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MP65-20 UTILITY OF APPARENT DIFFUSION COEFFICIENT VALUES FOR CHARACTERIZATION OF METASTATIC LYMPH NODES IN BLADDER CANCER
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
of them were primary G2 tumours (NS) and no other factors were related to progression. All the patients that developed muscle invasive disease, there was a previous high grade NMIBC recurrence. CONCLUSIONS: Never a patient with G1-2 NMIBC will develop at the first recurrence a muscle invasive disease. There is always a progression of grade at the previous recurrence before developing a muscle invasive disease. 12 % of the patients that had grade progression finally developed muscle invasive disease.
Characteristics associated with performance of primary radical cystectomy for stage I high grade urothelial carcinoma of the bladder Characteristic
OR [CI]
P Value
Age (years) 50
Characteristic
Large metropolitan
71
0.46 [0.38-
<0.001
INTRODUCTION AND OBJECTIVES: The role of early cystectomy for T1 high grade (HG) urothelial carcinoma of the bladder is controversial, and the risk of tumor upstaging is poorly characterized. Using a large national tumor registry, we evaluated performance trends of primary radical cystectomy (RC) for T1HG disease, and examined rates of pathologic upstaging to T2 disease at the time of surgery. METHODS: Using the National Cancer Database (NCDB), all patients diagnosed clinically with stage I high grade urothelial carcinoma from 1998-2010 were identified. Characteristics of patients treated with primary RC were compared using Chi-squared tests. Multivariable logistic regressions were performed to identify demographic, clinical, and hospital characteristics associated with use of primary RC, using a subset of patients with available Charlson score. RESULTS: Of 53,696 patients diagnosed with T1HG disease, 6.8% (3675) underwent primary RC. The proportion of patients undergoing RC increased over the study period (4.7% [1998] versus 9.2% [2010]; p<0.001). Comparing patients selected for primary RC to those who were not, significant differences were seen with respect to age, insurance status, race/ethnicity, and geographic region (p<0.05, all comparisons), while no differences were seen with respect to gender. Following adjustment, Charlson score, age, insurance, race/ethnicity, year of diagnosis, location, and hospital type were associated with performance of primary RC (Table 1). Pathologic upstaging to T2 urothelial carcinoma at the time of RC occurred in 37.5% of patients, while 3.9% were down-staged to pT0 disease. CONCLUSIONS: In the NCDB, utilization of primary RC for T1HG urothelial carcinoma has doubled from 1998 to 2010, but is still performed in less than 10% of patients. In those selected for surgery, we observed that 37.5% were pathologically upstaged to T2 disease, supporting the role of restaging transurethral resection and early RC in select patients.
Small metropolitan
0.56]
0.74 [0.67-
<0.001
White
1.0
AA
0.8 [0.660.97]
0.02
1.0
1
1.3 [1.1-1.4]
2
1.2 [1.0-1.4]
<0.001 0.0339
Median Income $30K
1.0
$35-45.9K
1.2 [1.0-1.4]
0.86 [0.79-
0.0012
0.94]
Race
0
Jeffrey Tomaszewski*, Elizabeth Handorf, Charles Concodora, Reza Mehrazin, Alexander Kutikov, Rosalia Viterbo, David Chen, Richard Greenberg, Robert Uzzo, Marc Smaldone, Philadelphia, PA
P Value
0.8]
Charlson-Deyo Score
PERFORMANCE OF PRIMARY RADICAL CYSTECTOMY AND RISK OF PATHOLOGIC UPSTAGING IN PATIENTS WITH STAGE I HIGH GRADE UROTHELIAL CARCINOMA OF THE BLADDER: A NATIONAL CANCER DATABASE ANALYSIS
OR [CI]
Geographic Location 1.0
Source of Funding: None
MP65-19
e699
0.0344
Suburban
1.1 [1.0-1.3]
0.0418
Rural
1.3 [1.1-1.5]
0.0014
Hospital Category
Community
1.0
Comprehensive Community
1.45 [1.3-1.7]
<0.001
Academic
5.7 [5.0-6.7]
<0.001
Payor Group Private/HMO
1.0
Medicaid
1.5 [1.2-1.9]
None/Unknown
1.4 [1.2-1.7]
0.0013 <0.001
All non-significant associations, facility location, and year of diagnosis withheld for clarity of presentation
Source of Funding: none
MP65-20 UTILITY OF APPARENT DIFFUSION COEFFICIENT VALUES FOR CHARACTERIZATION OF METASTATIC LYMPH NODES IN BLADDER CANCER Ahmed M. Mansour*, Mohamed E. Abou-El-Ghar, Huda F. Refaie, Ahmed El-Assmy, Ahmed Mosbah, Hassan abol-Enein, Tarek El-Diasty, Mansoura, Egypt INTRODUCTION AND OBJECTIVES: Diffusion-weighted MR imaging (DW-MRI) has been recently utilized for characterization of bladder cancer phenotypes and clinical aggressiveness. The purpose of our study is to assess the utility of apparent diffusion coefficient (ADC) for distinguishing lymph nodes harboring metastatic disease in bladder cancer patients with enlarged pelvic lymph nodes. METHODS: The study cohort included 138 patients who underwent MRI with diffusion weighted imaging prior to radical cystectomy between April 2012 and May 2013. ADC values were measured in a circular region of interest where lymph node enlargement was found. Two radiologists blinded to the pathologic outcome interpreted the DW images. All patients underwent radical cystectomy with bilateral extended lymphadenectomy extending above the bifurcation of the common iliac vessels. Anatomical mapping of the removed lymph nodes was performed intraoperatively and the nodes were sent in separate packages for pathological assessment. ADC values obtained from areas of lymph node enlargement were then correlated with the final pathological assessment of the resected lymph nodes. RESULTS: One hundred and thirty eight patients were evaluated by DW-MRI. Patients with radiological lymph node enlargement were identified (n¼88, 63%) ADC values were calculated in areas of lymph node enlargement in four anatomical regions on each side, namely, common iliac, external iliac, internal iliac and obturator regions. Mean(SD) ADC value was 1.06 (0.2) *103 mm2/ s. There was a significant difference in ADC values of areas of metastatic lymph nodes and areas of negative node involvement (p¼0.0012). ROC analysis identified an optimal ADC threshold of 1.25 *103 mm2/s for identifying the presence or absence of metastatic disease. CONCLUSIONS: Our results suggests that DW-MRI ADC values correlate with the presence of metastatic disease in patients with bladder cancer and radiologically enlarged lymph nodes. Source of Funding: None
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
of them were primary G2 tumours (NS) and no other factors were related to progression. All the patients that developed muscle invasive disease, there was a previous high grade NMIBC recurrence. CONCLUSIONS: Never a patient with G1-2 NMIBC will develop at the first recurrence a muscle invasive disease. There is always a progression of grade at the previous recurrence before developing a muscle invasive disease. 12 % of the patients that had grade progression finally developed muscle invasive disease.
Characteristics associated with performance of primary radical cystectomy for stage I high grade urothelial carcinoma of the bladder Characteristic
OR [CI]
P Value
Age (years) 50
Characteristic
Large metropolitan
71
0.46 [0.38-
<0.001
INTRODUCTION AND OBJECTIVES: The role of early cystectomy for T1 high grade (HG) urothelial carcinoma of the bladder is controversial, and the risk of tumor upstaging is poorly characterized. Using a large national tumor registry, we evaluated performance trends of primary radical cystectomy (RC) for T1HG disease, and examined rates of pathologic upstaging to T2 disease at the time of surgery. METHODS: Using the National Cancer Database (NCDB), all patients diagnosed clinically with stage I high grade urothelial carcinoma from 1998-2010 were identified. Characteristics of patients treated with primary RC were compared using Chi-squared tests. Multivariable logistic regressions were performed to identify demographic, clinical, and hospital characteristics associated with use of primary RC, using a subset of patients with available Charlson score. RESULTS: Of 53,696 patients diagnosed with T1HG disease, 6.8% (3675) underwent primary RC. The proportion of patients undergoing RC increased over the study period (4.7% [1998] versus 9.2% [2010]; p<0.001). Comparing patients selected for primary RC to those who were not, significant differences were seen with respect to age, insurance status, race/ethnicity, and geographic region (p<0.05, all comparisons), while no differences were seen with respect to gender. Following adjustment, Charlson score, age, insurance, race/ethnicity, year of diagnosis, location, and hospital type were associated with performance of primary RC (Table 1). Pathologic upstaging to T2 urothelial carcinoma at the time of RC occurred in 37.5% of patients, while 3.9% were down-staged to pT0 disease. CONCLUSIONS: In the NCDB, utilization of primary RC for T1HG urothelial carcinoma has doubled from 1998 to 2010, but is still performed in less than 10% of patients. In those selected for surgery, we observed that 37.5% were pathologically upstaged to T2 disease, supporting the role of restaging transurethral resection and early RC in select patients.
Small metropolitan
0.56]
0.74 [0.67-
<0.001
White
1.0
AA
0.8 [0.660.97]
0.02
1.0
1
1.3 [1.1-1.4]
2
1.2 [1.0-1.4]
<0.001 0.0339
Median Income $30K
1.0
$35-45.9K
1.2 [1.0-1.4]
0.86 [0.79-
0.0012
0.94]
Race
0
Jeffrey Tomaszewski*, Elizabeth Handorf, Charles Concodora, Reza Mehrazin, Alexander Kutikov, Rosalia Viterbo, David Chen, Richard Greenberg, Robert Uzzo, Marc Smaldone, Philadelphia, PA
P Value
0.8]
Charlson-Deyo Score
PERFORMANCE OF PRIMARY RADICAL CYSTECTOMY AND RISK OF PATHOLOGIC UPSTAGING IN PATIENTS WITH STAGE I HIGH GRADE UROTHELIAL CARCINOMA OF THE BLADDER: A NATIONAL CANCER DATABASE ANALYSIS
OR [CI]
Geographic Location 1.0
Source of Funding: None
MP65-19
e699
0.0344
Suburban
1.1 [1.0-1.3]
0.0418
Rural
1.3 [1.1-1.5]
0.0014
Hospital Category
Community
1.0
Comprehensive Community
1.45 [1.3-1.7]
<0.001
Academic
5.7 [5.0-6.7]
<0.001
Payor Group Private/HMO
1.0
Medicaid
1.5 [1.2-1.9]
None/Unknown
1.4 [1.2-1.7]
0.0013 <0.001
All non-significant associations, facility location, and year of diagnosis withheld for clarity of presentation
Source of Funding: none
MP65-20 UTILITY OF APPARENT DIFFUSION COEFFICIENT VALUES FOR CHARACTERIZATION OF METASTATIC LYMPH NODES IN BLADDER CANCER Ahmed M. Mansour*, Mohamed E. Abou-El-Ghar, Huda F. Refaie, Ahmed El-Assmy, Ahmed Mosbah, Hassan abol-Enein, Tarek El-Diasty, Mansoura, Egypt INTRODUCTION AND OBJECTIVES: Diffusion-weighted MR imaging (DW-MRI) has been recently utilized for characterization of bladder cancer phenotypes and clinical aggressiveness. The purpose of our study is to assess the utility of apparent diffusion coefficient (ADC) for distinguishing lymph nodes harboring metastatic disease in bladder cancer patients with enlarged pelvic lymph nodes. METHODS: The study cohort included 138 patients who underwent MRI with diffusion weighted imaging prior to radical cystectomy between April 2012 and May 2013. ADC values were measured in a circular region of interest where lymph node enlargement was found. Two radiologists blinded to the pathologic outcome interpreted the DW images. All patients underwent radical cystectomy with bilateral extended lymphadenectomy extending above the bifurcation of the common iliac vessels. Anatomical mapping of the removed lymph nodes was performed intraoperatively and the nodes were sent in separate packages for pathological assessment. ADC values obtained from areas of lymph node enlargement were then correlated with the final pathological assessment of the resected lymph nodes. RESULTS: One hundred and thirty eight patients were evaluated by DW-MRI. Patients with radiological lymph node enlargement were identified (n¼88, 63%) ADC values were calculated in areas of lymph node enlargement in four anatomical regions on each side, namely, common iliac, external iliac, internal iliac and obturator regions. Mean(SD) ADC value was 1.06 (0.2) *103 mm2/ s. There was a significant difference in ADC values of areas of metastatic lymph nodes and areas of negative node involvement (p¼0.0012). ROC analysis identified an optimal ADC threshold of 1.25 *103 mm2/s for identifying the presence or absence of metastatic disease. CONCLUSIONS: Our results suggests that DW-MRI ADC values correlate with the presence of metastatic disease in patients with bladder cancer and radiologically enlarged lymph nodes. Source of Funding: None