Oksana Yaskiv

Partial Nephrectomy is Associated with Higher Risk of Relapse Compared with Radical Nephrectomy for Clinical Stage T1 Renal Cell Carcinoma Pathologically Up Staged to T3a

Purpose: We studied recurrence‐free survival after partial vs radical nephrectomy for clinical stage T1 renal cell carcinoma in all patients and in those up staged to pathological stage T3a. Materials and Methods: We retrospectively reviewed the records of 1,250 patients who underwent partial or radical nephrectomy for clinically localized T1 renal cell carcinoma between 2006 and 2014. Recurrence‐free survival was estimated using the Kaplan‐Meier method and evaluated as a function of nephrectomy type with the log rank test and Cox models, adjusting for clinical, radiological and pathological characteristics. Results: A total of 86 recurrences (7%) were observed during a median followup of 37 months. No difference in recurrence‐free survival between partial and radical nephrectomy was found among all clinical stage T1 renal cell carcinomas. T3a up staging was noted in 140 patients (11%) and recurrent disease was observed in 44 (31.4%) during a median followup of 38 months. Among up staged T3a cases partial nephrectomy was associated with shorter recurrence‐free survival compared to radical nephrectomy on univariable analysis (recurrence HR 2.04, 95% CI 1.12–3.68, p = 0.019) and multivariable analysis (recurrence HR 5.39, 95% CI 1.94–14.9, p = 0.001). Conclusions: In a subgroup of patients clinically staged T1 renal cell carcinoma will be pathologically up staged to T3a. Among these patients those who undergo partial nephrectomy appear to have inferior recurrence‐free survival relative to those who undergo radical nephrectomy.

Intraductal Carcinoma of the Prostate Diagnosed by Multi-Parametric Prostate Magnetic Resonance Imaging (MRI) and MRI/Ultrasound Fusion-Guided Biopsy

Intraductal carcinoma of the prostate (IDC-P) is an aggressive form of prostate cancer (CaP) with clinical and pathological features distinguishing it from high-grade prostatic intraepithelial neoplasia (HG-PIN). IDC-P is characterized by a high volume and high-grade disease, with an aggressive behavior. We present the case of a 63-year-old male with diagnostic MRI imaging indicative of IDC-P. To our knowledge, this is the first reported case of IDC-P identified with multi-parametric MRI.

Paraneoplastic Syndrome Secondary to Treatment Emergent Neuroendocrine Tumor in Metastatic Castration-resistant Prostate Cancer: A Unique Case

Treatment-emergent neuroendocrine prostate cancer has become increasingly more common owing to the development of second-generation anti-hormonal therapy. It is characterized by a morphology similar to small-cell carcinoma, a low prostate-specific antigen, and visceral metastasis. This case features a paraneoplastic Cushing syndrome, initial resistance to androgen receptortargeted therapy, a continuously rising prostatespecific antigen, and a lack of disease spread to visceral organs. RNA sequencing revealed a gene expression profile consistent with a neuroendocrine tumor and identified the potential therapeutic targets such as Aurora kinase A and EZH2. Regardless of PSA levels and the extent of metastatic disease, patients with initial resistance to androgen receptor-directed and new-onset paraneoplastic syndrome should raise a high suspicion of neuroendocrine prostate cancer.

PD62-10 IDENTIFICATION OF MOLECULAR BIOMARKERS OF CISPLATIN-BASED CHEMOSENSITIVITY IN PATIENTS UNDERGOING NEOADJUVANT CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER

malignancies, however, its impact on muscle mass in MIUC patients is undefined. As neoadjuvant chemotherapy (NC) prior to radical cystectomy is the current standard of care in MIUC, our objective was to describe preoperative changes in body composition in patients receiving platinum-based NC. METHODS: Patients with cT2-4, N0-1, M0 UC of the bladder who underwent NC were retrospectively identified. Skeletal muscle index (SMI, cm^2/m^2) was calculated using validated methodology (cross sectional area of skeletal muscle/height^2 at L3) from pre(preNC) and post-NC (post-NC) computed tomography images. Patients were classified as being sarcopenic according to consensus definitions: Male: SMI <55 cm^2/m^2, Female: SMI <38.5 cm^2/m^2. Pre-NC and post-NC median body mass index (BMI) and SMI were compared using paired Wilcoxon signed rank tests. RESULTS: The cohort consisted of 26 patients, with a median age 70 years, including 7 females (27%). Chemotherapy regimens included dose-dense methotrexate, vinblastine, doxorubicin and cisplatin in 8 (31%), gemcitabine/cisplatin in 16 (62%) and gemcitabine/carboplatin in 1 (3.8%). Median number of cycles was 3.5 (range 2-6). Median preand post-NC BMI were 27.1kg/m^2 and 27.2kg/m^2 (p1⁄40.36). Median preand post-NC cross-sectional lumbar muscle area were 141 and 129.4 cm^2 (p<0.001). Median preand post-NC SMI were 49.2 and 44.5 cm^2/m^2 (p<0.001). Median % change in SMI was -6.4% (Figure). Pre-NC, 18 (69%) patients were sarcopenic vs. 21 (81%, p1⁄40.002) postNC. Percent change in SMI did not differ according to baseline sarcopenia status or number of chemotherapy cycles. CONCLUSIONS: Although BMI remained stable, we observed a significant decrease in lean muscle mass among MIUC patients treated with platinum-based NC prior to cystectomy, with an associated increase in the prevalence of sarcopenia. These patients may benefit from pre-habilitative interventions to mitigate lean muscle loss prior to cystectomy. The association of change in SMI with surgical outcome in this cohort is under investigation.