiogenesis (LVD, by using anti-D2-40 antibody). In addition, expressions of invasionrelated molecules, including vascular endothelial growth factor (VEGF)A and -C, matrix metalloproteinase (MMP)-2 and -9, urokinase-type plasminogen activator (uPA), and cyclooxygenase (COX)-2 are also investigated by immunohistochemical techniques in formalinfixed specimens. RESULTS: Patients were divided into 3 groups according to smoking status; never-smoker (n¼54, 40.3%), former smoker (46, 34.3%), and current smoker (34, 25.4%). Mean/SD LVD in current smoker (40.9/12.9%) was significantly higher than that in never-smoker (34.4/10.6%; P¼0.034). In addition, smoking status was positively correlated with presence of intra-tumoral lymphvessel (iLV) (P¼0.010) and expressions of COX-2 (P¼0.040) and MMP-9 (P¼0.036), but not with other factors. When we investigated the influence of smoking status on these factors in a multi-variate analysis model including pathological features, presence of iLV, LVD, and COX-2 expression were identified to be independent factors. Similar multivariate analyses also showed that presence of iLVD and COX-2 expression were independent factors for metastasis after radical operation.
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Tuesday, May 20, 2014
CONCLUSIONS: Our study showed lymph-angiogenesis and COX-2 expression are strongly influenced by smoking status in UCUUT patients, and that these factors may play important roles for tumor metastasis after radical nephroureterectomy. Our results are important to discuss observation strategy and pathological changes by smoking in these patients. Source of Funding: None.
MP77-14 CAN PRE-OPERATIVE CT IDENTIFY POSITIVE LYMPH NODES IN PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA? Alyssa Yee*, Eugene Cha, John Sfakianos, Philip Kim, Fara Friedman, Itay Sternberg, Jonathan Coleman, New York, NY INTRODUCTION AND OBJECTIVES: There is no consensus regarding the indications for lymph node dissection (LND) for upper tract urothelial carcinoma (UTUC) or the extent of LND necessary for adequate staging. We sought to evaluate the performance of CT scan in identifying positive LNs in UTUC patients undergoing radical nephroureterectomy (RNU). METHODS: We queried a prospectively maintained institutional database and identified 411 consecutive patients who underwent RNU from 1995-2013. The location of suspicious LNs identified on preoperative axial imaging was categorized as para-caval (PC), interaortocaval (IAC), para-aortic (PA), hilar, and pelvic. This categorization was applied to the location of positive LNs on pathology and inclusion of regions in LND templates. The performance of pre-operative imaging in LN-positive patients was assessed. RESULTS: Of 411 UTUC patients treated with RNU, 279 (68%) underwent LND, with a median of 8 LNs removed (IQR 3-14). There were 52 (18.6%) LN-positive patients with a median of two positive LNs (IQR 1-4). For 24 LN-positive patients with right-sided tumors, involved LNs were located in the PC (16), IAC (4), hilar (8), and pelvic (1) regions. For 28 LN-positive patients with left-sided tumors, involved LNs were located in the PA (18), IAC (3), hilar (8), and pelvic (3) regions. Pre-operative axial imaging (CT 46, MRI 4) was available for 50/52 LNpositive patients. The sensitivity of imaging for detecting LN-positive patients was, at best, 48%, as 26/50 of the LN-positive patients (52%) had normal imaging. Sixty-two patients had preoperative imaging identifying suspicious LNs in 92 regions; 63 of these regions were included in LND. The positive predictive value of imaging was approximately 41%, as 26 of 63 suspicious LN regions included in LND were positive on pathology. CONCLUSIONS: Axial imaging prior to RNU has poor sensitivity for identifying UTUC patients with positive LNs and should not be used as a screening criterion for performance of LND. However, in patients with suspicious LNs identified on imaging, LND templates should be extended to include those regions. Prospective studies are needed to assess the distribution of positive LNs in patients with UTUC, stratified by laterality and tumor location, so that LND templates can be standardized.
MP77-15 DEGREE OF HYDRONEPHROSIS PREDICTS ADVERSE PATHOLOGICAL FEATURES AND WORSE ONCOLOGIC OUTCOMES IN HIGH-GRADE UPPER TRACT UROTHELIAL CARCINOMA Paul Chung*, Laura-Maria Krabbe, Oussama Darwish, Mary Westerman, Aditya Bagrodia, Bishoy Gayed, Ahmed Haddad, Payal Kapur, Arthur Sagalowsky, Yair Lotan, Vitaly Margulis, Dallas, TX INTRODUCTION AND OBJECTIVES: To evaluate whether degree of hydronephrosis (HN) is predictive of worse oncologic outcomes and can be used as a surrogate for presence of adverse pathologic features and oncological outcomes in patients with high-grade (HG), but not low-grade (LG) upper tract urothelial carcinoma (UTUC). METHODS: We retrospectively reviewed 141 patients with localized UTUC that underwent extirpative surgery. Pre-operative imaging was used to evaluate ipsilateral HN. We evaluated the association between degree of HN (none/mild vs. moderate/severe), pathological findings and oncological outcomes in patients with HG vs. LG tumors. RESULTS: HG UTUC was present in 113 (80%) patients, muscle-invasive disease (pT2) in 49 (35%) and non-organ-confined disease in 41 (29%). At a median follow-up of 34 months (range 1149), 49 (35%) patients experienced intravesical recurrence, 28 (20%) developed local/systemic recurrence and 24 (17%) died of UTUC. HN was graded as none/mild in 77 (55%) patients and moderate/severe in 64 (45%). In patients with HG, but not LG UTUC, degree of HN was associated with advanced pathologic stage (p<0.001), positive lymph nodes (p¼0.01), local/systemic recurrence-free survival (RFS) (HR 5.5, p¼0.019) and cancer-specific survival (CSS) (HR 5.2, p¼0.022). On multivariable analysis of pre-operative factors, degree of HN in patients with HG was associated with muscle invasion (HR 5.0, 95% CI 2.16-11.46, p<0.001), non-organ-confined disease (HR 3.3, 95% CI 1.42-7.52, p¼0.005), local/systemic RFS (HR 2.5, 95% CI 1.08-5.74, p¼0.032) and CSS (HR 2.5, 95% CI 1.036.09, p¼0.044). CONCLUSIONS: Degree of HN can serve as a surrogate of advanced disease and predict worse oncological outcomes in patients with HG UTUC.
Patients with suspicious LNs identified on preoperative axial imaging Right-Sided
Left-Sided
Tumors
Tumors
(n¼31) Suspicious
Pathology
in LND
Positive
17
5/17 (29%)
15
6
3/6 (50%)
3
0
Imaging Para-caval LN
22
Interaortocaval
All Patients
(n¼31) Included
Suspicious Imaging 3
(n¼62) Included
Pathology
in LND
Positive
1
1/3 (33%)
Pathology Positive 6/20 (30%)
5
5
0/5 (0%)
3/11 (27%)
24
20
12/20 (60%)
12/20 (60%)
LN Para-aortic LN
0/0 (0%)
Hilar LN
3
3
1/3 (33%)
5
3
1/3 (33%)
2/6 (33%)
Pelvic LN
7
6
1/6 (17%)
5
2
2/2 (100%)
3/8 (38%)
50
32
10/32 (31%)
42
31
16/31 (52%)
26/63 (41%)
All LN Regions
Source of Funding: none
e917
Source of Funding: None