709 POSITIVE NODE RATIO AND TOTAL NUMBER OF POSITIVE NODES MAY PREDICT RECURRENCE IN EARLY STAGE NON-SEMINOMATOUS GERM-CELL TUMOURS UNDERGOING PRIMARY RETROPERITONEAL LYMPH-NODE DISSECTION

Vol. 189, No. 4S, Supplement, Sunday, May 5, 2013

RESULTS: 203 patients met the inclusion criteria. Clinical stage at initial presentation was A in 43 (21.2%), B in 95 (46.8%) and C in 63 (31.0%) and unknown in 2(1%). Sixty-one (30%) patients underwent primary RPLND, 110(54.2%) underwent PC RPLND and 32(15.8%) underwent mass resections. Of the 203 patients, 25 underwent additional 30 resections after the first redo, totaling 233 redo procedures. Median time to redo surgery was 22 months. The most common additional procedures were thoracotomy in 43 and nephrectomy in 43. There were 23 (16.0%) Clavien grade 3 or greater complications. Of the 233 redo surgeries pathology revealed teratoma in 77 (33%) and necrosis in 32 (13.7%). Active cancer was identified in 124 (53.3%) and of these 38 (16.3%) represented variant histology. At a mean follow up of 45.5 months the 5 years disease-free survival was 53.3%, with cancer specific survival of 59.4%. The cancer specific survival for patients with active cancer was 39.7% compared to 78.8% for patients with necrosis or teratoma. CONCLUSIONS: Patients undergoing redo PC RPLND experience a higher complication rate, a higher incidence of active cancer and a lower survival compared to standard PCRPLND. Factors influencing the incidence of redo surgery likely include tumor biology and surgical experience. Source of Funding: None

708 THE CHARACTERISTICS OF INGUINAL LYMPH NODES MAY PREDICT PELVIC LYMPH NODES INVOLVEMENT IN PENILE CANCER: A SINGLE-INSTITUTIONAL EXPERIENCE Mario Catanzaro*, Giovanni Lughezzani, Nicola Nicolai, Tullio Torelli, Luigi Piva, Davide Biasoni, Silvia Stagni, Andrea Necchi, Patrizia Giannatempo, Daniele Raggi, Elena Faré, Maurizio Colecchia, Roberto Salvioni, Milano, Italy INTRODUCTION AND OBJECTIVES: The need for a concomitant pelvic lymph node dissection (LND) in patients with penile cancer with inguinal lymph nodes metastases (LNM) is still a matter of debate. We aimed at determining the predictors of pelvic LNM in a singleinstitutional population of patients with pathologically determined inguinal LNM. METHODS: A total of 261 node-positive groins were retrieved from our institutional database. A concomitant pelvic LND was performed in case of clinically evident positive nodes. In case of lowvolume inguinal disease, the decision to perform a deferred pelvic LND was determined based on pathological inguinal nodes characteristics. Logistic regression models (LRMs) were fitted to test the predictors of pelvic lymph nodes involvement. The minimum p-value method according to Mazumdar-Glassman was used to determine the most significant cut-off values for each predictor. RESULTS: Overall, pelvic LNM were observed in 48 (18.3%) cases. The mean number of positive inguinal and pelvic lymph nodes was 1.9 (range:1-8) and 1.2 (range: 0-12), respectively. Mean inguinal LNM volume was 3.3 cm (range: 1-10 cm). At univariable LRMs, both the number of inguinal LNM (OR: 1.51: 95% CI: 1.20-1.90; p⬍0.001) and the volume of inguinal LNM (OR: 1.02: 95% CI: 1.01-1.04; p⫽0.027) emerged as significant predictors of pelvic LNM. In addition, the two variables were independent predictors of pelvic LNM in multivariable LRMs (p⫽0.022 and 0.029, respectively). The most significant cut-off values were respectively 3 for the number of inguinal LNM and 4 cm for the volume of inguinal LNM. Specifically, patients with ⬎⫽3 inguinal LNM had a 2.82-fold higher risk of harboring pelvic LNM relative to patients with ⬍⫽2 inguinal LNM (95% CI: 1.45-5.49; p⫽0.002). Similarly, patients with a inguinal LNM ⬎⫽4 cm had a 2.37-fold higher risk of harboring pelvic LNM relative to individuals with LNM⬍4 cm (95% CI: 1.12-5.05; p⫽0.025). In the current series, no significant relationship was observed between the presence of extranodal extension of the disease and pelvic LNM (p⫽0.174).

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CONCLUSIONS: Number and volume of inguinal LNM are significantly associated with pelvic nodal metastases. Surgical planning for pelvic LND should take into account these parameters. Source of Funding: None

709 POSITIVE NODE RATIO AND TOTAL NUMBER OF POSITIVE NODES MAY PREDICT RECURRENCE IN EARLY STAGE NONSEMINOMATOUS GERM-CELL TUMOURS UNDERGOING PRIMARY RETROPERITONEAL LYMPH-NODE DISSECTION Nicola Nicolai*, Giovanni Lughezzani, Davide Biasoni, Mario Catanzaro, Silvia Stagni, Tullio Torelli, Luigi Piva, Andrea Necchi, Patrizia Giannatempo, Daniele Raggi, Elena Faré, Maurizio Colecchia, Roberto Salvioni, Milano, Italy INTRODUCTION AND OBJECTIVES: Presence of nodal metastases at primary retroperitoneal lymph node dissection (RPLND) frequently triggers adjuvant chemotherapy in non-seminomatous germcell tumours of the testis (NSGCT). We evaluated the predictors of recurrence according to nodal disease-associated parameters among patients undergoing primary RPLND who did not receive adjuvant chemotherapy. METHODS: We identified 84 patients (median age 26, IQR: 21-30) with complete data who underwent primary RPLND (unilateral 41 or 48.8%, bilateral 43 or 52.2%) between 3/1991 and 3/2011, had pathologically ascertained nodal metastases and did not receive adjuvant chemotherapy. Nodal disease-associated variables were considered both as continuous-coded and as categorical-coded. The Mazumdar-Glassman method was used to determine the most significant cut-off value. The Kaplan-Mayer method was used to determine recurrence-free survival (RFS) rates. Cox regression models were fitted to test the predictors of RFS. RESULTS: Medians were as follows: number of positive nodes (NPN): 2 (IQR 1-3); number of removed nodes (NRN): 22 (IQR 15-30); number of negative nodes (NNN): 20 (IQR 13-27); positive nodes ratio (PNR: NPN/tNRN): 8.7 (IQR 5.3-14.3). Following a median follow-up of 38 months (IQR 5-65), 16 (19%) patients relapsed. The 2-yrs RFS rate was 82.1%. At univariable Cox regression analyses, NPN and PNR were significantly associated with RFS both when considered as continuous variables (NPN: HR 1.37; 95% CI 1.09-1.72; p⫽ .005 and PNR: HR 1.07; 95% CI 1.03-1.11; p ⬍ .001) and as categorical variables (NPN: HR 3.84, 95% CI 1.42-10.39; p⫽ .008 and PNR: HR 5.93, 95% CI 1.69-20.85; p⫽ .005). The most significant cut-off values were 9% for PNR and 3 for NPN. The 2-yrs RFS rate was 97.2% Vs 64.8% for patients with PNR ⱖ 9% Vs ⬍9%, respectively (Log rank p ⫽ .002),. Similarly, 2-yr RFS rates were 90% Vs 63% for patients with NPN ⱖ3 Vs NPN is ⬍ 3 (Log rank p ⫽ .004). NRN, NNN and RPLND extension were not significantly associated with RFS. CONCLUSIONS: Most of the patients with nodal metastases at RPLND who did not undergo adjuvant chemotherapy do not relapse. Small tumour burden (NPN ⬍ 3) and a very low nodal density (PNR ⱕ 9%) are associated with very favourable outcomes, as ⬎ 90% of patients will remain disease-free 2 yrs after RPLND. Recurrence probability for patients with “unfavourable” features was not lower than 63%. Although these findings need to be confirmed, they may indicate that an adjuvant treatment could be safely omitted. Source of Funding: None

710 MODELLING MANAGEMENT STRATEGIES FOR STAGE I SEMINOMA: DIRECT AND INDIRECT COSTS FOR THE FIRST FIVE YEARS Richard Johnston*, Craig Nichols, Chris Porter, Seattle, WA INTRODUCTION AND OBJECTIVES: Patients with stage I pure seminoma can be managed with surveillance, chemotherapy or