38 LYMPHOVASCULAR INVASION IS A PATHOLOGIC FEATURE OF BIOLOGICALLY AGGRESSIVE DISEASE IN PATIENTS WITH UROTHELIAL CARCINOMA OF THE UPPER URINARY TRACT: AN INTERNATIONAL EXTERNAL VALIDATION STUDY

38

LYMPHOVASCULAR INVASION IS A PATHOLOGIC FEATURE OF BIOLOGICALLY AGGRESSIVE DISEASE IN PATIENTS WITH UROTHELIAL CARCINOMA OF THE UPPER URINARY TRACT: AN INTERNATIONAL EXTERNAL VALIDATION STUDY

1RYDUD*0DWVXPRWR..DVVRXI::DOWRQ-7)ULWVFKH+0 %DVWLDQ-30DUW¯QH]6DODPDQFD-,6HLW]&/HPEHUJHU5-%XUJHU0 (O+DNLP$%DED60DUWLJQRQL**XSWD$.DUDNLHZLF]3, )LFDUUD96KDULDW6) 1 University of Padua, Dept. of Oncological and Surgical Sciences, Padua, Italy, 2 Kitasato University School of Medicine, Dept. of Urology, Sagamihara, Japan, 3 McGill University Health Centre, Dept. of Urology, Montréal, Canada, 4Derby City General Hospital, Dept. of Urology, Derby City, United Kingdom, 5Caritas St.Josef Medical Center, University of Regensburg, Dept. of Urology, Regensburg, Germany, 6Ludwig-Maximilians-University, Dept. of Urology, Munich, Germany, 7 Hospital University Puerta De Hierro-Majadahonda, Dept. of Urology, Madrid, Spain, 8General Hospital Bolzano, Dept. of Urology, Bolzano, Italy, 9Nottingham City Hospital, Dept. of Urology, Nottingham, United Kingdom, 10University of Verona, Dept. of Pathology, Verona, Italy, 11University of Texas Southwestern Medical Center, Dept. of Urology, Dallas, United States of America, 12University of Montréal, Dept. of Urology, Montréal, Canada Introduction & Objectives: /\PSKRYDVFXODU LQYDVLRQ /9,  LGHQWLᚏHG IROORZLQJ SDWKRORJLFDO VOLGH UHYLHZ KDV EHHQ VKRZQ WR EH DQ LQGHSHQGHQW SUHGLFWRU RI UHFXUUHQFHIUHH5)6 DQGFDQFHUVSHFLᚏFVXUYLYDO&66 LQDPXOWLFHQWHUVHULHV RISDWLHQWVXQGHUJRLQJUDGLFDOQHSKURXUHWHUHFWRP\518 IRUXSSHUXULQDU\WUDFW XURWKHOLDO FDUFLQRPD 878&  +RZHYHU WKH YDOLGLW\ RI /9, LQ HYHU\GD\ SUDFWLFH ZKHUHSDWKRORJLFDOUHUHYLHZRIDOOVOLGHVLVXQFRPPRQKDVQRWEHHQDVVHVVHG 2XU DLP ZDV \R HYDOXDWH WKH SURJQRVWLF UROH RI /9, LQ DQ LQWHUQDWLRQDO FRKRUW RI SDWLHQWVWUHDWHGZLWK518IRU878&ZLWKRXWSDWKRORJLFDOVOLGHUHYLHZ Material & Methods: :HFROOHFWHGGDWDIURPSDWLHQWVWUHDWHGZLWK518IRU 878&ZLWKRXWQHRDGMXYDQWFKHPRWKHUDS\ZHUHFROOHFWHGDWFHQWUHVORFDWHGLQ (XURSH$VLDDQG&DQDGD:HHYDOXDWHGSDWLHQWVಬFKDUDFWHULVWLFV5)6DQG&66 Results: /9,ZDVSUHVHQWLQSDWLHQWV $WDPHGLDQIROORZXSRIPR  RI WKH SDWLHQWV GHYHORSHG GLVHDVH UHFXUUHQFH DQG  GLHG RI 878& 7KH ᚏYH\HDU 5)6 DQG &66 UDWHV ZHUH  DQG  UHVSHFWLYHO\ LQ WKH DEVHQFH RI /9, FRPSDUHG ZLWK  DQG  UHVSHFWLYHO\ LQ WKH SUHVHQFH RI/9,SYDOXHV 2QPXOWLYDULDEOH&R[UHJUHVVLRQDQDO\VHV/9,ZDVDQ LQGHSHQGHQW SUHGLFWRU RI 5)6 +D]DUG UDWLR +5   S   DQG &66 +5  S   6LPLODUO\ DPRQJ SDWLHQWV ZLWK S11[ GLVHDVH /9, ZDV DQ LQGHSHQGHQWSUHGLFWRURI5)6+5S  DQG&66+5S  Conclusions: ,Q D ODUJH PXOWLFHQWHU VHULHV RI SDWLHQWV WUHDWHG ZLWK 518 IRU 878&DQGZKHUHQRSDWKRORJLFDOVOLGHUHYLHZZDVSHUIRUPHG/9,ZDVSUHVHQWLQ DSSUR[LPDWHO\DQGZDVDQLQGHSHQGHQWSUHGLFWRURIERWK5)6DQG&66/9, VWDWXVVKRXOGDOZD\VEHLQFOXGHGLQWKHSDWKRORJLFUHSRUWRI518VSHFLPHQVDQG SDWLHQWVZLWK/9,VKRXOGEHFRQVLGHUHGIRUDGMXYDQWWKHUDS\VWXGLHV)LQDOO\/9, VKRXOGEHFRQVLGHUHGIRULQFOXVLRQLQWKH$-&&710VWDJLQJV\VWHP

39

PROGNOSTIC FACTORS OF “HIGH GRADE” TA BLADDER CANCERS ACCORDING TO WHO 2004 CLASSIFICATION: ARE THESE EQUIVALENTS TO “HIGH RISK” NON MUSCLE INVASIVE BLADDER CANCER?

*RQWHUR3*LOOR$)LRULWR&2GHUGD03DFFKLRQL'%XVVRODWL* &DVHWWD*7L]]DQL$5LFFHUL) 1 University of Turin, Dept. of Urology, Turin, Italy, 2University of Turin, Dept. of Pathology, Turin, Italy, 3University of Turin, Dept. of Foundation, Turin, Italy Introduction & Objectives: 7KHZLGHVSUHDGDGRSWLRQRIWKHQHZ,683:+2 JUDGLQJV\VWHPIRUEODGGHUFDQFHU%& UHVXOWHGLQDQLQFUHDVHGQXPEHURI OHVLRQV EHLQJ GHᚏQHG DV ಯKLJK JUDGHರ 7D OHVLRQV SUHYLRXVO\ FODVVLᚏHG DV HLWKHU 7D*RU7D* &RQIXVLRQH[LVWDVWRZKHWKHUWKHVHOHVLRQVVKRXOGEHFRQVLGHUHG DV ಯKLJK ULVNರ QRQ PXVFOH LQYDVLYH %& GXH WR WKH ODFN RI FOLQLFDO YDOLGDWLRQ :H GHWHUPLQHGWKHORQJWHUPRXWFRPHDQGLPSDFWRISURJQRVWLFIDFWRUVRIDVHULHVRI 7DKLJKJUDGH%& Material & Methods:  KLJK JUDGHV 7D %&  * DQG  * DFFRUGLQJ WR WKH:+2FODVVLᚏFDWLRQ ZHUHLGHQWLᚏHGIURPRXULQVWLWXWLRQDOGDWDEDVHDIWHU LQGHSHQGHQWUHYLHZIURPSDWKRORJLVWV&RPSOHWHIROORZXSGDWDZHUHDYDLODEOH IRU  VXEMHFWV 3URJUHVVLRQ ZDV DQDO\VHG DFFRUGLQJ WR  GHᚏQLWLRQV   WKH RFFXUUHQFHRIDQ\7ุWXPRXUUHFXUUHQFHDQG WKHRFFXUUHQFHRIDQ\7ุWXPRXU UHFXUUHQFH 7KH SUREDELOLWLHV RI UHFXUUHQFH DQG SURJUHVVLRQ IUHH VXUYLYDO IRU ERWK GHᚏQLWLRQV  ZHUH FDOFXODWHG DFFRUGLQJ WR .DSODQ0HLHU PHWKRG 7UDGLWLRQDO SURJQRVWLFYDULDEOHVSUHYLRXVJUDGLQJV\VWHP.LDQG3LPPXQRKLVWRFKHPLVWU\ ZHUHFRQVLGHUHGLQDPXOWLYDULDWH&R[UHJUHVVLRQPRGHO Results: 7HQ \HDUV UHFXUUHQFH SURJUHVVLRQ   DQG SURJUHVVLRQ   IUHH VXUYLYDO ZHUH   DQG  UHVSHFWLYHO\ 3UHYLRXV JUDGLQJ V\VWHP * YV *  VLJQLᚏFDQWO\ SUHGLFWHG SURJUHVVLRQ   EXW QRW UHFXUUHQFH DQG SURJUHVVLRQ   LQ WKH XQLYDULDWH PRGHO ,Q WKH PXOWLYDULDWH PRGHO .L ZDV WKH RQO\ LQGHSHQGHQW SUHGLFWRURISURJUHVVLRQDFFRUGLQJWRERWKGHᚏQLWLRQV+5 S DQG S UHVSHFWLYHO\  Conclusions: +LJK JUDGH 7D %&V DV GHᚏQHG E\ :+2  FDUU\ D IDYRXUDEOH

Eur Urol Suppl 2010;9(2):46

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40

THE RATES OF METASTATIC BLADDER CANCER ARE INCREASING OVER TIME: A POPULATION-BASED ANALYSIS

/LEHUPDQ'-HOGUHV&/XJKH]]DQL*%XGDXV/6XQ06KDULDW6) 3HUURWWH3*UDHIHQ00RQWRUVL).DUDNLHZLF]3, 1 University of Montreal Health Center, Dept. of Urology, Montreal, Canada, 2 University of Montreal Health Center, Dept. of Cancer Prognostics and Health Outcomes, Montreal, Canada, 3Vita-Salute San Raffaele, Dept. of Urology, Milan, Italy, 4Martini-Clinic, Dept. of Prostate Cancer, Hamburg, Germany Introduction & Objectives: 7R DVVHVV WKH UDWH RI PHWDVWDWLF EODGGHU FDQFHU DW GLDJQRVLVLQDSRSXODWLRQEDVHGWXPRXUUHJLVWU\ Material & Methods: %HWZHHQ  DQG   SDWLHQWV ZHUH LGHQWLᚏHG ZLWKLQ  6XUYHLOODQFH (SLGHPLRORJ\ DQG (QG 5HVXOWV 6((5  UHJLVWULHV ZLWK GLDJQRVLV RI EODGGHU FDQFHU RI DOO VWDJHV :H H[DPLQHG WKH UDWHV RI PHWDVWDWLF EODGGHU FDQFHU DW GLDJQRVLV WKURXJKRXW WKH HQWLUH VWXG\ SHULRG 0XOWLYDULDEOH ORJLVWLFUHJUHVVLRQPRGHOVH[DPLQHGWKHLPSDFWRI\HDURIVXUJHU\RQPHWDVWDWLF EODGGHUFDQFHUGLDJQRVLVDIWHUDGMXVWLQJIRUSDWLHQWDJHJHQGHUDQGUDFH Results: 7KHRYHUDOOUDWHRIPHWDVWDWLFEODGGHUFDQFHUZDVDQGLWLQFUHDVHG IURPWRRYHUWKHVWXG\SHULRGUHODWLYHLQFUHDVH˴WUHQGS  7KHLQFUHDVHLQPHWDVWDWLFEODGGHUFDQFHUUDWHVZDVPRUHSURQRXQFHGLQIHPDOHV UHODWLYHLQFUHDVHIURPWR˴WUHQGS  WKDQLQPDOHVUHODWLYH LQFUHDVHIURPWR˴WUHQGS DQGLQRFWRJHQDULDQVUHODWLYH LQFUHDVHIURPWR˴WUHQGS  WKDQLQ\RXQJHUSDWLHQWVUHODWLYH LQFUHDVHIURPWR˴ WUHQGS  DQGLQ&DXFDVLDQVUHODWLYH LQFUHDVHIURPWR˴WUHQGS WKDQLQRWKHUUDFHFDWHJRULHV UHODWLYHLQFUHDVHIURPWR˴WUHQGS  6WDWLVWLFDOO\VLJQLᚏFDQW GLᚎHUHQFHVLQPHWDVWDWLFEODGGHUFDQFHUUDWHVH[LVWHGLQYDULRXV6((5UHJLVWULHV )RUH[DPSOHWKHLQFUHDVHLQPHWDVWDWLFUDWHVZDVWKHKLJKHVWLQWKH/RV$QJHOHVDQG 8WDKUHJLVWULHVUHODWLYHLQFUHDVHIURPWR˴WUHQGSDQG UHODWLYHLQFUHDVHIURPWR˴WUHQGS  ,QPXOWLYDULDEOHORJLVWLF UHJUHVVLRQ PRGHOV DJH JHQGHU DQG UDFH UHSUHVHQWHG LQGHSHQGHQW SUHGLFWRUV RI PHWDVWDWLF EODGGHU FDQFHU GLDJQRVLV Sื  )LQDOO\ PRUH FRQWHPSRUDU\ \HDU UHPDLQHG WKH IRUHPRVW SUHGLFWRU RI KLJKHU UDWH RI PHWDVWDWLF EODGGHU FDQFHU DW LQLWLDOGLDJQRVLVS  Conclusions: 7KHLQFUHDVHLQPHWDVWDWLFEODGGHUFDQFHUUDWHLVZRUULVRPH'HOD\ DWSUHVHQWDWLRQDVZHOODVDGHOD\LQUHIHUUDOVPD\EHWKHXQGHUO\LQJFDXVHEHKLQG WKHVHLQFUHDVLQJUDWHV$OWKRXJKWKHLQFUHDVHLQWUHQGVDUHPDUJLQDOLWUHSUHVHQWV D FDXVH IRU FRQFHUQ ZKLFK LQGLFDWHV WKDW SULPDU\ FDUH SK\VLFLDQV DQG SDWLHQWV VKRXOG EH EHWWHU VHQVLWL]HG WR WKH LPSRUWDQFH RI H[SHGLWHG UHIHUUDOV DQG VHOI GLDJQRVLV

41

PERSONALIZED MANAGEMENT OF UPPER URINARY TRACT UROTHELIAL CARCINOMA: THE EFFECT OF AGE ON CANCER-SPECIFIC MORTALITY

/LEHUPDQ',VEDUQ+-HOGUHV&%XGDXV//XJKH]]DQL*6XQ0 6KDULDW6)3HUURWWH30RQWRUVL)*UDHIHQ0.DUDNLHZLF]3, 1 University of Montreal Health Center, Dept. of Urology, Montreal, Canada, 2 Martini-Clinic, Dept. of Prostate Cancer, Hamburg, Germany, 3University of Montreal Health Center, Dept. of Cancer Prognostics and Health Outcomes, Montreal, Canada, 4Vita-Salute San Raffaele, Dept. of Urology, Milan, Italy Introduction & Objectives: 7KH SURJQRVWLF VLJQLᚏFDQFH RI DGYDQFHG DJH RQ FDQFHUVSHFLᚏFPRUWDOLW\&60 DIWHUQHSKURXUHWHUHFWRP\18 IRULQYDVLYHXSSHU XULQDU\WUDFWXURWKHOLDOFDQFHU878& LVFRQWURYHUVLDO:HDVVHVVHGWKHHᚎHFWRI DGYDQFHGDJHRQ&60DIWHU18LQDODUJHSRSXODWLRQEDVHGFRKRUW Material & Methods: :HUHOLHGRQSDWLHQWVZKRZHUHWUHDWHGZLWK18IRU 878&LQ6XUYHLOODQFH(SLGHPLRORJ\DQG(QG5HVXOWVUHJLVWULHVEHWZHHQ DQG8VLQJWKHPRVWVLJQLᚏFDQWFXWRᚎYDOXHVDJHZDVVWUDWLᚏHGLQWRWKUHH VWUDWD ื \HDUV YV  WR  \HDUV YV ุ \HDUV 'LᚎHUHQFHV LQ WKH UDWHV RI &60ZHUHDVVHVVHGXVLQJFXPXODWLYHLQFLGHQFHSORWVWKDWDFFRXQWIRURWKHUFDXVH PRUWDOLW\ 8QLYDULDEOH DQG PXOWLYDULDEOH FRPSHWLQJULVNV UHJUHVVLRQ PRGHOV ZHUH XVHGWRDVVHVVWKHHᚎHFWRIDJHRQ&60 Results: 7KH \HDU FXPXODWLYH &60 UDWHV ZHUH UHVSHFWLYHO\   DQG IRUSDWLHQWVื\HDUVRIDJHWR\HDUVRIDJHDQGุ\HDUVRIDJH *UD\S $IWHUDFFRXQWLQJIRURWKHUFDXVHPRUWDOLW\WKH\HDU2&0UDWHV IRUWKHVDPHDJHJURXSVZHUHUHVSHFWLYHO\DQG*UD\Sื  $GYDQFHG DJH UHDFKHG LQGHSHQGHQW SUHGLFWRU VWDWXV RI &60 LQ FRPSHWLQJULVNV UHJUHVVLRQDQDO\VHVSื  Conclusions: $GYDQFHGDJHZDVIRXQGWREHDQLQGHSHQGHQWSUHGLFWRURI&60 DIWHU18HYHQDIWHUFRQWUROOLQJIRUWKHSRWHQWLDOO\FRQIRXQGLQJHᚎHFWRIRWKHUFDXVH PRUWDOLW\ ,Q FRQVHTXHQFH WKH GHOHWHULRXV HᚎHFW RI DGYDQFHG DJH WKDW PD\ EH UHODWHGWRSRVWSRQHGVXUJHU\VKRXOGEHFRQVLGHUHGLQFOLQLFDOGHFLVLRQPDNLQJ