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MP27-12 PROGNOSTIC VALUE OF LYMPH NODE YIELD DURING NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
e367
Source of Funding: none
MP27-12 PROGNOSTIC VALUE OF LYMPH NODE YIELD DURING NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA Andrew Winer*, Emily Vertosick, Renato Beluco, Sigrid Carlsson, Samuel Kaffenberger, Aditya Bagrodia, Katie Murray, Daniel Sjoberg, John Sfakianos, Eugene Cha, Guido Dalbagni, Jonathan Coleman, New York, NY INTRODUCTION AND OBJECTIVES: The association between the number of lymph nodes removed during radical nephroureterectomy (RNU) with lymph node dissection (LND) for upper tract urothelial carcinoma (UTUC) and cancer-specific outcomes has been studied in previous reports with varying results. The aim of this study was to investigate whether removal of more lymph nodes during RNU with LND for UTUC has a beneficial impact on recurrence-free and cancer-specific survival (RFS and CSS). METHODS: We performed a retrospective review of patients who underwent RNU with concomitant LND for UTUC at our institution between 1976 and 2014. We created Cox regression models including an interaction term between nodal status (positive or negative) and the total number of nodes removed to assess whether the number of nodes removed affected RFS or CSS differently by nodal status. We used Kruskal-Wallis tests to assess whether any additional clinicopathologic characteristics were associated with the extent of LND. RESULTS: In this cohort of 442 patients, there were 222 recurrences, and 94 patients died from disease, with a median follow-up of 6.2 years (IQR 2.6, 10.2) for survivors. The median number of lymph nodes removed was 9 (IQR 4, 16). A total of 78 patients (18%) had positive nodes, with a median of 2 positive nodes removed (IQR 1, 5). There were several significant associations between patient and disease characteristics and the number of nodes removed (Table 1). Among patients with negative nodes (pN0), there was no evidence of an association between nodal yield and RFS (HR 1.02 per 5 nodes removed, 95% CI 0.95, 1.10, p¼0.6). However, in patients with node-positive disease (pN1), we observed improved RFS with an increase in number of nodes removed (HR 0.81 per 5 nodes removed, 95% CI 0.67, 0.98, p¼0.026). Additionally, analysis among node-positive men showed a non-significant improvement in CSS associated with removing an increased number of nodes (HR 0.90 per 5 nodes removed, 95% CI 0.75, 1.08, p¼0.2). CONCLUSIONS: We found that increased number of nodes excised at the time of RNU with LND for UTUC was associated with improved RFS in node-positive patients. These findings provide the rationale for further defining the role of extended-template LND in selected high-risk cohorts.
Source of Funding: none
MP27-13 ARISTOLOCHIC ACID INDUCED UNIQUE ONCOLOGICAL CHARACTERISTIC IN CHINA: GENDER RELATED DIFFERENCES IN UPPER TRACT UROTHELIAL CARCINOMA Gengyan Xiong*, Yunchao Xing, Qi Tang, Xuesong Li, Liqun Zhou, Beijing, China, People’s Republic of INTRODUCTION AND OBJECTIVES: Contrary to the west upper tract urothelial carcinoma (UTUC) patients, there were significant gender differences in Chinese UTUCs. We initiated this study to investigated the prognostic factors and possible cause of gender difference in China. METHODS: 687 pathologically diagnosed UTUC patients treated in our center were enrolled. We evaluated the differences in oncological characteristics, epigenetic biomarkers, cancer specific survival, bladder recurrence and contralateral upper tract recurrence. RESULTS: 1. The majority of patients were females (55.5%). They showed a poorer renal function (p¼0.003), lower proportion of tumor stage III/IV (p¼0.006) and smaller tumor diameters (p¼0.005) than males. 2. The cancer specific survival (CSS) in male patients was much poorer than females (p<0.001), and there were significant gender related differences on prognostic factors: Main tumor located in ureter (p<0.001), larger main tumor diameter (>5cm, p<0.001), patients with severe chronic kidney disease (p¼0.017), papillary tumor architecture (p¼0.023), higher tumor stage (p<0.001), positive N status (p¼0.001) and methylated ABCC6 promoter (p¼0.004) were associated with poorer survival in female cohort. Older age (p¼0.002), ipsilateral hydronephrosis (p¼0.018), larger tumor diameter (p¼0.020), sessile tumor architecture (p¼0.007), higher tumor stage (p¼0.001) and methylated TMEFF2 promoter (p¼0.012) were associated with higher cancer specific mortality in male patients. 3. The aristolochic acid should be the main cause of gender difference in Chinese UTUC patients. The AA induced UTUCs presented smaller tumor diameter (p¼0.004), lower tumor stage (p¼0.001), less positive N status (p¼0.035), more multifocality (p¼0.001), lower methylation index (p¼0.005) and much poorer renal function (p¼0.001). Though AA-UTUC patients present better survival (p¼0.023), their bladder (p¼0.005) and contralateral upper tract recurrence (p<0.001) situation was extremely worse.
Vol. 195, No. 4S, Supplement, Saturday, May 7, 2016
e367
Source of Funding: none
MP27-12 PROGNOSTIC VALUE OF LYMPH NODE YIELD DURING NEPHROURETERECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA Andrew Winer*, Emily Vertosick, Renato Beluco, Sigrid Carlsson, Samuel Kaffenberger, Aditya Bagrodia, Katie Murray, Daniel Sjoberg, John Sfakianos, Eugene Cha, Guido Dalbagni, Jonathan Coleman, New York, NY INTRODUCTION AND OBJECTIVES: The association between the number of lymph nodes removed during radical nephroureterectomy (RNU) with lymph node dissection (LND) for upper tract urothelial carcinoma (UTUC) and cancer-specific outcomes has been studied in previous reports with varying results. The aim of this study was to investigate whether removal of more lymph nodes during RNU with LND for UTUC has a beneficial impact on recurrence-free and cancer-specific survival (RFS and CSS). METHODS: We performed a retrospective review of patients who underwent RNU with concomitant LND for UTUC at our institution between 1976 and 2014. We created Cox regression models including an interaction term between nodal status (positive or negative) and the total number of nodes removed to assess whether the number of nodes removed affected RFS or CSS differently by nodal status. We used Kruskal-Wallis tests to assess whether any additional clinicopathologic characteristics were associated with the extent of LND. RESULTS: In this cohort of 442 patients, there were 222 recurrences, and 94 patients died from disease, with a median follow-up of 6.2 years (IQR 2.6, 10.2) for survivors. The median number of lymph nodes removed was 9 (IQR 4, 16). A total of 78 patients (18%) had positive nodes, with a median of 2 positive nodes removed (IQR 1, 5). There were several significant associations between patient and disease characteristics and the number of nodes removed (Table 1). Among patients with negative nodes (pN0), there was no evidence of an association between nodal yield and RFS (HR 1.02 per 5 nodes removed, 95% CI 0.95, 1.10, p¼0.6). However, in patients with node-positive disease (pN1), we observed improved RFS with an increase in number of nodes removed (HR 0.81 per 5 nodes removed, 95% CI 0.67, 0.98, p¼0.026). Additionally, analysis among node-positive men showed a non-significant improvement in CSS associated with removing an increased number of nodes (HR 0.90 per 5 nodes removed, 95% CI 0.75, 1.08, p¼0.2). CONCLUSIONS: We found that increased number of nodes excised at the time of RNU with LND for UTUC was associated with improved RFS in node-positive patients. These findings provide the rationale for further defining the role of extended-template LND in selected high-risk cohorts.
Source of Funding: none
MP27-13 ARISTOLOCHIC ACID INDUCED UNIQUE ONCOLOGICAL CHARACTERISTIC IN CHINA: GENDER RELATED DIFFERENCES IN UPPER TRACT UROTHELIAL CARCINOMA Gengyan Xiong*, Yunchao Xing, Qi Tang, Xuesong Li, Liqun Zhou, Beijing, China, People’s Republic of INTRODUCTION AND OBJECTIVES: Contrary to the west upper tract urothelial carcinoma (UTUC) patients, there were significant gender differences in Chinese UTUCs. We initiated this study to investigated the prognostic factors and possible cause of gender difference in China. METHODS: 687 pathologically diagnosed UTUC patients treated in our center were enrolled. We evaluated the differences in oncological characteristics, epigenetic biomarkers, cancer specific survival, bladder recurrence and contralateral upper tract recurrence. RESULTS: 1. The majority of patients were females (55.5%). They showed a poorer renal function (p¼0.003), lower proportion of tumor stage III/IV (p¼0.006) and smaller tumor diameters (p¼0.005) than males. 2. The cancer specific survival (CSS) in male patients was much poorer than females (p<0.001), and there were significant gender related differences on prognostic factors: Main tumor located in ureter (p<0.001), larger main tumor diameter (>5cm, p<0.001), patients with severe chronic kidney disease (p¼0.017), papillary tumor architecture (p¼0.023), higher tumor stage (p<0.001), positive N status (p¼0.001) and methylated ABCC6 promoter (p¼0.004) were associated with poorer survival in female cohort. Older age (p¼0.002), ipsilateral hydronephrosis (p¼0.018), larger tumor diameter (p¼0.020), sessile tumor architecture (p¼0.007), higher tumor stage (p¼0.001) and methylated TMEFF2 promoter (p¼0.012) were associated with higher cancer specific mortality in male patients. 3. The aristolochic acid should be the main cause of gender difference in Chinese UTUC patients. The AA induced UTUCs presented smaller tumor diameter (p¼0.004), lower tumor stage (p¼0.001), less positive N status (p¼0.035), more multifocality (p¼0.001), lower methylation index (p¼0.005) and much poorer renal function (p¼0.001). Though AA-UTUC patients present better survival (p¼0.023), their bladder (p¼0.005) and contralateral upper tract recurrence (p<0.001) situation was extremely worse.