ADRENOCORTICAL CARCINOMA: A 30-YEAR EXPERIENCE AT A SINGLE INSTITUTION

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THE JOURNAL OF UROLOGY®

19 RISK OF MALNUTRITION IN UROLOGICAL PATIENTS Alexander Karl*, Peter Rittler, Alexander Buchner, Munich, Germany; Vincent Fradet, San Francisco, CA; Sebastian Walther, Christian G Stief, Munich, Germany INTRODUCTION AND OBJECTIVE: For different diseases and medical fields malnutrition has been shown to be associated with an impaired patient outcome. In general there is a lack of data on the prevalence of malnutrition in urological patients. The assessment of the risk for malnutrition is needed in order to raise awareness of this condition and to initiate nutrition therapy if needed. METHODS: Nutritional state was assessed prospectively using the Nutritional Risk Screening test (NRS 2002). Eight-hundred and ninety-seven patients were evaluated at a urological department in Germany. The Nutritional risk screening started in January 2007 and closed in July 2007. Seven-hundred fifty-one (84%) patients were male and one-hundred forty-six (16%) were female; the median age was sixty-six yrs (18-98 yrs). Four-hundred forty-one patients presented with benign disease and four-hundred fifty-six patients with a malignant disease. RESULTS: Based on the NRS a severe risk of malnutrition was diagnosed in 144 (16%) patients (NRS Score > 3). The NRS score was assessed at score 0 (no malnutrition), 1-2 (risk for malnutrition) and 3-5 (severe risk for malnutrition) in 45, 708 and 144 patients, respectively. As significant risk factors were detected - age and malignant disease (p<0.001). Also type of surgery was significantly associated with a subsequent risk of malnutrition (p<0.001). Gender and body mass index had no significant influence. CONCLUSIONS: In this study 16% of urological patients were at severe risk of malnutrition according to the NRS 2002. Higher age, type of procedure and malignant disease were associated significantly with a higher risk for malnutrition. Further evaluation of these patients and adequate nutritional supportive therapy should be considered in these patients in order to may optimize their clinical outcome.

Vol. 181, No. 4, Supplement, Saturday, April 25, 2009

1; there was a significant difference between subjects with and without nocturia (p<0.0002). The multivariate hazard ratios (95% confidence intervals) for mortality with nocturia were 2.68(1.12-6.43). CONCLUSIONS: We conclude that there is a significantly increased mortality rate associated with nocturia (q2 voids/night), even after adjustment for several factors which may contribute to mortality.

Hazard ratios of mortality according to nocturia

ASSOCIATION BETWEEN NOCTURIA AND MORTALITY IN A COMMUNITY-DWELLING ELDERLY POPULATION AGED 70 YEARS AND OVER: RESULTS OF A 3-YEAR PROSPECTIVE COHORT STUDY IN JAPAN Haruo Nakagawa*, Kaijun Niu, Atsushi Hozawa, Yoshihiro Ikeda, Yasuhiro Kaiho, Kaori Masuda-Ohmori, Ryoichi Nagatomi, Ichiro Tsuji, Yoichi Arai, Sendai, Japan INTRODUCTION AND OBJECTIVE: Nocturia is a common problem which increases with age. It is often a result of an overproduction of urine at night (nocturnal polyuria), but may also be associated with several physiological conditions, such as cardiovascular disease, diabetes mellitus, sleep apnea syndrome, renal dysfunction, lower urinary tract dysfunction and sleep disorders. An increased mortality rate has been reported with nocturia, and may be related to these associated conditions, or independently to nocturia. This study aimed to evaluate the association between nocturia and mortality in a community-based elderly population. METHODS: We conducted a Comprehensive Geriatric Assessment of all residents aged q70 years in 2003 in an urban district of north Japan. The population-based cross-sectional survey was conducted using an extensive health interview for each participant. Mortality over 3 years was investigated using data from the national health insurance system. Differences in survival stratified by presence/ absence of nocturia (q2 voids/night) were assessed with Kaplan-Meier curves, and statistical significance was calculated with the log-rank test. The risk of mortality with or without nocturia was compared using a time varying multivariate Cox proportional hazard model. RESULTS: 788 people were included in the study (28.9% participation rate; 429 females, 359 males; mean age 74.9 ± 4.77 [range: 70-97]). Kaplan-Meier curves representing mortality are shown in Figure

a1

q2

15685.4

13391.8

No. of cases

7

24

Model 1*

1.00

4.02(1.73-9.32)

Model 2**

1.00

2.88(1.21-6.84)

Model 3***

1.00

2.68(1.12-6.43)

Hazard Ratio (95% Confidence Interval)

Source of Funding: None

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night time frequency Person-months of follow up

**: Adjusted for age, sex, BMI, ***: Adjusted for model 2 + diabetes, hypertension, history of coronary heart disease, nephropathy, alcohol consumption, use of tranquilizers, use of hypnotics, use of diuretics, and history of delivery.

Source of Funding: Chiyoda Health Foundation and The Universe Foundation

Adrenal: Benign Disease, Tumors, Physiology & Pharmacology, Surgery Podium 1 Saturday, April 25, 2009

1:00 pm - 3:00 pm

21 ADRENOCORTICAL CARCINOMA: A 30-YEAR EXPERIENCE AT A SINGLE INSTITUTION Marcos Lucon*, Maria Adelaide A Pereira, Daniel Soares Freire, Antonio M Lucon, Maria Candida Fragoso, Miguel Srougi, Berenice Bilharinho Mendonca, Sao Paulo, Brazil INTRODUCTION AND OBJECTIVE: adrenocortical carcinoma is a rare disease associated with dismal prognosis. The results of a large retrospective cohort comprising 100 patients with adrenocortical carcinoma treated at a single institution are reported. METHODS: from January 1976 to July 2008, 100 patients with adrenocortical carcinoma were evaluated. The diagnosis was established when three or more patterns of Weiss´s criteria were presented or identification of metastasis when tumor tissue was not available for pathologic examination. The age at diagnosis, tumor size, stage, functional

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Vol. 181, No. 4, Supplement, Saturday, April 25, 2009

status and score of Weiss´s criteria were evaluated as prognostic factors. RESULTS: A bimodal pattern of distribution of cases with one peak in the first decade and one peak in the fourth decade of life was observed. Metastases occurred at presentation in 26 cases (26%). Of the remaining 74 patients with initially localized disease, 25 (34%) had dissemination during follow-up. Five-year overall survival was 100% for stage I, 60% for stages II (p <0.05 stage I vs. stage I), 43% for stage III (p <0.05 stage II vs. stage III) and 15% for stage IV (p <0.05 stage III vs. stage IV). Children and adolescents younger than 15 years had higher 5-year overall survival when compared to adults (82% vs. 36%, p < 0.001). Also, tumor size and functional status were both associated with prognosis, since overall survival was longer for patients with tumors smaller than 10 cm and those with androgen-only secretion, when compared to larger tumors and other secretion patterns (pure Cushing’s syndrome, mixed secretion [Cushing plus androgens and/or estrogens] and non-functioning tumors), respectively. Finally, the number of Weiss’ criteria was associated with reduced 5-year overall survival (Weiss 4-5: 79%; Weiss 6-7: 64%; Weiss 8-9: 0%; P<0.01). CONCLUSIONS: in this large retrospective cohort, staging was the most important prognostic factor for adrenocortical carcinoma. Other important variables were age at diagnosis, tumor size, hormonal status and score of Weiss’ criteria.

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22 SURGICAL AND FUNCTIONAL OUTCOMES OF PARTIAL ADRENALECTOMY FOR PHEOCHROMOCYTOMA IN PATIENTS WITH A SOLITARY ADRENAL GLAND Thomas H Sanford*, Karel Pacak, Peter A Pinto, W. Marston Linehan, Gennady Bratslavsky, Bethesda, MD INTRODUCTION AND OBJECTIVE: Patients with pheochromocytoma are prone to develop bilateral adrenal lesions. Although total adrenalectomy minimizes the risk of local recurrence there is a risk for bilateral adrenal involvement and the potential need for steroid dependence. This scenario is further complicated in patients with a pheochromocytoma in a solitary adrenal gland. Adrenal-sparing surgery may allow patients to forgo the morbidity associated with long-term steroid replacement therapy. In this study we evaluate surgical and functional outcomes of partial adrenalectomy in patients with a solitary adrenal gland. METHODS: We identified patients with a solitary adrenal gland that underwent partial adrenalectomy for treatment of pheochromocytoma at the National Institutes of Health between 1994 and 2008. A review of the operative reports and hospital records was performed. Demographics, perioperative and functional outcomes, as well as recurrence data were collected. The functional outcomes were determined by the need for postoperative steroid supplementation at the time of the discharge from the hospital and at the time of the most recent follow up. The recurrence was determined by review of imaging reports during follow up visits. RESULTS: A total of 19 patients with a solitary adrenal underwent partial adrenalectomy. The cohort included 13 patients with von HippelLindau (VHL), 3 patients with multiple endocrine neoplasia type II (MEN II), one patient with neurofibromatosis (NF-1), and two others without known hereditary genetic disorder. Eight patients had prior nonadrenal abdominal surgeries. Majority of procedures were performed laparoscopically (12 out of 19) with the median EBL of 200cc (251,000) and there were no conversions. The median number of lesions removed was 1 (1-3) with median size of 2.0 cm (1.0-8.0). There were 3 intraoperative complications (1 diaphragmatic injury, 1 pleural injury, and 1caval injury) that were all successfully repaired without any sequelae. Eight patients required steroid supplementation upon discharge with 3 subsequently discontinuing steroid supplementation. With the median follow up of 3.6 years (0.3 -12) there was only one recurrence. CONCLUSIONS: Partial adrenalectomy in patients with solitary adrenal is a feasible procedure with reasonable functional outcomes. It allows the majority of patients to avoid steroid dependence and has a low recurrence rate at the intermediate follow up. Source of Funding: NIH

23 MORTALITY PREDICTIONS IN PATIENTS WITH ADRENOCORTICAL CARCINOMA Laurent Zini*, Vincent Cloutier, Philippe Arjane, Umberto Capitanio, Claudio Jeldres, Hendrik Isbarn, Shahrokh F Shariat, Alain Duclos, Hugues Widmer, Fred Saad, Paul Perrotte, Alberto Briganti, Nazareno Suardi, Andrea Gallina, Francesco Montorsi, Pierre I Karakiewicz, Montreal, QC, Canada

Source of Funding: None

INTRODUCTION AND OBJECTIVE: The cancer-specific and overall mortality of patients with adrenocortical carcinoma (ACC) may be quite variable. We developed nomograms predicting ACC-specific and overall mortality in patients managed with either surgery or no surgery for ACC. METHODS: The models were developed in a cohort of 205 ACC patients and externally validated it using a cohort of 207 ACC patients, identified in the 1973-2004 Surveillance, Epidemiology and End Results (SEER) database. The predictors consisted of age, gender, race, stage and surgery status. Nomograms based on Cox regression model-derived coefficients were used for prediction of the ACC-specific and overall mortality, and were tested using area under the Receiver Operating Characteristics (ROC) curve. RESULTS: In cancer-specific analyses, the median survival of