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1627 PROSPECTIVE EVALUATION OF PREOPERATIVE NUTRITIONAL STATUS IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL CYSTECTOMY
Vol. 189, No. 4S, Supplement, Tuesday, May 7, 2013
THE JOURNAL OF UROLOGY姞
Preoperative WEIGHT
R⫹ 78
R⫺ 92
2WEEK R⫹ 76
R⫺ 82
3MONTH R⫹ 69
R⫺ 90
e669
6MONTH R⫹ 70
1YEAR
R⫺ 96
R⫹ 60
R⫺ 87
BMI
27
30
27
27
24
29
27
30
22
28
FFM
54
61
54
56
51
60
51
64
46
64
TBF%
28
33
26
32
28
33
28
33
24
27
R⫹ Associated with Risk; R⫺ Not associated with Risk; FFM: Free Fat Mass; TBF%: Total Body Fat %;
Source of Funding: None
1628 RISK STRATIFICATION FOR LOCAL-REGIONAL FAILURE AFTER CYSTECTOMY Brian Baumann*, Jiwei He, Wei-Ting Hwang, Kai Tucker, Philadelphia, PA; Seth Lerner, Houston, TX; Cathy Tangen, Seattle, WA; Harry Herr, New York, NY; Thomas Guzzo, S. Bruce Malkowicz, John Christodouleas, Philadelphia, PA Source of Funding: None
1627 PROSPECTIVE EVALUATION OF PREOPERATIVE NUTRITIONAL STATUS IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL CYSTECTOMY Aabroo Khan*, Mary Platek, Shabnam Rehman, Rakeeba Din, Yi Shi, Faris Azzouni, Gregory Wilding, Khurshid Guru, Buffalo, NY INTRODUCTION AND OBJECTIVES: Poor nutrition status is associated with adverse outcome after radical cystectomy. Use of validated nutrition screening tools has not been advocated in a prospective fashion. We attempted to prospectively evaluate nutritional status and identify associated risks in patients undergoing Robot-Assisted Radical Cystectomy (RARC) using the Nutrition Risk Screening 2002 (NRS 2002); a validated assessment tool. We also examined nutrition-related biochemical indices and body composition percentage in this patient population over one year period. METHODS: All consecutive patients undergoing RARC at Roswell Park cancer Institute during year 2011 were offered to enroll in this prospective study. Using the NRS 2002, patients are scored for nutrition risk at baseline and are categorized as at nutrition risk or not at risk. A tanita scale is used to measure body composition. Surgical complications after surgery and laboratory values (hemoglobin, hematocrit, albumin, and total leukocytic count “TLC”) were also collected at 2 weeks, 3, 6 and 12-month intervals. RESULTS: 33 patients are currently enrolled in the study. Mean age and body mass index (BMI) are 71 years and 27.5 kg (SD: ⫹/⫺0.9) respectively. NRS 2002 identified 73% of the cohort to be at nutrition risk and at baseline, 46% of the cohort already had mild to severe deficits in nutritional status. In comparison to patients not at risk, those at risk were older (p⬍ .01), and had unintentional weight loss prior to surgery (p⫽.047). Length of stay was higher in those at risk (12 days vs. 9 days) (p⫽0.47).Decreasing trends for weight, BMI, body composition and hemoglobin from baseline through one year post-op were present in the at risk group.(Table). CONCLUSIONS: Patients undergoing RARC present with nutritional deficiency and report unintentional weight loss indicating poor nutrition status. Patients at nutrition risk based on the NRS 2002 continue to have weight loss and worsening nutritional status during their postoperative course.
INTRODUCTION AND OBJECTIVES: Several organizations are designing trials to study adjuvant radiation (RT) after radical cystectomy and pelvic lymph node dissection (RC) ⫹/⫺ chemotherapy for bladder cancer, but patients most likely to benefit from RT have not been clearly identified. This study’s purpose was to evaluate and refine a recently published risk stratification model for local-regional failure (LF) by applying it to a multi-center patient cohort. METHODS: The original stratification was derived from 442 patients treated with RC ⫹/⫺ chemotherapy at the University of Pennsylvania (PENN) between 1990 - 2008 who were prospectively followed with routine pelvic CT or MRI. Analysis identified 3 patient subgroups with significantly different LF risk based on pathologic stage (pT) and number of nodes dissected. This risk rubric was then applied to 264 patients treated with RC ⫹/⫺ chemotherapy in SWOG 8710, a multicenter randomized trial. In both cohorts, LF was scored as any pelvic failure detected before or within 3 months of distant failure. Competing risk analysis was used. RESULTS: SWOG patients differed significantly from PENN patients in mean age, pT stage, number of nodes removed, surgical margin status, and use of neoadjuvant chemotherapy ( p⬍0.01 for all comparisons). The original risk stratification was not fully validated in the SWOG cohort who had less pronounced LF differences in ⱖpT3 patients who had ⱖ10 versus ⬍10 nodes removed. Regression analysis of the SWOG data suggested margin status was a more important stratifying variable than number of nodes dissected. A revised risk stratification using pT stage, margin status, and number of nodes removed identified 3 subgroups in both SWOG and PENN cohorts with significantly different LF risk: low (ⱕpT2), intermediate (ⱖpT3, negative margins AND ⱖ10 nodes removed), and high (ⱖpT3 with positive margins OR ⬍10 nodes removed) with 5 year LF rates of 8%, 20% & 41% in the SWOG group and 8%, 19% & 41% in the PENN cohort (Figure). Gray’s test p⬍0.01 and C-index was 0.7 for the risk stratification model for both cohorts. CONCLUSIONS: The revised risk grouping combining pT stage, margin status and number of nodes excised stratified LF risk in two significantly different bladder cancer populations and may inform selection of patients for adjuvant RT trials. External validation of this revised stratification rubric is warranted.
THE JOURNAL OF UROLOGY姞
Preoperative WEIGHT
R⫹ 78
R⫺ 92
2WEEK R⫹ 76
R⫺ 82
3MONTH R⫹ 69
R⫺ 90
e669
6MONTH R⫹ 70
1YEAR
R⫺ 96
R⫹ 60
R⫺ 87
BMI
27
30
27
27
24
29
27
30
22
28
FFM
54
61
54
56
51
60
51
64
46
64
TBF%
28
33
26
32
28
33
28
33
24
27
R⫹ Associated with Risk; R⫺ Not associated with Risk; FFM: Free Fat Mass; TBF%: Total Body Fat %;
Source of Funding: None
1628 RISK STRATIFICATION FOR LOCAL-REGIONAL FAILURE AFTER CYSTECTOMY Brian Baumann*, Jiwei He, Wei-Ting Hwang, Kai Tucker, Philadelphia, PA; Seth Lerner, Houston, TX; Cathy Tangen, Seattle, WA; Harry Herr, New York, NY; Thomas Guzzo, S. Bruce Malkowicz, John Christodouleas, Philadelphia, PA Source of Funding: None
1627 PROSPECTIVE EVALUATION OF PREOPERATIVE NUTRITIONAL STATUS IN PATIENTS UNDERGOING ROBOT-ASSISTED RADICAL CYSTECTOMY Aabroo Khan*, Mary Platek, Shabnam Rehman, Rakeeba Din, Yi Shi, Faris Azzouni, Gregory Wilding, Khurshid Guru, Buffalo, NY INTRODUCTION AND OBJECTIVES: Poor nutrition status is associated with adverse outcome after radical cystectomy. Use of validated nutrition screening tools has not been advocated in a prospective fashion. We attempted to prospectively evaluate nutritional status and identify associated risks in patients undergoing Robot-Assisted Radical Cystectomy (RARC) using the Nutrition Risk Screening 2002 (NRS 2002); a validated assessment tool. We also examined nutrition-related biochemical indices and body composition percentage in this patient population over one year period. METHODS: All consecutive patients undergoing RARC at Roswell Park cancer Institute during year 2011 were offered to enroll in this prospective study. Using the NRS 2002, patients are scored for nutrition risk at baseline and are categorized as at nutrition risk or not at risk. A tanita scale is used to measure body composition. Surgical complications after surgery and laboratory values (hemoglobin, hematocrit, albumin, and total leukocytic count “TLC”) were also collected at 2 weeks, 3, 6 and 12-month intervals. RESULTS: 33 patients are currently enrolled in the study. Mean age and body mass index (BMI) are 71 years and 27.5 kg (SD: ⫹/⫺0.9) respectively. NRS 2002 identified 73% of the cohort to be at nutrition risk and at baseline, 46% of the cohort already had mild to severe deficits in nutritional status. In comparison to patients not at risk, those at risk were older (p⬍ .01), and had unintentional weight loss prior to surgery (p⫽.047). Length of stay was higher in those at risk (12 days vs. 9 days) (p⫽0.47).Decreasing trends for weight, BMI, body composition and hemoglobin from baseline through one year post-op were present in the at risk group.(Table). CONCLUSIONS: Patients undergoing RARC present with nutritional deficiency and report unintentional weight loss indicating poor nutrition status. Patients at nutrition risk based on the NRS 2002 continue to have weight loss and worsening nutritional status during their postoperative course.
INTRODUCTION AND OBJECTIVES: Several organizations are designing trials to study adjuvant radiation (RT) after radical cystectomy and pelvic lymph node dissection (RC) ⫹/⫺ chemotherapy for bladder cancer, but patients most likely to benefit from RT have not been clearly identified. This study’s purpose was to evaluate and refine a recently published risk stratification model for local-regional failure (LF) by applying it to a multi-center patient cohort. METHODS: The original stratification was derived from 442 patients treated with RC ⫹/⫺ chemotherapy at the University of Pennsylvania (PENN) between 1990 - 2008 who were prospectively followed with routine pelvic CT or MRI. Analysis identified 3 patient subgroups with significantly different LF risk based on pathologic stage (pT) and number of nodes dissected. This risk rubric was then applied to 264 patients treated with RC ⫹/⫺ chemotherapy in SWOG 8710, a multicenter randomized trial. In both cohorts, LF was scored as any pelvic failure detected before or within 3 months of distant failure. Competing risk analysis was used. RESULTS: SWOG patients differed significantly from PENN patients in mean age, pT stage, number of nodes removed, surgical margin status, and use of neoadjuvant chemotherapy ( p⬍0.01 for all comparisons). The original risk stratification was not fully validated in the SWOG cohort who had less pronounced LF differences in ⱖpT3 patients who had ⱖ10 versus ⬍10 nodes removed. Regression analysis of the SWOG data suggested margin status was a more important stratifying variable than number of nodes dissected. A revised risk stratification using pT stage, margin status, and number of nodes removed identified 3 subgroups in both SWOG and PENN cohorts with significantly different LF risk: low (ⱕpT2), intermediate (ⱖpT3, negative margins AND ⱖ10 nodes removed), and high (ⱖpT3 with positive margins OR ⬍10 nodes removed) with 5 year LF rates of 8%, 20% & 41% in the SWOG group and 8%, 19% & 41% in the PENN cohort (Figure). Gray’s test p⬍0.01 and C-index was 0.7 for the risk stratification model for both cohorts. CONCLUSIONS: The revised risk grouping combining pT stage, margin status and number of nodes excised stratified LF risk in two significantly different bladder cancer populations and may inform selection of patients for adjuvant RT trials. External validation of this revised stratification rubric is warranted.