Ahmed Aboumohamed

MP80-18 LOW UTILIZATION OF ADJUVANT THERAPY FOR ADVERSE PATHOLOGIC FEATURES FOLLOWING RADICAL PROSTATECTOMY IN AFRICAN AMERICANS DOES NOT TRANSLATE TO AN INCREASED RISK OF BIOCHEMICAL RECURRENCE

INTRODUCTION AND OBJECTIVES: There is an ongoing debate on removing the label of cancer from Gleason 6 tumors. The aim of the study was to analyze long-term oncological outcomes in patients with pathologic Gleason 3+3 score after radical prostatectomy and to add further knowledge to the discussion. METHODS: We retrospectively analyzed the data of 2942 patients who underwent RP between January 1998 and 2010 and showed a Gleason score 3þ3 in final pathology. Biochemical recurrence (BCR)-free survival, metastasis-free survival (MFS) and cancer-specific survival (CSS) was reported. In multivariate regression analyses further prognosticators of oncological outcome in these patients were analyzed. RESULTS: Median follow-up was 80.7 months. 795 (27.1%) patients underwent lymph node dissection, whereas only one of these patients had positive lymph nodes. Mean preoperative PSA was 6.6 ng/ml, 9.1% of patients had a positive surgical margin and 94.4% had an organ-confined tumor. 198 patients (7.2%) recurred during the follow-up period, 15 (0.5%) patients developed metastasis and 7 (0.2%) patients died of their disease. Patients developing metastases had a significantly higher preoperative PSA (p1⁄40.03) and were more likely to harbor a non-organ-confined tumor (p<0.001). 10-years BCR-free survival, MFS and CSS in patients with Gleason 3+3 was 90.7%, 99.2% and 99.6%, respectively. During follow-up only 1.2% of patients received ADT and 3.7% underwent adjuvant or salvage radiation. In multivariate regression, lymph node status, surgical margin status, preoperative PSA and pT-stage were prognostic factors for BCR. Moreover, lymph node status and pT-stage were significantly associated with occurrence of metastases. CONCLUSIONS: Only 0.5% and 0.2% of the patients with a Gleason 3+3 score in final histology developed metastasis or died of their disease. These data are in favor of removing the label of cancer from Gleason 3+3.

Prediction of systemic spread independent of local extension or nodal disease by venous tumor thrombus in renal cell carcinoma.

435 Background: Renal cell carcinoma (RCC) venous extension is a challenging condition. Its prognostic significance is not well established. We investigated possible prognostic correlations between venous extension in RCC, with its various levels, and local extension, lymphatic spread and systemic metastasis; and its impact on progression free survival (PFS) and overall survival (OS). METHODS We analyzed an IRB-approved prospectively-maintained kidney cancer database at Roswell Park Cancer Institute. Patients with venous involvement were identified, classified according to the highest cephalic venous thrombus extension into 3 groups; group 1, renal vein; group 2, infrahepatic; group 3, subdiaphragmatic. Preoperative, postoperative, and pathologic factors were recorded. Patient characteristics were compared between groups using Kruskal-Wallis and Chi-Square tests for quantitative and categorical variables respectively. RESULTS 711 patients underwent nephrectomy for RCC between 2004 and 2011. Out of 63 patients with RCC and venous tumor thrombus, 55 patients were analyzed in this study who underwent radical nephrectomy and venous thrombectomy. Median age was 63 years and median follow-up was 18.7 months. 37 patients were group 1, 10 were group 2, and 8 were group 3. 1 and 3 year PFS were 66% and 38.5% respectively, and 1 and 3 year OS were 74.2% and 47.4% respectively. There were no statistically significant differences in OS or PFS between different groups. Among several factors examined, venous extension was associated with increased risk of distant metastasis, and that risk did not increase with higher cephalic venous extension (p = 0.011). When patients were categorized by local extension and nodal disease spread, there was no statistically significant association with venous tumor extension (p =0.24 and 0.35 respectively), though they were independently associated with distant spread (p = 0.002 and 0.013 respectively) and OS (p =0.005 and0.03 respectively). CONCLUSIONS Venous tumor extension alone can serve as an independent predictor of distant metastasis in patients with RCC. Our analysis suggests that cephalic venous thrombus extension does not impact patient survival.

Robot-assisted radical prostatectomy: getting your ducks in a row!

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