Stefano Puliatti

A novel tool for predicting extracapsular extension during graded partial nerve sparing in radical prostatectomy

To create a statistical tool for the estimation of extracapsular extension (ECE) level of prostate cancer and determine the nerve‐sparing (NS) approach that can be safely performed during radical prostatectomy (RP).

PD49-06 THE ADHERENCE TO THE EAU GUIDELINES ON PENILE CANCER TREATMENT COULD INFLUENCE THE SURVIVAL: MULTICENTER, RETROSPECTIVE, EUROPEAN STUDY.

METHODS: Invasive penile cancer cases from 2010-2012 were identified from the NCDB. Pathologic tumor stage was recorded including spongiosal versus carvernosal involvement. Differences in demographic (age, race, comorbid status) and pathologic features (size of tumor, grade, nodal status, LVI, histology, and extranodal extension) between T2 and T3 tumors were compared using c and t-tests. Univariate and multivariate logistic regression was performed to determine the odds of positive lymph nodes (pN+) at inguinal lymph node dissection (ILND) relative to T-stage. RESULTS: There were 367 T2 and 507 T3 patients with penile cancer. The proportion of cases with pN+ disease was 15%, 32%, 46% and 58% for T1, T2, T3 and T4 cases, respectively. Compared to T2 tumors, T3 tumors were larger (mean size 5.8 cm vs. 4.3 cm), more often treated with radical penectomy (36% vs 17%), had higher positive surgical margin rates (12% vs 9%), more aggressive pathology (32% vs 27% poorly differentiated), and were more likely to have lymphovascular invasion (42% vs 31%) (all p < 0.05). In univariate analysis, compared to T1 tumors, T2 (OR 2.8, 95% CI 1.9-4.2) and T3 (OR 4.7, 95% CI 3.3-6.8) were both associated with an increased risk of positive lymph nodes. Although in multivariate analysis, both T2 (OR 2.0, 95% CI 1.2-3.3) and T3 (OR 2.3, 95% CI 1.4-3.6) remained significantly associated with risk of positive lymph nodes compared to T1 disease, there was no increase in risk between T2 and T3 disease (OR 1.1, 95% CI 0.7-1.8, p 1⁄4 0.56). CONCLUSIONS: The proposed new AJCC staging system for the penile cancer distinguishes spongiosal (T2) from cavernosal (T3) involvement and identifies significant differences in pathologic features of the tumors (grade, LVI and size). There does not appear to be a difference in positive lymph node status between the two grades when other clinical and pathological variables are considered. Further study is required to confirm these findings and the prognostic implications of the proposed new staging system.

Rare metastatic sites of renal cell carcinoma: urethra and spermatic cord.

Introduction About 20% of patients with a diagnosis of primary renal cell carcinoma (RCC) present directly with metastatic disease. The aim of the present manuscript is to describe, for the first time a RCC metastasis located to the distal female urethra and to present an update on metastatic locations to the male spermatic cord. Materials and methods We report two cases of rare RCC metastases. The first concerns a 92-year-old female patient who came to our attention for recurrent urethral bleeding, which was initially believed to be secondary to urethral mucosal ectropion. Pathology demonstrated a RCC metastasis. The second concerns a 67-year-old male patient with a previous history of RCC who came to our attention for the finding of palpable, mobile and indolent right inguinal lump. Given the past history of malignancy, it was excised and revealed to be a RCC metastasis. Discussion In the first case, the pathologic specimen allowed the detection of an unknown renal tumor, whereas in the second, the previous neoplastic history of the patient has led clinicians to focus on a possible neoplastic recurrence, perform a correct excision of the node, and begin an early systemic therapy. Conclusions These cases are emblematic of possible unexpected RCC metastasis. These findings should be taken into account in order to clarify the differential diagnosis and to address these patients to a correct therapeutic course.