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PD27-03 ONCOLOGIC SURVEILLANCE FOLLOWING RADICAL CYSTECTOMY: AN INDIVIDUALIZED RISK-BASED APPROACH.
THE JOURNAL OF UROLOGYâ
e650
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
Source of Funding: Roswell Park Alliance Foundation
PD27-03 ONCOLOGIC SURVEILLANCE FOLLOWING RADICAL CYSTECTOMY: AN INDIVIDUALIZED RISK-BASED APPROACH. Suzanne Stewart-Merrill*, Hershey, PA; Stephen Boorjian, R. Houston Thompson, Rochester, MN; Sarah Psutka, Chicago, IL; John Cheville, Prabin Thapa, Matthew Tollefson, Igor Frank, Rochester, MN INTRODUCTION AND OBJECTIVES: The appropriate duration of surveillance for bladder cancer (BC) following radical cystectomy (RC) remains unknown. Uniform adherence to current guidelines has the potential for over utilization of resources in some patients and deficiency of testing in others. Herein, we provide an approach to surveillance which balances the risk of recurrence versus the risk of non-BC death. METHODS: We identified 2438 patients who underwent RC for M0 BC between 1980 and 2007. Patients were stratified for analysis by pathologic stage (pT0Nx-0, pTa/CIS/1Nx-0, pT2Nx-0, pT3/4Nx-0, and pTanyN+), relapse location (urethra, upper urinary tract, abdomen, thorax, and other), age (<¼ 60, 61-70, 71-80, >80yrs) and Charlson Co-morbidity Index (CCI <¼ 2 and CCI >¼ 3). Risks of disease recurrence and non-BC death were estimated using parametric models for time-to-failure using Weibull distributions. Surveillance duration was estimated at the point when the risk of non-BC death exceeded the risk of recurrence. RESULTS: At a median follow-up of 6.0 yrs (IQR 2.0,11.1), a total of 713 patients developed recurrence. As shown in the Table, vastly different surveillance durations were appreciated for various stage, age, and CCI groups before the risk of non-BC death exceeded the risk of recurrence. Specifically, among patient’s age <¼ 60yrs with pT2Nx-0 disease, the risk of non-BC death exceeded the risk of recurrence to the abdomen at 7.5yrs if the patients CCI was >¼ 3, but failed to do so until 10 years if the patient’s CCI was <¼ 2. On the other hand, for patient’s age > 80yrs with pT2Nx-0 disease, the risk of non-BC death exceeded the risk of abdominal recurrence at 1yr following surgery regardless of the patient’s CCI. CONCLUSIONS: We present an individualized approach to post-RC surveillance that bases duration of follow-up on the interplay between competing risk factors of recurrence and non-BC death. This strategy may improve the balance between the derived benefit from surveillance and medical resource allocation.
Source of Funding: None
PD27-04 DEVELOPMENT, VALIDATION & CLINICAL APPLICATION OF AN INTRA-OPERATIVE ASSESSMENT OF COMPLETION & APPROPRIATENESS OF LND AFTER RADICAL CYSTECTOMY: PELVIC LYMPHADENECTOMY APPROPRIATENESS & COMPLETION EVALUATION (PLACE) Ahmed Hussein*, Buffalo, NY; Nobuyuki Hinata, Kobe, Japan; Justen Kozlowski, Buffalo, NY; Hassan Abol-Enein, Mansoura, Egypt; Ronney Abaza, Dublin, OH; Daniel Eun, Philadelphia, PA; Shamim Khan, London, United Kingdom; James Mohler, Buffalo, NY; Piyush Agrawal, Bethesda, MD; Kamal Pohar, Coloumbus, OH; Richard Sarle, Dearborn, MI; Ronald Boris, Indianapolis, IN; Khurshid Guru, Buffalo, NY INTRODUCTION AND OBJECTIVES: Consensus exists on performing a Lymph Node Dissection (LND) after Radical Cystectomy (RC), although its extent and yield are both variable. The final operative view of the surgical field after completion of LND is the best quality measure of a thorough LND. We sought to develop a scoring tool to determine the intraoperative completeness and appropriateness of a LND after RC. METHODS: A consensus-based completion and appropriateness rating system for intraoperative LND was developed. We sought to evaluate the applicability and clinical relevance of the scoring system for surgeons. Ten Expert surgeons (Open & Robotic) assessed 21 videos, each shows bilateral LND performed after RC. Clinical and pathological data was obtained using a quality assurance database and assessed. RESULTS: All quality completion and appropriateness metrics were assessed on all 42 LNDs based on the PLACE scoring system. The lymph node was 23 (range 14-64). Despite surgeon variability in
e650
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
Source of Funding: Roswell Park Alliance Foundation
PD27-03 ONCOLOGIC SURVEILLANCE FOLLOWING RADICAL CYSTECTOMY: AN INDIVIDUALIZED RISK-BASED APPROACH. Suzanne Stewart-Merrill*, Hershey, PA; Stephen Boorjian, R. Houston Thompson, Rochester, MN; Sarah Psutka, Chicago, IL; John Cheville, Prabin Thapa, Matthew Tollefson, Igor Frank, Rochester, MN INTRODUCTION AND OBJECTIVES: The appropriate duration of surveillance for bladder cancer (BC) following radical cystectomy (RC) remains unknown. Uniform adherence to current guidelines has the potential for over utilization of resources in some patients and deficiency of testing in others. Herein, we provide an approach to surveillance which balances the risk of recurrence versus the risk of non-BC death. METHODS: We identified 2438 patients who underwent RC for M0 BC between 1980 and 2007. Patients were stratified for analysis by pathologic stage (pT0Nx-0, pTa/CIS/1Nx-0, pT2Nx-0, pT3/4Nx-0, and pTanyN+), relapse location (urethra, upper urinary tract, abdomen, thorax, and other), age (<¼ 60, 61-70, 71-80, >80yrs) and Charlson Co-morbidity Index (CCI <¼ 2 and CCI >¼ 3). Risks of disease recurrence and non-BC death were estimated using parametric models for time-to-failure using Weibull distributions. Surveillance duration was estimated at the point when the risk of non-BC death exceeded the risk of recurrence. RESULTS: At a median follow-up of 6.0 yrs (IQR 2.0,11.1), a total of 713 patients developed recurrence. As shown in the Table, vastly different surveillance durations were appreciated for various stage, age, and CCI groups before the risk of non-BC death exceeded the risk of recurrence. Specifically, among patient’s age <¼ 60yrs with pT2Nx-0 disease, the risk of non-BC death exceeded the risk of recurrence to the abdomen at 7.5yrs if the patients CCI was >¼ 3, but failed to do so until 10 years if the patient’s CCI was <¼ 2. On the other hand, for patient’s age > 80yrs with pT2Nx-0 disease, the risk of non-BC death exceeded the risk of abdominal recurrence at 1yr following surgery regardless of the patient’s CCI. CONCLUSIONS: We present an individualized approach to post-RC surveillance that bases duration of follow-up on the interplay between competing risk factors of recurrence and non-BC death. This strategy may improve the balance between the derived benefit from surveillance and medical resource allocation.
Source of Funding: None
PD27-04 DEVELOPMENT, VALIDATION & CLINICAL APPLICATION OF AN INTRA-OPERATIVE ASSESSMENT OF COMPLETION & APPROPRIATENESS OF LND AFTER RADICAL CYSTECTOMY: PELVIC LYMPHADENECTOMY APPROPRIATENESS & COMPLETION EVALUATION (PLACE) Ahmed Hussein*, Buffalo, NY; Nobuyuki Hinata, Kobe, Japan; Justen Kozlowski, Buffalo, NY; Hassan Abol-Enein, Mansoura, Egypt; Ronney Abaza, Dublin, OH; Daniel Eun, Philadelphia, PA; Shamim Khan, London, United Kingdom; James Mohler, Buffalo, NY; Piyush Agrawal, Bethesda, MD; Kamal Pohar, Coloumbus, OH; Richard Sarle, Dearborn, MI; Ronald Boris, Indianapolis, IN; Khurshid Guru, Buffalo, NY INTRODUCTION AND OBJECTIVES: Consensus exists on performing a Lymph Node Dissection (LND) after Radical Cystectomy (RC), although its extent and yield are both variable. The final operative view of the surgical field after completion of LND is the best quality measure of a thorough LND. We sought to develop a scoring tool to determine the intraoperative completeness and appropriateness of a LND after RC. METHODS: A consensus-based completion and appropriateness rating system for intraoperative LND was developed. We sought to evaluate the applicability and clinical relevance of the scoring system for surgeons. Ten Expert surgeons (Open & Robotic) assessed 21 videos, each shows bilateral LND performed after RC. Clinical and pathological data was obtained using a quality assurance database and assessed. RESULTS: All quality completion and appropriateness metrics were assessed on all 42 LNDs based on the PLACE scoring system. The lymph node was 23 (range 14-64). Despite surgeon variability in