- Email: [email protected]
MP10-05 IS DE NOVO UPPER TRACT UROTHELIAL CARCINOMA A DISTINCT ENTITY FROM BLADDER CARCINOMA?
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
study. Potential preoperative risk predictors were collected from medical history, TURBT pathology, preoperative labs, proposed procedure type, and prior treatments. Postoperative complications were graded using the Clavien-Dindo scale. Multivariate logistic regression models were used to predict post-operative complications. Accuracy of prediction models was assessed using the area under the receiver operating characteristic curve. RESULTS: Of the potential preoperative risk factors, 5, 10 and 16 unique predictors along with two way interactions were determined to have strong association with 90 day postoperative complications, yielding an AUC of 0.69, 0.79 and 0.91 respectively. This is illustrated in Figure 1. CONCLUSIONS: Our findings suggest routinely collected preoperative patient-level clinical variables may be useful for determining patient risk for short-term postoperative complications. The flexibility in our prediction model for the number of predictor inputs allow users to tailor the degree of risk assessment based on a patient’s baseline heath status. A simple and accessible prediction model with selective predictors may help identify at risk patients for patient education, counseling and development of risk reduction strategies.
Source of Funding: none
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despite adjustment for age but was attenuated and no longer statistically significant after adjustment for propensity score, and confounding variables (adjusted HR¼1.01, 95% CI: 0.62-1.63; p¼0.976). CONCLUSIONS: RC&UD was independently associated with a faster decline in renal function over time, as measured by annualized eGFR decline. RC&UD was associated with higher risk of eGFR decline of 30% or more in unadjusted analysis but not in adjusted analysis. Our findings will inform future prospective studies to examine this association and investigate intervention strategies to prevent renal injury in this population.
Source of Funding: University of Florida, Clinical and Translational Research Institute. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
MP10-04 EFFECT OF RADICAL CYSTECTOMY AND URINARY DIVERSION FOR BLADDER CANCER TREATMENT ON RENAL FUNCTION OVER TIME Shahab Bozorgmehri*, Gainesville, FL; Scott Gilbert, Tampa, FL; Xiaomin Lu, Robert L. Cook, Rebecca Beyth, Muna Canales, Gainesville, FL INTRODUCTION AND OBJECTIVES: We determined the effect of radical cystectomy (RC) and urinary diversion (UD) for bladder cancer treatment compared to controls on renal function over time. METHODS: In this retrospective study of 384 patients with bladder cancer who sought care in a tertiary health care center from 2000 to 2014, we determined the effect of RC&UD (n¼172) on renal function over time using bladder cancer patients treated without RC&UD (n¼212) as a comparison group. Renal function decline was defined using (a) annualized estimated glomerular filtration rate (eGFR) decline and (b) time to decrease in eGFR of 30% or more from baseline. We used propensity score regression adjustment to address confounding by indication. Unadjusted and adjusted linear mixed-effects and Cox proportional hazards models were used to assess the association between RC&UD and eGFR slope and time to decrease in eGFR of 30% or more, respectively. RESULTS: Mean age was 6812 years; average follow-up was 1713 months. Patients with RC&UD experienced a faster decline in renal function over time as compared to those without RC&UD (see Figure). After adjusting for age, propensity score, and other confounding variables, the difference in mean eGFR slope in patients with RC&UD, compared to those without RC&UD, was stable and remained statistically significant (p< 0.001). Patients with RC&UD had a higher risk of eGFR decline of 30% or more, compared to those without RC&UD (unadjusted HR¼1.88, 95%CI: 1.35-2.63; p<0.001); this persisted
MP10-05 IS DE NOVO UPPER TRACT UROTHELIAL CARCINOMA A DISTINCT ENTITY FROM BLADDER CARCINOMA? Hanan Goldberg*, Thenappan Chandrasekar, Zachary Klaassen, Robert Hamilton, Girish Kulkarni, Neil Fleshner, Toronto, Canada INTRODUCTION AND OBJECTIVES: Upper tract urothelial carcinoma (UTUC) accounts for <5% of all urothelial cancers (UC). It is usually considered a part of the spectrum of UC, manifesting as bladder cancer (BC) primarily. Our objective was to find whether there are clinical differences between UTUC tumors that present de novo (DnUTUC) and those that present secondarily (SUTUC)(i.e.: having had a prior history of BC). METHODS: The SEER database was queried for all patients with UTUC from 1988-2013. Data collected consisted of demographic, clinical, pathologic and survival parameters. All parameters were compared between DnUTUC and SUTUC patients, including survival analyses. RESULTS: A total of 20,448 patients with UTUC were identified. Patients coded as MXNX or M1 were eliminated in order to determine stratum specific differences (N¼9707). Table 1 demonstrates baseline demographic, pathologic and follow-up data. Approximately 72% of patients had DnUTUC, and almost 28% had a prior history of BC. Patients with DnUTUC were on average: younger, more likely to be female and more racially diverse. DnUTUC tumors tended to be larger, disproportionately high grade and stage. Interestingly, renal pelvic tumors were more prevalent as well. In terms of survival (Table 2), covariates associated with diminished CSS include: increasing age, tumor size, stage and grade and whether the tumor was de novo. Furthermore, variables associated with impaired OS include: (increasing age, tumor size, stage and grade).
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THE JOURNAL OF UROLOGYâ
CONCLUSIONS: This large cohort represents a unique opportunity to asses for differences in what is otherwise a rare condition and to our knowledge is the first to suggest that DnUTUC may represent a distinct clinical entity from BC. Although surveillance bias may explain the baseline differences in tumor characteristics, multivariate adjustment still demonstrates a distinct outcome for these patients. Further investigations including biomarker profiling between DnUTUC and SUTUC may further shed light into biological differences between these heretofore similar microscopic entities.
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
MP10-06 ISOLATED RED PATCHES SEEN DURING ENDOSCOPIC SURVEILLANCE OF BLADDER CANCER e HOW OFTEN SHOULD WE BIOPSY? Nkwam Nkwam*, Shaun Trecarten, Stefan Momcilovic, Alvaro Bazo, Gurminder Mann, Benedict Sherwood, Richard Parkinson, Nottingham, United Kingdom INTRODUCTION AND OBJECTIVES: Red patches in the bladder are often seen during endoscopic surveillance of bladder cancer at cystoscopy, particularly in patients who have had intravesical BCG treatment. However, it is difficult to distinguish BCG artefact from malignancy, namely carcinoma in-situ (CIS) in the absence of narrow band imaging or photodynamic diagnostics. Therefore, can we safely assume that histologically benign persistent red patches biopsied previously within a certain timeframe will remain benign entities? Our objectives are to establish whether the regular biopsy of red patches seen during endoscopic surveillance for bladder cancer is worthwhile and determine a suitable time frame for repeat biopsy of prior histologically benign persistent red patches in patients on endoscopic surveillance for bladder cancer. METHODS: 4,805 flexible cystoscopy (FC) reports over a 12month period (January - December 2015) were retrospectively reviewed at a UK tertiary teaching hospital and those undergoing cystoscopic surveillance for bladder cancer and found to have solitary red patches at flexible cystoscopy were included in the study. A proportion of these cases had biopsies taken which underwent histopathological analysis. RESULTS: 241 flexible cystoscopies performed on 183 patients on endoscopic surveillance for bladder cancer had red patches and of these, 120 (49.8%) had a history of intravesical BCG therapy. Eightyfive patients (35.3%) underwent biopsy of the red patch. Malignancy was found in 20 biopsies (23.5%), of which, 11 out of 20 (55%) were CIS. Sixteen of these recurrences had been biopsied previously of which 11 (68.8%) were benign at last biopsy, 6 of which in the last 12 months. The remaining four recurrences had no previous biopsy. Eleven out of sixteen (68.8%) of recurrences were found in patients who had been biopsied within the last 12 months. No cases of malignancy were identified in patients with low-risk bladder cancer. CONCLUSIONS: We recommend the biopsy of all red patches found during endoscopic surveillance of patients with intermediate/high risk bladder cancer due to the significant incidence of malignant recurrence identified, particularly if no biopsy has been performed within the previous 12 months due to the high yield of malignant recurrence identified. This is independent of previous biopsy histology. Source of Funding: None.
MP10-07 INCREASED RISK OF BLADDER CANCER IN CHRONIC KIDNEY DISEASE PATIENTS WITH RENAL TRANSPLANTATION Min-Che Tung*, Kuan-Chun Hsueh, Taichung, Taiwan; Kuan-Hua Huang, Tainan, Taiwan; Chiao-Ling Chen, YUAN-HUNG WANG, Chia-Chang Wu, New Taipei City, Taiwan
Source of Funding: None
INTRODUCTION AND OBJECTIVES: Chronic kidney disease (CKD) patients without effective treatment and follow-up usually progressed to end-stage renal disease (ESRD). Various therapeutic modalities including hemodialysis, peritoneal dialysis and renal transplantation are usually used to treat CKD patients. However, whether various therapeutic modalities can modify the risk of chronic diseases such as malignancies in CKD patients remains unclear. Therefore, the present study aims to investigate the association between therapeutic modalities of CKD patients and chronic diseases in Taiwan. METHODS: The National Health Insurance program was implemented since March 1995 by the National Health Insurance Administration, Ministry of Health and Welfare, with a coverage over
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
study. Potential preoperative risk predictors were collected from medical history, TURBT pathology, preoperative labs, proposed procedure type, and prior treatments. Postoperative complications were graded using the Clavien-Dindo scale. Multivariate logistic regression models were used to predict post-operative complications. Accuracy of prediction models was assessed using the area under the receiver operating characteristic curve. RESULTS: Of the potential preoperative risk factors, 5, 10 and 16 unique predictors along with two way interactions were determined to have strong association with 90 day postoperative complications, yielding an AUC of 0.69, 0.79 and 0.91 respectively. This is illustrated in Figure 1. CONCLUSIONS: Our findings suggest routinely collected preoperative patient-level clinical variables may be useful for determining patient risk for short-term postoperative complications. The flexibility in our prediction model for the number of predictor inputs allow users to tailor the degree of risk assessment based on a patient’s baseline heath status. A simple and accessible prediction model with selective predictors may help identify at risk patients for patient education, counseling and development of risk reduction strategies.
Source of Funding: none
e109
despite adjustment for age but was attenuated and no longer statistically significant after adjustment for propensity score, and confounding variables (adjusted HR¼1.01, 95% CI: 0.62-1.63; p¼0.976). CONCLUSIONS: RC&UD was independently associated with a faster decline in renal function over time, as measured by annualized eGFR decline. RC&UD was associated with higher risk of eGFR decline of 30% or more in unadjusted analysis but not in adjusted analysis. Our findings will inform future prospective studies to examine this association and investigate intervention strategies to prevent renal injury in this population.
Source of Funding: University of Florida, Clinical and Translational Research Institute. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
MP10-04 EFFECT OF RADICAL CYSTECTOMY AND URINARY DIVERSION FOR BLADDER CANCER TREATMENT ON RENAL FUNCTION OVER TIME Shahab Bozorgmehri*, Gainesville, FL; Scott Gilbert, Tampa, FL; Xiaomin Lu, Robert L. Cook, Rebecca Beyth, Muna Canales, Gainesville, FL INTRODUCTION AND OBJECTIVES: We determined the effect of radical cystectomy (RC) and urinary diversion (UD) for bladder cancer treatment compared to controls on renal function over time. METHODS: In this retrospective study of 384 patients with bladder cancer who sought care in a tertiary health care center from 2000 to 2014, we determined the effect of RC&UD (n¼172) on renal function over time using bladder cancer patients treated without RC&UD (n¼212) as a comparison group. Renal function decline was defined using (a) annualized estimated glomerular filtration rate (eGFR) decline and (b) time to decrease in eGFR of 30% or more from baseline. We used propensity score regression adjustment to address confounding by indication. Unadjusted and adjusted linear mixed-effects and Cox proportional hazards models were used to assess the association between RC&UD and eGFR slope and time to decrease in eGFR of 30% or more, respectively. RESULTS: Mean age was 6812 years; average follow-up was 1713 months. Patients with RC&UD experienced a faster decline in renal function over time as compared to those without RC&UD (see Figure). After adjusting for age, propensity score, and other confounding variables, the difference in mean eGFR slope in patients with RC&UD, compared to those without RC&UD, was stable and remained statistically significant (p< 0.001). Patients with RC&UD had a higher risk of eGFR decline of 30% or more, compared to those without RC&UD (unadjusted HR¼1.88, 95%CI: 1.35-2.63; p<0.001); this persisted
MP10-05 IS DE NOVO UPPER TRACT UROTHELIAL CARCINOMA A DISTINCT ENTITY FROM BLADDER CARCINOMA? Hanan Goldberg*, Thenappan Chandrasekar, Zachary Klaassen, Robert Hamilton, Girish Kulkarni, Neil Fleshner, Toronto, Canada INTRODUCTION AND OBJECTIVES: Upper tract urothelial carcinoma (UTUC) accounts for <5% of all urothelial cancers (UC). It is usually considered a part of the spectrum of UC, manifesting as bladder cancer (BC) primarily. Our objective was to find whether there are clinical differences between UTUC tumors that present de novo (DnUTUC) and those that present secondarily (SUTUC)(i.e.: having had a prior history of BC). METHODS: The SEER database was queried for all patients with UTUC from 1988-2013. Data collected consisted of demographic, clinical, pathologic and survival parameters. All parameters were compared between DnUTUC and SUTUC patients, including survival analyses. RESULTS: A total of 20,448 patients with UTUC were identified. Patients coded as MXNX or M1 were eliminated in order to determine stratum specific differences (N¼9707). Table 1 demonstrates baseline demographic, pathologic and follow-up data. Approximately 72% of patients had DnUTUC, and almost 28% had a prior history of BC. Patients with DnUTUC were on average: younger, more likely to be female and more racially diverse. DnUTUC tumors tended to be larger, disproportionately high grade and stage. Interestingly, renal pelvic tumors were more prevalent as well. In terms of survival (Table 2), covariates associated with diminished CSS include: increasing age, tumor size, stage and grade and whether the tumor was de novo. Furthermore, variables associated with impaired OS include: (increasing age, tumor size, stage and grade).
e110
THE JOURNAL OF UROLOGYâ
CONCLUSIONS: This large cohort represents a unique opportunity to asses for differences in what is otherwise a rare condition and to our knowledge is the first to suggest that DnUTUC may represent a distinct clinical entity from BC. Although surveillance bias may explain the baseline differences in tumor characteristics, multivariate adjustment still demonstrates a distinct outcome for these patients. Further investigations including biomarker profiling between DnUTUC and SUTUC may further shed light into biological differences between these heretofore similar microscopic entities.
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
MP10-06 ISOLATED RED PATCHES SEEN DURING ENDOSCOPIC SURVEILLANCE OF BLADDER CANCER e HOW OFTEN SHOULD WE BIOPSY? Nkwam Nkwam*, Shaun Trecarten, Stefan Momcilovic, Alvaro Bazo, Gurminder Mann, Benedict Sherwood, Richard Parkinson, Nottingham, United Kingdom INTRODUCTION AND OBJECTIVES: Red patches in the bladder are often seen during endoscopic surveillance of bladder cancer at cystoscopy, particularly in patients who have had intravesical BCG treatment. However, it is difficult to distinguish BCG artefact from malignancy, namely carcinoma in-situ (CIS) in the absence of narrow band imaging or photodynamic diagnostics. Therefore, can we safely assume that histologically benign persistent red patches biopsied previously within a certain timeframe will remain benign entities? Our objectives are to establish whether the regular biopsy of red patches seen during endoscopic surveillance for bladder cancer is worthwhile and determine a suitable time frame for repeat biopsy of prior histologically benign persistent red patches in patients on endoscopic surveillance for bladder cancer. METHODS: 4,805 flexible cystoscopy (FC) reports over a 12month period (January - December 2015) were retrospectively reviewed at a UK tertiary teaching hospital and those undergoing cystoscopic surveillance for bladder cancer and found to have solitary red patches at flexible cystoscopy were included in the study. A proportion of these cases had biopsies taken which underwent histopathological analysis. RESULTS: 241 flexible cystoscopies performed on 183 patients on endoscopic surveillance for bladder cancer had red patches and of these, 120 (49.8%) had a history of intravesical BCG therapy. Eightyfive patients (35.3%) underwent biopsy of the red patch. Malignancy was found in 20 biopsies (23.5%), of which, 11 out of 20 (55%) were CIS. Sixteen of these recurrences had been biopsied previously of which 11 (68.8%) were benign at last biopsy, 6 of which in the last 12 months. The remaining four recurrences had no previous biopsy. Eleven out of sixteen (68.8%) of recurrences were found in patients who had been biopsied within the last 12 months. No cases of malignancy were identified in patients with low-risk bladder cancer. CONCLUSIONS: We recommend the biopsy of all red patches found during endoscopic surveillance of patients with intermediate/high risk bladder cancer due to the significant incidence of malignant recurrence identified, particularly if no biopsy has been performed within the previous 12 months due to the high yield of malignant recurrence identified. This is independent of previous biopsy histology. Source of Funding: None.
MP10-07 INCREASED RISK OF BLADDER CANCER IN CHRONIC KIDNEY DISEASE PATIENTS WITH RENAL TRANSPLANTATION Min-Che Tung*, Kuan-Chun Hsueh, Taichung, Taiwan; Kuan-Hua Huang, Tainan, Taiwan; Chiao-Ling Chen, YUAN-HUNG WANG, Chia-Chang Wu, New Taipei City, Taiwan
Source of Funding: None
INTRODUCTION AND OBJECTIVES: Chronic kidney disease (CKD) patients without effective treatment and follow-up usually progressed to end-stage renal disease (ESRD). Various therapeutic modalities including hemodialysis, peritoneal dialysis and renal transplantation are usually used to treat CKD patients. However, whether various therapeutic modalities can modify the risk of chronic diseases such as malignancies in CKD patients remains unclear. Therefore, the present study aims to investigate the association between therapeutic modalities of CKD patients and chronic diseases in Taiwan. METHODS: The National Health Insurance program was implemented since March 1995 by the National Health Insurance Administration, Ministry of Health and Welfare, with a coverage over