Daisuke Noro

Prognostic benefit of surgical management in renal cell carcinoma patients with thrombus extending to the renal vein and inferior vena cava: 17-year experience at a single center

BackgroundManagement of renal cell carcinoma (RCC) with tumor thrombus extending to the renal vein and inferior vena cava (IVC) is challenging. The aim of this study was to evaluate the benefit of surgical management in such patients.MethodsFrom February 1995 to February 2013, 520 patients were treated for RCC at Hirosaki University Hospital, Hirosaki, Japan. The RCC patients with tumor thrombus extending to the renal vein (n = 42) and IVC (n = 43) were included in this study. The records of these 85 patients were retrospectively reviewed to assess the relevant clinical and pathological variables and survival. Prognostic factors were identified by multivariate analysis. The benefit of surgical management was evaluated using propensity score matching to compare overall survival between patients who received surgical management and those who did not.ResultsRCC was confirmed by pathological examination of surgical or biopsy specimens in 74 of the 85 patients (87%). Sixty-five patients (76%) received surgical management (radical nephrectomy with thrombectomy). Distant metastasis was identified in 45 patients (53%). The proportion of patients with tumor thrombus level 0 (renal vein only), I, II, III, and IV was 49%, 13%, 18%, 14%, and 5%, respectively. The estimated 5-year overall survival rate was 70% in patients with thrombus extending to the renal vein and 23% in patients with thrombus extending to the IVC. Multivariate analysis identified thrombus extending to the IVC, presence of distant metastasis, surgical management, serum albumin concentration, serum choline esterase concentration, neutrophil-lymphocyte ratio, and Carlson comorbidity index as independent prognostic factors. In propensity score-matched patients, overall survival was significantly longer in those who received surgical management than those who did not.ConclusionsSurgical management may improve the prognosis of RCC patients with thrombus extending to the renal vein and IVC.

BK Virus–Associated Urothelial Carcinoma of a Ureter Graft in a Renal Transplant Recipient: A Case Report

BACKGROUND Urothelial carcinomas of ureter grafts in renal transplant patients are rare. Here we report our experience with a case of BK virus-associated urothelial carcinoma in a ureter graft. CASE REPORT A 47-year-old man developed chronic renal failure secondary to diabetes mellitus and started maintenance hemodialysis in September 2007. Two months later, the patient received a renal transplant from his 70-year-old mother. The patient developed BK virus-associated nephropathy 1 year after transplantation and presented with a decline in renal function and hydronephrosis in the transplanted kidney 4 years 6 months after transplantation. Cystoscopy and retrograde pyelography revealed an irregular filling defect in the ureter graft. Cytologic diagnosis of his urine revealed a high-grade urothelial carcinoma. Computerized tomography showed a cT2 ureteral tumor and no involvement of other organs. The patient subsequently underwent a transplant nephroureterectomy with bladder cuff resection. Histopathologic findings revealed a high-grade urothelial carcinoma, pT2, in the ureter graft with SV40-positive staining. The patient was closely observed without adjuvant chemotherapy therapy and remained disease free 1 year after surgery. Renal transplant recipients with BK virus infection are at high risk of developing urologic malignancies. Close attention is necessary to diagnose post-transplantation urologica malignancies as early as possible.

Significance of preoperative butyrylcholinesterase level as an independent predictor of survival in patients with upper urinary tract urothelial carcinoma treated with nephroureterectomy

Objectives Butyrylcholinesterase (BChE) is an alpha-glycoprotein synthesized in the liver. Its serum levels are reportedly correlated with disease activity in patients with cancer. The aim of this study was to estimate the potential prognostic significance of preoperative serum BChE levels in patients with upper urinary tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU). Methods Of the 220 patients with UTUC who underwent RNU between 1995 and 2016 at Hirosaki University Hospital, 149 patients with available laboratory data were included for analysis. Covariates included age, sex, preoperative laboratory data, clinical T and N grades, tumor grade, tumor location and preoperative chemotherapy. Univariate and multivariate analyses were performed to identify clinical factors associated with overall survival (OS) and disease-free survival (DFS). Univariate analysis was performed using the Kaplan-Meier and log-rank methods, and the multivariate analysis was performed using a Cox proportional hazard model. Results The median BChE level was 276 U/l and the optimal cut-off point for the serum BChE level was determined to be 218 IU/ml. The 5-year OS and DFS rates were 81.0% and 73.7%, respectively. The 5-year OS and DFS rates were significantly greater in the BChE ≥ 218 than <218 U/l groups (86.6% vs. 53.7%, P < 0.001 and 76.4% vs. 58.3%, P = 0.049, respectively). In multivariate analysis, BChE levels were most significantly associated with OS, whereas BChE level and tumor grade were significantly associated with DFS. Conclusions This study validated preoperative serum BChE levels as an independent prognostic factor for UTUC after RNU.

Aberrant N-Glycosylation Profile of Serum Immunoglobulins is a Diagnostic Biomarker of Urothelial Carcinomas

The aim of this study to determine whether the aberrant N-glycosylated serum immunoglobulins (Igs) can be applied as a diagnostic marker of urothelial carcinoma (UC). Between 2009 and 2016, we randomly obtained serum available from 237 UC and also 96 prostate cancer as other cancer controls from our serum bank and also obtained—from 339 healthy volunteers (HV)—controls obtained from community-dwelling volunteers in Iwaki Health Promotion Project. A total of 32 types of N-glycan levels on Igs were determined by high-throughput N-glycomics and analyzed by multivariable discriminant analysis. We found five UC-associated aberrant N-glycans changes on Igs and also found that asialo-bisecting GlcNAc type N-glycan on Igs were significantly accumulated in UC patients. The diagnostic N-glycan Score (dNGScore) established by combination of five N-glycans on Igs discriminated UC patients from HV and prostate cancer (PC) patients with 92.8% sensitivity and 97.2% specificity. The area under the curve (AUC) for of the dNGScore was 0.969 for UC detection that was much superior to that of urine cytology (AUC, 0.707) and hematuria (AUC, 0.892). Furthermore, dNGScore can detect hematuria and urine cytology negative patients. The dNGscore based on aberrant N-glycosylation signatures of Igs were found to be promising diagnostic biomarkers of UCs.

Differences in semen characteristics between patients with testicular cancer and other malignancies using various cut‐off values

To compare semen parameters between patients with testicular cancer and other malignancies using various cut‐off values, and to evaluate the correlation between semen parameters and intracytoplasmic sperm injection outcomes.

MP58-02 ABERRANT N-GLYCOSYLATION PROFILE OF SERUM IMMUNOGLOBULINS IS A DIAGNOSTIC BIOMARKER OF UROTHELIAL CARCINOMAS

RESULTS: In TCGA data, neither basal nor luminal markers levels significantly correlated with metastasis or lymphovascular invasion (LVI); P 1⁄4 0.2 to 0.9. Only KRT5 significantly but inversely correlated with lymph node (LN) positivity; P1⁄40.011. EGFR levels did not correlate with metastasis, LVI, or LN positivity; P > 0.05. In TCGA dataset 77 (18.9%), 50 (12.3%) and 14 (3.4%) expressed basal, luminal and DN subtypes, respectively; 266 (66.4%) patients did not conform to any group. In univariate or multivariate analyses, the subtypes also did not correlate with metastasis, LVI or LN status. Only luminal subtype associated with better OS; P1⁄40.003. However no subtype significantly correlated with RFS. In KM analysis no subtype stratified patients regarding RFS (P>0.2). Oncomine BCa datasets validated these results. CONCLUSIONS: TCGA and Oncomine datasets show that the majority of MIBCa tissues express a mixed pattern of basal and luminal markers. Furthermore, basal, luminal or DN subtypes do not associate with clinical parameters or prognosis of MIBCa patients.

Neoadjuvant chemohormonal therapy followed by robot-assisted and minimum incision endoscopic radical prostatectomy in patients with high-risk prostate cancer: comparison of perioperative and oncological outcomes at single institution

PurposeOptimal management strategies for patients with high-risk prostate cancer (PCa) have not been established. This study aimed to estimate the impact of surgical procedures on perioperative and oncological outcomes in patients with high-risk PCa who received neoadjuvant chemohormonal therapy (CHT) prior to radical prostatectomy (RP).MethodsIn this retrospective study, we focused on patients with high-risk PCa who received neoadjuvant CHT followed by RP. The enrolled patients were divided into the following two groups according to surgical procedure: the robot-assisted RP (RARP) group and minimum incision endoscopic RP (MIE-RP) group. The primary endpoint was biochemical recurrence-free survival (BRFS).ResultsA total of 522 high-risk PCa patients were enrolled in this study. The median operating time was significantly shorter in the MIE-RP group than in the RARP group. The median estimated blood loss was significantly lower in the RARP group than in the MIE-RP group. The rates of positive surgical margins (PSMs) were not statistically significant in either group. During the follow-up period, biochemical recurrence (BCR) without clinical recurrence occurred in 60 (23.9%) patients in the MIE-RP group and 5 (1.8%) in the RARP group. The 5-year BRFS rate was 76.5% in the MIE-RP group and 97.6% in the RARP group (P < 0.001). On multivariate analysis, RARP, PSM, pathological T stage, and initial prostate-specific antigen were significantly associated with BCR.ConclusionsNeoadjuvant CHT with subsequent RARP may decrease the risk of BCR when compared to MIE-RP.

MP16-13 CLINICAL BENEFIT OF PRESURGICAL AXITINIB THERAPY IN RENAL CELL CARCINOMA PATIENTS WITH THROMBUS EXTENDING TO INFERIOR VENA CAVA

of patients had progressive disease (PD). Median PFS was 5.5 months and median OS was 18.0 months. Among all patients analyzed for Tcell response, five showed vaccine-induced (VI) T-cell responses against at least one HLA class I-restricted TUMAP and two patients with responses to multiple TUMAPs (Figure 1). The T-cell response rate in this study was similar to our previous study in Europe and US. Interestingly, two of the immune responders were of HLA-A*0206 phenotype, a HLA suballele rarely occurring in Europe and US but common in Japan. CONCLUSIONS: This study showed safety and tolerability of IMA901 vaccination and immune responses in Japanese RCC patients.

PD53-09 MEN WITH TESTICULAR CANCER HAVE LOWER SEMEN QUALITY COMPARED TO THOSE WITH OTHER MALIGNANCIES

Takuma Narita*, Shingo Hatakeyama, Tohru Yoneyama, Hirosaki, Japan; Shintaro Narita, Akita, Japan; Shinichi Yamashita, Koji Mitsuzuka, Sendai, Japan; Toshihiko Sakurai, Yamagata, Japan; Sadafumi Kawamura, Tatsuo Tochigi, Natori, Japan; Ippei Takahashi, Shigeyuki Nakaji, Yuki Tobisawa, Hayato Yamamoto, Takuya Koie, Hirosaki, Japan; Norihiko Tsuchiya, Yamagata, Japan; Tomonori Habuchi, Akita, Japan; Yoichi Arai, Sendai, Japan; Chikara Ohyama, Hirosaki, Japan

MP86-02 PREVALENCE OF FRAILTY AMONG UROLOGICAL CANCER PATIENTS IN COMPARISON WITH COMMUNITY-DWELLING POPULATION

INTRODUCTION AND OBJECTIVES: Frailty, defined as a measure of decreased physiologic reserve, is strongly associated with increased susceptibility to disability and poor outcomes. The purpose of this study was to describe the extent of frailty among patients with various urologic diagnoses and to explore whether or not frailty differed between patients who did and did not undergo urologic surgery. METHODS: This is a prospective study of men and women ages 65 and older presenting to an academic non-oncologic urology practice between December 2015 and May 2016. Frailty was measured in individuals via the Timed Up and Go Test (TUGT) upon intake. Based on the TUGT, individuals were classified as not frail (1⁄410 sec), intermediately frail (11-14 sec) or frail (1⁄415 sec). The TUGT and other clinical data were abstracted from the electronic medical record using EPIC analytical software into an on-going database. TUGT values were reported overall, by urologic diagnosis, and according to whether or not they were associated with a urologic procedure. RESULTS: There were 1089 unique individuals who presented to our practice and had a TUGT during the study period. Among these individuals, the mean age was 73.3 ( 6.3) years, 77.6% were male, 64.7% were white and the mean TUGT was 11.6 ( 6.0) seconds, with 30.0% and 15.2% classified as intermediately frail and frail, respectively. TUGT time (and hence frailty) increased linearly with increasing age (Figure). TUGT values differed by urologic diagnosis ranging from 9.9 ( 3.0) seconds among individuals with general male urology diagnoses to 14.3 ( 11.9) seconds among individuals with urinary tract infections (UTIs). There were no statistically significant differences in TUGT values between individuals who did and did not undergo urologic surgery. CONCLUSIONS: Frailty is common, increases with age, and varies based on urologic diagnosis among individuals presenting to an academic non-oncologic urology practice. Interestingly, frailty did not differ between individuals who did and did not undergo urologic surgery, suggesting that there is a potential opportunity to incorporate frailty into the perioperative decision-making process. Since frailty is prevalent among urologic patients and linked to poor outcomes, consideration of frailty in the surgical decision-making process is warranted and may improve outcomes. Source of Funding: NIDDK K12 DK83021-07