- Email: [email protected]
MP63-19 PREDICTORS OF READMISSION FOLLOWING OPEN AND MINIMALLY INVASIVE PARTIAL NEPHRECTOMY USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE
THE JOURNAL OF UROLOGYâ
e796
MP63-17 TRENDS OF ACUTE KIDNEY INJURY AFTER RADICAL OR PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA Marianne Schmid*, Hamburg, Germany; Praful Rafi, London, United Kingdom; Nandita Krishna, Boston, MA; Akshay Sood, Deepansh Dalela, Detroit, MI; Felix Chun, Hamburg, Germany; Adam Kibel, Boston, MA; Mani Menon, Detroit, MI; Paul Nguyen, Toni Choueiri, Boston, MA; Margit Fisch, Hamburg, Germany; Quoc-Dien Trinh, Boston, MA INTRODUCTION AND OBJECTIVES: Renal cell carcinoma (RCC) patients treated with radical (RN) or partial nephrectomy (PN) are at risk of postoperative acute kidney injury (AKI). We sought to investigate the incidence, trends and predictors of postoperative AKI in a large cohort of RCC patients treated with RN or PN. METHODS: Between January 1998 and December 2010, patients who underwent RN or PN for RCC were identified within the Nationwide Inpatient Sample. Incidence and temporal trends of AKI were analyzed. Association between AKI and in-hospital complications, mortality, length of stay and charges were evaluated using logistic regression models adjusted for clustering. Finally, predictors of AKI were identified using multivariable logistic regression analysis. RESULTS: Overall, 253,222 (78.1%) and 71,176 (21.9%) patients respectively underwent RN and PN. Of these, 17,828 (5.5%) experienced AKI. Incidence of AKI following RN/PN significantly increased over the period (estimated annual percentage change [EAPC]¼16.6% [17.7-18.8], p<0.001). Although higher overall incidence of AKI was observed after RN compared to PN (RN: 0.38/ 100,000 vs. PN: 0.09/100,000), the rate of increase in AKI over time was greater following PN compared to RN (RN: EAPC¼15.5% [16.817.9]; PN: EAPC¼19.0% [22.2-25.5], p<0.001) following PN. Incidence of any complication, mortality, prolonged hospital stay and excessive hospital costs were significantly greater in patients who experienced AKI, irrespective of the procedure (RN or PN) [all p<0.001]. Predictors of AKI after RN/PN included older age, higher comorbid status, higher chronic kidney disease stage and surgery at urban hospitals (all p<0.05). CONCLUSIONS: There is rising incidence of AKI after RN and PN. Increasing awareness of AKI incidence, identification of patients at risk prior to surgery, early postoperative AKI diagnosis, collaboration with nephrologists, implementation of renoprotective strategies, and long-term renal functional follow-up are warranted in these patients to provide improved outcomes and reduce costs.
Vol. 193, No. 4S, Supplement, Monday, May 18, 2015
INTRODUCTION AND OBJECTIVES: Currently, in the United Kingdom, there has been a paradigm shift of streamlining patients with renal lesions to high volume tertiary referral cancer centers for specialist treatment. With this, there is a need for outcome measures to direct quality control. Herein, we report a single tertiary referral United Kingdom cancer center experience with the treatment of over 1000 consecutive renal lesions. We test the comparative results of outcomes associated with the surgical management of the renal lesions using a novel decision tree neural outcome measures tool. METHODS: From Sept. 1989 to Oct. 2014 we performed 1,084 procedures targeted at renal lesions: Laparoscopic(Lap) Simple Nephrectomy¼34; Lap Radical Nephrectomy¼151; HAL (Hand Assisted Laparoscopic) Radical Nephrectomy¼94; HAL Simple Nephrectomy¼3; LapNephroureterectomy¼70; Open Nephroureterectomy¼30; HAL Nephroureterectomy¼8; Open Simple Nephrectomy¼16; Open Radical Nephrectomy¼287; Open Partial Nephrectomy¼185; Robot Assisted Partial Nephrectomy¼98; Lap Partial Nephrectomy¼17; HAL Partial Nephrectomy¼7 and Cryotherapy(Percutaneous and Lap¼84. Hospital records and outcomes were interrogated for demographic and outcome parameters with the aid of the data analysis neural platforms. The procedures were stratified into procedure-based arms with individual outcome measures. Each outcome measure was compared against a targeted standard based on published figures for global centers of excellence in each arm using a novel decision tree neural outcome measures tool. The tool is essentially a purpose designed data mining computer programme. A score of (e5 to þ5) was given based on achievement of targeted markers for a designated standard. A score of e5 was deemed to be unacceptable and a score of þ5 indicated perfect outcomes, per stratified group. A score of 2-3 was given for performance that is on par with centers of excellence. The outcomes of the tool were analysed by two independent assessors. RESULTS: Overall the median Clavien Dindo Score was 1 (range 1-5). When applied to the decision tree neural outcome measures tool, parameters indicated achievement of 90% in the range (2 to 3); 6% scored (1) and 4% scored (4). The independent assessment correlated accurately with the findings of the neural network. CONCLUSIONS: In order to secure optimal outcomes, where feasible, there may be a call for a mandate for performance in high volume dedicated tertiary referral oncological centers in the future. We developed a decision tree outcomes measures tool that can aid with monitoring the outcomes of renal lesion-directed therapies on a large scale. Source of Funding: none
MP63-19 PREDICTORS OF READMISSION FOLLOWING OPEN AND MINIMALLY INVASIVE PARTIAL NEPHRECTOMY USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE Ahmed Serhan, Ahmad Shabsigh*, Columbus, OH Source of Funding: none
MP63-18 SURGICAL TREATMENT IN 1,084 CONSECUTIVE RENAL LESIONS IN A SINGLE TERTIARY REFERRAL UNITED KINGDOM CENTER e TARGETED OUTCOME MEASURES USING A NOVEL DECISION TREE PLATFORM Sashi Kommu*, Robert Mcarthur, Rajesh Nair, Meghana Kulkarni, Prasanna Sooriakumaran, Panos Tsavalas, Samer Katmawi-Sabbagh, Pieter le Roux, Christopher Anderson, London, United Kingdom
INTRODUCTION AND OBJECTIVES: Post-operative readmissions have a significant impact on the health care cost. They reflect the quality of care and the complexity of our patients. Our objective is to define the rates and the predictors of unplanned readmissions following open and minimally invasive partial nephrectomy for renal tumors. METHODS: We performed a retrospective review of prospectively collected database (NSQIP) of all patients who underwent open and minimally invasive partial nephrectomy between 2005 and 2012. Patient’s demographics, unplanned readmission rate and its causes were reported. Multivariate analysis was performed to characterize predictors of readmission.
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Monday, May 18, 2015
RESULTS: Between 2005 and 2012, a total of 4872 cases were identified. 2137 patients (43.9%) underwent open partial nephrectomy (OPN) while 2735 patients (56.1%) were managed through minimally invasive partial nephrectomy (MPN). Unplanned readmissions were significantly lower in MPN group (2.1% vs. 3.5%, P¼ 0.008). For OPN patients, pneumonia, sepsis, wound disruption and deep venous thrombosis were the most common causes of readmission. For MPN group, sepsis was the most common contributor. Logistic regression analysis was performed to define the predictors of readmission. For open partial nephrectomy, bleeding necessitating blood transfusion (OR 1.454, 95%CI: 1.031-2.050, P¼0.03), >10% loss of body weight in last 6 months (OR 7.482, 95% CI: 1.918 - 29.190, P¼ 0.004) were the significant predictors, while Diabetes was near significant predictor (OR 1.818, 95%, CI: 0.965 3.425, P¼0.064). For MPN, operative time (OR 1.005, 95%, CI: 1.002 - 1.008, P¼0.003), and bleeding necessitating blood transfusion (OR 1.908, 95%, CI: 1.184 - 3.076, P¼ 0.008) were the only significant predictors. CONCLUSIONS: In addition to preservation of kidney function and shorter hospital stay, MPN appears to have a lower rate of readmission. Predictors of readmission vary between different treatment options and selection of treatment should be based on general condition as well as tumor characteristics.
e797
development and validation cohorts were detected in patients Fuhrman grade III/IV tumors (p<0.001) (Image). CONCLUSIONS: The number of examined LNs needed for adequate nodal staging in ccRCC depends on pathological tumor stage and Fuhrman grade. We developed here and then externally validated a pNSS, which could help to refine patients counseling, decision-making regarding risk stratified surveillance regimens and inclusion criteria for clinical trials of adjuvant therapy.
Source of Funding: None
MP63-20 DEVELOPMENT AND EXTERNAL VALIDATION OF A PATHOLOGICAL NODAL STAGING SCORE FOR PATIENTS WITH CLEAR CELL RENAL CELL CARCINOMA Malte Rieken*, Basel, Switzerland; Stephen Boorjian, Rochester, MN; Luis Kluth, Hambug, Germany; Evanguelos Xylinas, Paris, France; Umberto Capitanio, Alberto Briganti, Milan, Italy; R. Houston Thompson, Bradley Leibovich, Rochester, MN; Laura-Maria Krabbe, Vitaly Margulis, Dallas, TX; Jay Raman, Mikhail Regelman, Hershey, PA; Tobias Klatte, Vienna, Austria; Alexander Bachmann, Basel, Switzerland; Pierre Karakiewicz, Mon^t, Paris, France; Richard Lee, treal, Canada; Morgan Roupre € nen, New York, NY; Shahrokh Shariat, Vienna, Austria Mithat Go INTRODUCTION AND OBJECTIVES: Lymph node metastasis (LNM) is a strong predictor of adverse outcomes in patients with clear cell renal cell carcinoma (ccRCC). We aimed to develop and externally validate a model that quantifies the likelihood that a pathologically nodenegative patient has, indeed, no LNM. METHODS: Data from 1389 patients treated with radical nephrectomy (RN) and lymph node dissection (LND) were analyzed. We estimated the sensitivity of pathologic nodal staging using a betabinomial model and developed a pathological nodal staging score (pNSS), which represents the probability that a patient is correctly staged as node-negative as a function of the number of examined lymph nodes (LNs). For external validation, we used data from 2279 patients in the Surveillance, Epidemiology and End Results (SEER) database. RESULTS: The mean and median number of LNs removed were 7.0 and 5.0 (standard deviation, SD: 6.6, interquartile range, IQR: 7.0) in the development cohort and 5.6 and 2.0 (SD: 8.6, IQR: 5.0) in the validation cohort, respectively. LNM was detected in 14.3% (n¼198) of the patients in the development cohort compared to 10.0% (n¼227) in the validation cohort (p<0.001). The probability of missing a positive LN decreased with increasing number of LNs examined. When compared to the probabilities of missing a LN in the development cohort, fewer LNs were needed in the validation cohort to reach the same level of probability; however these differences were not statistically significant (all p-values>0.05). In both the validation and the development cohort, the number of LNs needed for correctly staging a patient as node negative increased with higher pathological tumor stage and Fuhrman Grade. Significant differences in the probabilities between the
Source of Funding: “none”
Bladder Cancer: Natural History and Pathophysiology Moderated Poster 64 Monday, May 18, 2015
10:30 AM-12:30 PM
MP64-01 EXPRESSION PROFILE OF EPITHELIAL-MESENCHYMAL TRANSITION MARKERS IN RADICAL CYSTECTOMY SPECIMENS: COMPARATIVE STUDY BETWEEN UROTHELIAL AND BILHARZIAL SQUAMOUS CELL CARCINOMAS OF THE BLADDER Satoshi Imai, Hideaki Miyake*, Hosney Behnsawy, Masato Fujisawa, Kobe, Japan INTRODUCTION AND OBJECTIVES: Bilharzial squamous cell carcinoma (BSCC) of the bladder is characterized by extremely aggressive biological features compared with non-bilharzial-related urothelial carcinoma (UC); however, there have been few findings on the molecular mechanism during the progression of BSCC. The objectives of this study were to evaluate the expression of multiple molecular markers involved in epithelial-mesenchymal transition (EMT), a key process mediating the progression of various malignant tumors, in invasive UC and BSCC of the bladder, and to comparatively analyze the impact of these markers on clnicopathological features between UC and BSCC. METHODS: Expression levels of 12 EMT markers, including E-cadherin, N-cadherin, b-catenin, g-catenin, MMP-2, MMP-9, Slug, Snail, Twist, vimentin, ZEB1 and ZEB2, in radical cystectomy specimens from 74 Japanese patients with UC and 45 Egyptian patients with BSCC were measured by immunohistochemical staining. These findings were analyzed according to several clinicopathological outcomes. RESULTS: Despite the lack of a significant difference in the pathological stage between the UC and BSCC groups, the UC group was likely to have significantly high grade disease compared
e796
MP63-17 TRENDS OF ACUTE KIDNEY INJURY AFTER RADICAL OR PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA Marianne Schmid*, Hamburg, Germany; Praful Rafi, London, United Kingdom; Nandita Krishna, Boston, MA; Akshay Sood, Deepansh Dalela, Detroit, MI; Felix Chun, Hamburg, Germany; Adam Kibel, Boston, MA; Mani Menon, Detroit, MI; Paul Nguyen, Toni Choueiri, Boston, MA; Margit Fisch, Hamburg, Germany; Quoc-Dien Trinh, Boston, MA INTRODUCTION AND OBJECTIVES: Renal cell carcinoma (RCC) patients treated with radical (RN) or partial nephrectomy (PN) are at risk of postoperative acute kidney injury (AKI). We sought to investigate the incidence, trends and predictors of postoperative AKI in a large cohort of RCC patients treated with RN or PN. METHODS: Between January 1998 and December 2010, patients who underwent RN or PN for RCC were identified within the Nationwide Inpatient Sample. Incidence and temporal trends of AKI were analyzed. Association between AKI and in-hospital complications, mortality, length of stay and charges were evaluated using logistic regression models adjusted for clustering. Finally, predictors of AKI were identified using multivariable logistic regression analysis. RESULTS: Overall, 253,222 (78.1%) and 71,176 (21.9%) patients respectively underwent RN and PN. Of these, 17,828 (5.5%) experienced AKI. Incidence of AKI following RN/PN significantly increased over the period (estimated annual percentage change [EAPC]¼16.6% [17.7-18.8], p<0.001). Although higher overall incidence of AKI was observed after RN compared to PN (RN: 0.38/ 100,000 vs. PN: 0.09/100,000), the rate of increase in AKI over time was greater following PN compared to RN (RN: EAPC¼15.5% [16.817.9]; PN: EAPC¼19.0% [22.2-25.5], p<0.001) following PN. Incidence of any complication, mortality, prolonged hospital stay and excessive hospital costs were significantly greater in patients who experienced AKI, irrespective of the procedure (RN or PN) [all p<0.001]. Predictors of AKI after RN/PN included older age, higher comorbid status, higher chronic kidney disease stage and surgery at urban hospitals (all p<0.05). CONCLUSIONS: There is rising incidence of AKI after RN and PN. Increasing awareness of AKI incidence, identification of patients at risk prior to surgery, early postoperative AKI diagnosis, collaboration with nephrologists, implementation of renoprotective strategies, and long-term renal functional follow-up are warranted in these patients to provide improved outcomes and reduce costs.
Vol. 193, No. 4S, Supplement, Monday, May 18, 2015
INTRODUCTION AND OBJECTIVES: Currently, in the United Kingdom, there has been a paradigm shift of streamlining patients with renal lesions to high volume tertiary referral cancer centers for specialist treatment. With this, there is a need for outcome measures to direct quality control. Herein, we report a single tertiary referral United Kingdom cancer center experience with the treatment of over 1000 consecutive renal lesions. We test the comparative results of outcomes associated with the surgical management of the renal lesions using a novel decision tree neural outcome measures tool. METHODS: From Sept. 1989 to Oct. 2014 we performed 1,084 procedures targeted at renal lesions: Laparoscopic(Lap) Simple Nephrectomy¼34; Lap Radical Nephrectomy¼151; HAL (Hand Assisted Laparoscopic) Radical Nephrectomy¼94; HAL Simple Nephrectomy¼3; LapNephroureterectomy¼70; Open Nephroureterectomy¼30; HAL Nephroureterectomy¼8; Open Simple Nephrectomy¼16; Open Radical Nephrectomy¼287; Open Partial Nephrectomy¼185; Robot Assisted Partial Nephrectomy¼98; Lap Partial Nephrectomy¼17; HAL Partial Nephrectomy¼7 and Cryotherapy(Percutaneous and Lap¼84. Hospital records and outcomes were interrogated for demographic and outcome parameters with the aid of the data analysis neural platforms. The procedures were stratified into procedure-based arms with individual outcome measures. Each outcome measure was compared against a targeted standard based on published figures for global centers of excellence in each arm using a novel decision tree neural outcome measures tool. The tool is essentially a purpose designed data mining computer programme. A score of (e5 to þ5) was given based on achievement of targeted markers for a designated standard. A score of e5 was deemed to be unacceptable and a score of þ5 indicated perfect outcomes, per stratified group. A score of 2-3 was given for performance that is on par with centers of excellence. The outcomes of the tool were analysed by two independent assessors. RESULTS: Overall the median Clavien Dindo Score was 1 (range 1-5). When applied to the decision tree neural outcome measures tool, parameters indicated achievement of 90% in the range (2 to 3); 6% scored (1) and 4% scored (4). The independent assessment correlated accurately with the findings of the neural network. CONCLUSIONS: In order to secure optimal outcomes, where feasible, there may be a call for a mandate for performance in high volume dedicated tertiary referral oncological centers in the future. We developed a decision tree outcomes measures tool that can aid with monitoring the outcomes of renal lesion-directed therapies on a large scale. Source of Funding: none
MP63-19 PREDICTORS OF READMISSION FOLLOWING OPEN AND MINIMALLY INVASIVE PARTIAL NEPHRECTOMY USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) DATABASE Ahmed Serhan, Ahmad Shabsigh*, Columbus, OH Source of Funding: none
MP63-18 SURGICAL TREATMENT IN 1,084 CONSECUTIVE RENAL LESIONS IN A SINGLE TERTIARY REFERRAL UNITED KINGDOM CENTER e TARGETED OUTCOME MEASURES USING A NOVEL DECISION TREE PLATFORM Sashi Kommu*, Robert Mcarthur, Rajesh Nair, Meghana Kulkarni, Prasanna Sooriakumaran, Panos Tsavalas, Samer Katmawi-Sabbagh, Pieter le Roux, Christopher Anderson, London, United Kingdom
INTRODUCTION AND OBJECTIVES: Post-operative readmissions have a significant impact on the health care cost. They reflect the quality of care and the complexity of our patients. Our objective is to define the rates and the predictors of unplanned readmissions following open and minimally invasive partial nephrectomy for renal tumors. METHODS: We performed a retrospective review of prospectively collected database (NSQIP) of all patients who underwent open and minimally invasive partial nephrectomy between 2005 and 2012. Patient’s demographics, unplanned readmission rate and its causes were reported. Multivariate analysis was performed to characterize predictors of readmission.
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Monday, May 18, 2015
RESULTS: Between 2005 and 2012, a total of 4872 cases were identified. 2137 patients (43.9%) underwent open partial nephrectomy (OPN) while 2735 patients (56.1%) were managed through minimally invasive partial nephrectomy (MPN). Unplanned readmissions were significantly lower in MPN group (2.1% vs. 3.5%, P¼ 0.008). For OPN patients, pneumonia, sepsis, wound disruption and deep venous thrombosis were the most common causes of readmission. For MPN group, sepsis was the most common contributor. Logistic regression analysis was performed to define the predictors of readmission. For open partial nephrectomy, bleeding necessitating blood transfusion (OR 1.454, 95%CI: 1.031-2.050, P¼0.03), >10% loss of body weight in last 6 months (OR 7.482, 95% CI: 1.918 - 29.190, P¼ 0.004) were the significant predictors, while Diabetes was near significant predictor (OR 1.818, 95%, CI: 0.965 3.425, P¼0.064). For MPN, operative time (OR 1.005, 95%, CI: 1.002 - 1.008, P¼0.003), and bleeding necessitating blood transfusion (OR 1.908, 95%, CI: 1.184 - 3.076, P¼ 0.008) were the only significant predictors. CONCLUSIONS: In addition to preservation of kidney function and shorter hospital stay, MPN appears to have a lower rate of readmission. Predictors of readmission vary between different treatment options and selection of treatment should be based on general condition as well as tumor characteristics.
e797
development and validation cohorts were detected in patients Fuhrman grade III/IV tumors (p<0.001) (Image). CONCLUSIONS: The number of examined LNs needed for adequate nodal staging in ccRCC depends on pathological tumor stage and Fuhrman grade. We developed here and then externally validated a pNSS, which could help to refine patients counseling, decision-making regarding risk stratified surveillance regimens and inclusion criteria for clinical trials of adjuvant therapy.
Source of Funding: None
MP63-20 DEVELOPMENT AND EXTERNAL VALIDATION OF A PATHOLOGICAL NODAL STAGING SCORE FOR PATIENTS WITH CLEAR CELL RENAL CELL CARCINOMA Malte Rieken*, Basel, Switzerland; Stephen Boorjian, Rochester, MN; Luis Kluth, Hambug, Germany; Evanguelos Xylinas, Paris, France; Umberto Capitanio, Alberto Briganti, Milan, Italy; R. Houston Thompson, Bradley Leibovich, Rochester, MN; Laura-Maria Krabbe, Vitaly Margulis, Dallas, TX; Jay Raman, Mikhail Regelman, Hershey, PA; Tobias Klatte, Vienna, Austria; Alexander Bachmann, Basel, Switzerland; Pierre Karakiewicz, Mon^t, Paris, France; Richard Lee, treal, Canada; Morgan Roupre € nen, New York, NY; Shahrokh Shariat, Vienna, Austria Mithat Go INTRODUCTION AND OBJECTIVES: Lymph node metastasis (LNM) is a strong predictor of adverse outcomes in patients with clear cell renal cell carcinoma (ccRCC). We aimed to develop and externally validate a model that quantifies the likelihood that a pathologically nodenegative patient has, indeed, no LNM. METHODS: Data from 1389 patients treated with radical nephrectomy (RN) and lymph node dissection (LND) were analyzed. We estimated the sensitivity of pathologic nodal staging using a betabinomial model and developed a pathological nodal staging score (pNSS), which represents the probability that a patient is correctly staged as node-negative as a function of the number of examined lymph nodes (LNs). For external validation, we used data from 2279 patients in the Surveillance, Epidemiology and End Results (SEER) database. RESULTS: The mean and median number of LNs removed were 7.0 and 5.0 (standard deviation, SD: 6.6, interquartile range, IQR: 7.0) in the development cohort and 5.6 and 2.0 (SD: 8.6, IQR: 5.0) in the validation cohort, respectively. LNM was detected in 14.3% (n¼198) of the patients in the development cohort compared to 10.0% (n¼227) in the validation cohort (p<0.001). The probability of missing a positive LN decreased with increasing number of LNs examined. When compared to the probabilities of missing a LN in the development cohort, fewer LNs were needed in the validation cohort to reach the same level of probability; however these differences were not statistically significant (all p-values>0.05). In both the validation and the development cohort, the number of LNs needed for correctly staging a patient as node negative increased with higher pathological tumor stage and Fuhrman Grade. Significant differences in the probabilities between the
Source of Funding: “none”
Bladder Cancer: Natural History and Pathophysiology Moderated Poster 64 Monday, May 18, 2015
10:30 AM-12:30 PM
MP64-01 EXPRESSION PROFILE OF EPITHELIAL-MESENCHYMAL TRANSITION MARKERS IN RADICAL CYSTECTOMY SPECIMENS: COMPARATIVE STUDY BETWEEN UROTHELIAL AND BILHARZIAL SQUAMOUS CELL CARCINOMAS OF THE BLADDER Satoshi Imai, Hideaki Miyake*, Hosney Behnsawy, Masato Fujisawa, Kobe, Japan INTRODUCTION AND OBJECTIVES: Bilharzial squamous cell carcinoma (BSCC) of the bladder is characterized by extremely aggressive biological features compared with non-bilharzial-related urothelial carcinoma (UC); however, there have been few findings on the molecular mechanism during the progression of BSCC. The objectives of this study were to evaluate the expression of multiple molecular markers involved in epithelial-mesenchymal transition (EMT), a key process mediating the progression of various malignant tumors, in invasive UC and BSCC of the bladder, and to comparatively analyze the impact of these markers on clnicopathological features between UC and BSCC. METHODS: Expression levels of 12 EMT markers, including E-cadherin, N-cadherin, b-catenin, g-catenin, MMP-2, MMP-9, Slug, Snail, Twist, vimentin, ZEB1 and ZEB2, in radical cystectomy specimens from 74 Japanese patients with UC and 45 Egyptian patients with BSCC were measured by immunohistochemical staining. These findings were analyzed according to several clinicopathological outcomes. RESULTS: Despite the lack of a significant difference in the pathological stage between the UC and BSCC groups, the UC group was likely to have significantly high grade disease compared