Jane S. Cho

Modified retroperitoneal lymph node dissection for post-chemotherapy residual tumour: a long-term update

To update previously reported outcomes of modified‐template post‐chemotherapy retroperitoneal lymph node dissection (PC‐RPLND) in appropriately selected patients with metastatic non‐seminomatous germ cell tumour (NSGCT), as our previous report was criticised for short follow‐up and so we now provide a long‐term update on this cohort.

Use of the cell cycle progression (CCP) score for predicting systemic disease and response to radiation of biochemical recurrence.

BACKGROUND Determining the optimal treatment for biochemical recurrence (BCR) after radical prostatectomy (RP) is challenging. OBJECTIVE We evaluated the ability of CCP score (a prognostic RNA expression signature) to discriminate between systemic disease and local recurrence in patients with BCR after RP. METHODS Sixty patients with BCR after RP were selected for analysis based on: 1) metastatic disease, 2) non-response to salvage external beam radiotherapy (EBRT), and 3) durable response to salvage EBRT. CCP scores were generated from the RNA expression of 46 genes. Logistic regression assessed the association between CCP score and patient group. RESULTS Passing CCP scores were generated for 47 patients with complete clinical and pathologic data. CCP score predicted clinical status when comparing patients with metastatic disease or non-responders to salvage therapy to patients with durable response (p = 0.006). CCP score remained significantly predictive of clinical status after accounting for time to BCR, PSA level at BCR, and Gleason score (p = 0.0031). CONCLUSIONS Elevated CCP score was associated with increased risk of systemic disease, indicating that CCP score may be useful in identifying patients with BCR who are most likely to benefit from salvage radiation therapy.

PD33-03 ADJUSTED CLINICAL OUTCOMES IN PATIENTS WITH SARCOMATOID VARIANT UROTHELIAL CARCINOMA UNDERGOING RADICAL CYSTECTOMY FOR MUSCLE INVASIVE DISEASE

INTRODUCTION AND OBJECTIVES: Bladder cancer (BCa), may present with variant morphologic features that deviate from the urothelial common aspect. These characteristics that can be defined as pure or mixed variants may have prognostic and therapeutic implications. METHODS: We retrospectively evaluated histopathological data from 1,067 BCa patients treated with radical cystectomy (RC) and PLND for BCa between 1990 and 2013 at a single tertiary care referral center. All specimen were evaluated by dedicated uropathologists. Uniand multivariate Cox regression analyses tested the impact of different histopathological variant CSM (cancer specific mortality) and OM (overall mortality) after accounting for age at surgery, pathological N stage, use of perioperative chemotherapy, number of positive nodes, number of removed nodes, positive surgical margin, pathological T stage, lymph vascular invasion, use of adjuvant chemotherapy. RESULTS: Of 1,067 patients, 756 (70.9%) harbored pure urothelial BCa while 311 (29.1%) were found to have a variant. Of these, 202 (64.9%) had a mixed variant and 109 (35.1%) a pure variant. Considering uncommon variants, 21 (6.8%) were sarcomatoid, 10 (3.2%) lymphoepitelial, 19 (6.1%) small cell, 4 (1.3%) plasmacitoid, 2 (0.6%) nested, 109 (35.0%) squamous, 89 (28.6%) micropapillary, 23 (7.4%) glandular and 34 (10.9%) multiple mixed. With a median follow up of 65 months, CSM and OM were recorded in 365 (34.2%), 451 (42.3%) patients, respectively. The OM was 47% vs. 53% vs. 59% for pure urothelial vs. mixed vs. pure variants, respectively (Log rank p1⁄40.011). The 5-years CSM was 44% vs. 47% vs. 53% for pure urothelial vs. mixed vs. pure variants, respectively (Log rank p1⁄40.019). At MVA Cox regression analyses, the presence of pure histological variant was associated with higher CSM (HR: 1.60, p 0.3). In details, neuroendocrine (HR 4.30, CI 2.02-9.13, p<0.001), micropapillary (HR: 4.35, p1⁄40.02) and multiple mixed (HR: 1.73; p<0.03) variants were associated with higher CSM after RC. CONCLUSIONS: Our study confirm the negative impact of histological variant on the prediction on both CSM and OM after RC. The presence of a pure histopathological variant represents a strong negative predictor of survival, while patients with mixed urothelial and variant histologies did not harbor an increased risk of CSM and OM, as compared to conventional urothelial cancer.

Neoadjuvant chemotherapy in urothelial bladder cancer: impact of regimen and variant histology

AIM We compared the efficacy of methotrexate/vinblastine/doxorubicin/cisplatin (MVAC) versus gemcitabine/cisplatin in urothelial cancer and neoadjuvant chemotherapy (NACT) efficacy in variant histology (VH). MATERIALS & METHODS Radical cystectomy patients were retrospectively compared with those who received NACT. Factors associated with survival, pathologic complete response (pCR) and downstaging (pDS) were evaluated in multivariable models. RESULTS 9% of radical cystectomy patients (84/919) received NACT, with improved survival, pCR and pDS on both regimens. MVAC lead to higher pDS without an increase in pCR. On multivariable analysis, there was a nonsignificant increase in pDS with MVAC. NACT conferred similar responses in squamous and glandular differentiation VH. CONCLUSION NACT was associated with improved survival, pCR and pDS. Furthermore, responses to NACT were not dependent on presence of VH.

Does Squamous Differentiation Portend Worse Outcomes in Urothelial Bladder Cancer

Introduction: Interest on the impact of variant histology in bladder cancer prognosis is increasing. Although squamous differentiation is the most well characterized, only recently have less common variants gained increased recognition. We assessed whether squamous differentiation conferred a worse prognosis than nonvariant urothelial bladder cancer in a contemporary cohort of patients treated with radical cystectomy given the increased awareness of other less common variants. Methods: We identified patients with squamous differentiation or nonvariant histology on transurethral resection of bladder tumor and/or cystectomy pathology during a 10‐year period. Disease specific and overall survival were evaluated using Kaplan‐Meier methodology. Cox regression was used to assess variables associated with mortality. Results: Between 2003 and 2013, 934 patients underwent cystectomy for urothelial bladder cancer. Overall 617 nonvariant and 118 squamous differentiation cases were identified, and the remainder was nonsquamous differentiation variant histology. Overall 75% of patients with squamous differentiation had muscle invasive disease at diagnosis compared with 59% of those with nonvariant histology (p=0.002). Nonorgan confined disease at cystectomy was more common in patients with squamous differentiation (57% vs 44%, p=0.009). Among cases on neoadjuvant chemotherapy 20% (9 of 45) of nonvariant and 13% (1 of 8) of squamous differentiation were pT0N0 (p=0.527). Median followup was 52 months. Adjusted for demographics, pathological stage and chemotherapy, squamous differentiation was not associated with an increased risk of disease specific (HR 1.35, 95% CI 0.90–2.04, p=0.150) or all cause mortality (HR 0.90, 95% CI 0.60–1.25, p=0.515). Conclusions: In a contemporary cohort of urothelial bladder cancer with recognition and characterization of less commonly described variants, squamous differentiation is not associated with a worse disease specific and all cause mortality when compared to a pure nonvariant cohort.

MP10-08 MODIFIED TEMPLATE RETROPERITONEAL LYMPH NODE DISSECTION FOR POSTCHEMOTHERAPY RESIDUAL TUMOR: A LONG TERM UPDATE

CONCLUSIONS: Diagnostic and surveillance imaging for penile cancer is highly stage dependent. However, excessive number of imaging appears to be occurring among the lower risk population. Hopefully the introduction of the NCCN guidelines in 2014 will help to change this trend. Given the success of ultrasound and biopsy in the European literature, there should be consideration for wider adoption of this approach in the United States.