Vidit Sharma

MP22-15 RENAL MASS SIZE AND SYNCHRONOUS METASTATIC DISEASE IN RENAL CELL CARCINOMA: AN ANALYSIS OF THE NATIONAL CANCER DATABASE

onset in adults 46 years of age. Limited data exists regarding patients with early onset RCC. Our objective was to investigate the clinical and pathologic characteristics within this unique subset of patients with RCC. METHODS: We retrospectively reviewed our surgical pathology database from 2011-2016 for patients with RCC. The clinical and pathologic characteristics of patients 46 years were compared to the overall population. RESULTS: We identified 98/604 (16%) cases of RCC in patients 46 years. The median age of patients with early onset RCC compared to our control group was 38.6 (range 19-46) vs. 64.4 (range 47-89) years, respectively. Early onset RCC patients included Caucasians (55%), African Americans (40%), Latino (4%), and Asian (1%). Histologic subtypes, included clear cell (54%), papillary (29%), unclassified (7%), chromophobe (5%), clear cell papillary (3%), multilocular cystic neoplasm (1%), and carcinoid (1%). 20/28 (71%) of early onset papillary RCCs occurred in African Americans. Risk factors for RCC included hypertension (47%), smoking (22%), obesity (12%), diabetes mellitus (9%), and chronic kidney disease (CKD) or end-stage renal disease (ESRD) (16.3%). Known genetic syndromes prior to diagnosis were identified in 7/98 (7%) patients (1 Von Hippel Lindau, 2 Familial Adenomatous Polyposis, 1 Marfan, 1 Tuberous Sclerosis, 1 Birt-Hogg-Dube). There was no significant difference between the two groups in terms of tumor size, focality, margin status, presence of necrosis, or sarcomatoid features. Non-Caucasians were more likely to develop early onset RCC (OR 1.98; p1⁄40.001). Patients with early onset RCC were more likely to receive a radical nephrectomy (OR 1.98; p1⁄40.001), have lower grade tumors (OR 0.69; p1⁄40.033) and present with organ confined disease (p1⁄40.008). CONCLUSIONS: Despite having more indolent tumor characteristics and organ confined disease, early onset RCC patients were more likely to undergo a radical nephrectomy. In addition, a high percentage of these patients had either concurrent, or risk factors for developing, CKD/ESRD. These findings suggest that this population is potentially being over treated and should undergo nephron sparing surgery if surgically feasible.

MP77-17 IMPACT OF TIME FROM BIOPSY TO SURGERY ON COMPLICATIONS, FUNCTIONAL AND ONCOLOGIC OUTCOMES FOLLOWING RADICAL PROSTATECTOMY

on AS must undergo PSA testing and repeated biopsies over time in all proposed protocols and patients are subjected to discomfort and anxiety as well as to the complications of repeated biopsies. We tried to identify the predictors of progression-free survival (PFS) at a single institution AS program in order to identify patients in whom repeated biopsies could be avoided or reduced in frequency. METHODS: Between 2009 and 2016, 235 consecutive patients affected by low-risk PCa according to PRIAS criteria (cT1/T2a; PSA<10 ng/ml; PSA density <0.2; Gleason score <7; <3 positive cores) were enrolled in our AS program. Tumor progression was defined as pathological upgrading (Gleason >6 or >2 positive cores) at repeated yearly biopsies. First, Kaplan-Meier analyses were used to quantify progression-free survival at 1, 3 and 5 years, respectively. Second, we identified patients who were progression-free at 3 years of follow-up. Finally, univariable and multivariable logistic regression analyses were used to predict 3-year PFS. Covariates consisted of age, total PSA, clinical stage (cT) and number of positive cores at the time of enrolment as well as negative (no cancer) 1-year biopsy. RESULTS: Progression-free survival rate was 85%, 55%, and 40% at 1, 3 and 5 years, respectively. Median follow-up was 19 months. Overall, 56 (23.8%) patients were progression-free at 3 years of followup. Median number of cores at enrolment in AS program was 16 (IQR: 14-20), while median number of cores at first-year biopsy was 18 (IQR: 14-20). At univariable analyses, total PSA and negative 1-year biopsy were significant predictors of 3-year PFS (all p<0.05). Patients with negative biopsy at 1 year had a 3-year PFS of 75.8 vs. 29.0% in those with positive biopsy at 1-year. These results were confirmed at multivariable analyses, where a negative 1-year biopsy represented the only independent predictor of 3-year PFS (OR: 2.47; p1⁄40.04). CONCLUSIONS: The first biopsy after enrolment in AS program is an important predictor of PCa progression in the first 3 years in men on AS. Negative findings at 1-year biopsy suggest a high chance of 3-year PFS. Patients with negative 1-year biopsy could be followedup with less stringent biopsy protocol, in order to reduce possible biopsy-related side effects and discomfort.

MP55-07 LONG TERM OUTCOMES OF PATIENTS WITH CYSTIC CLEAR CELL RENAL CELL CARCINOMA

multi-center study and compared to radical nephrectomy (RN) performed in the same centers for tumors of comparable diameter and VTT. Demographics, perioperative complications, functional, and oncologic outcomes were compared between the two groups. Mean, median, standard deviation, and interquartile range (IQR) were used to report continuous variables, as appropriate. Survival analysis were used to assess recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS). Univariable (UVA) and multivariable (MVA) analyses were used to evaluate variables predicting complications, OS, CSS and RFS, and end-stage renal disease (ESRD, eGFR<30). RESULTS: Overall, 63 cases and 176 control were enrolled in the study. VTT was unsuspected pre-operatively in 46 (73%) of PN cases. Any grade and high grade postoperative complications were recorded in 41.9% and 22.2% for PN patients, respectively, and in 21.7% and 7.9% for RN patients, respectively (p values <0.05). Once adjusted for covariates, PN was associated with a significantly higher risk of any grade postoperative complications (OR 0.4; p1⁄40.026), whereas only a non-significant trend was identified for high grade complications (OR 0.3; p1⁄40.05). Median followup duration of the patients alive and disease free was 26.6 mo (IQR 8.7-39 mo) and 30 mo (IQR 13 64 mo) in the PN and RN group, respectively (p1⁄40.5). The two-year RFS, CSS and OS survival estimates were 91.8%, 94.0%, 88.1%, for PN, respectively, and 95.8%, 94.6%, 92.9% for RN, respectively. PN site of recurrence were: local in 3 (4,9%), nodal in 3 (4,9%) and distant in 11 (18%). No differences in RFS, CSS and OS survival estimates were found between PN and RN, both in UVA and MVA analyses, where only the classic pathological variables were independent predictors of RFS, CSS, and OS. Preoperative eGFR was similar in both groups, with roughly 3% of the patients presenting with ESRD at initial diagnosis. At follow-up, eGFR was similar in both groups, whereas the prevalence of ESRD was significantly higher in the PN group (32.7% vs 13.2%, p<0.01). However, in MVA analyses, baseline eGFR was the only independent predictor of ESRD (HR 1.0; p<0.01), whereas only a non-significant trend was identified for the type of surgery (HR 0.5; p1⁄40.07). CONCLUSIONS: PN in tumors with concomitant intraparenchymal vein branches thrombosis is feasible but it is associated with higher risk of complications. RFS, CSS and OS were similar in the two groups. Finally, we found a non-statistically significant trend in favor of PN for ESRD prevention.

PD66-12 OUTCOMES ON ILEAL MUCOSAL CUFF MANAGEMENT DURING RADICAL NEPHROURETERECTOMY

characteristics associated with patients’ risk of cancer-specific mortality (CSM). Kaplan-Meier analysis was used to evaluate recurrence free survival (RFS). RESULTS: Median patient age at RNU was 73.7 years (IQR 65.4, 79.5); 67% (n1⁄4249) were male and 64% (n1⁄4238) underwent extravesical excision. Median follow-up was 47 months (IQR 16.4, 101.4), during which time 52.4% (n1⁄4195) experienced a bladder or systemic recurrence and 17.5% (n1⁄465) died due to metastatic urothelial carcinoma. There was no statistically significant difference for 5-year RFS between the two groups (p1⁄40.29). On multivariable analysis features independently associated with increased risk of CSM included smoking history (HR 2.31; p1⁄40.03), high grade (HR 4.23; p<0.001), pT2 or higher (HR 2.51; p1⁄40.01), lymph node positive disease(HR 4.29; p<0.01) and tumor size > 3 cm (HR 2.10; p1⁄40.02). Importantly, approach to the bladder cuff excision was not associated with an increased risk of disease recurrence (HR1⁄41.11; p1⁄40.60) or CSM (HR 1.26; p1⁄40.52). CONCLUSIONS: Excision of the entire ureter, including the intramural component, is an important part of RNU. However, intraor extravesical approach to the distal ureter, does not affect RFS or CSM. Therefore, our data validates the oncologic safety of both approaches to the bladder cuff for patients undergoing RNU for UTUC.

PD72-07 MULTIPARAMETRIC MRI AFTER RADICAL PROSTATECTOMY PREDICTS SALVAGE RADIOTHERAPY OUTCOMES FOR PROSTATE CANCER

Nicola Fossati*, Milan, Italy; R. Jeffrey Karnes, Stephen Boorjian, Michele Colicchia, Rochester, NY; Alberto Bossi, Thomas Seisen, Villejuif, France; Cesare Cozzarini, Claudio Fiorino, Barbara Noris Chiorda, Giorgio Gandaglia, Milan, Italy; Thomas Wiegel, Ulm, Germany; Shahrokh F. Shariat, Gregor Goldner, Vienna, Austria; Steven Joniau, Antonino Battaglia, Karin Haustermans, Gert De Meerleer, Leuven, Belgium; Val erie Fonteyne, Piet Ost, Ghent, Belgium; Hein Van Poppel, Leuven, Belgium; Francesco Montorsi, Alberto Briganti, Milan, Italy

MP93-16 IMPACT OF OBESITY ON PROSTATE CANCER RECURRENCE AFTER RADICAL PROSTATECTOMY

INTRODUCTION AND OBJECTIVES: When operating deep in the abdomen and pelvis, excess fat can interfere with accessing key anatomical structures and create difficulty in dissection and reconstruction. Since intraperitoneal fat is avoided during extraperitoneal robot assisted radical prostatectomy (eRARP), some Urologists have advocated this approach over its transperitoneal counterpart (tRARP) when operating on morbidly obese men (BMI>40). Herein, we aim to compare outcomes of eRARP vs. tRARP in the morbidly obese. METHODS: A chart review of patients who have undergone robot assisted radical prostatectomy (RARP) at a tertiary care academic center from July 1, 2003 through April 30, 2016 was undertaken. Patients with BMI >40 were identified. Those with concomitant inguinal hernia repair were excluded. The resulting eRARP and tRARP groups were compared for demographic, clinical and pathologic characteristics. Regression analysis was performed between the groups with Age, BMI, ASA score and D’Amico classification as selected covariates. RESULTS: 3168 patients underwent RARP during this time period, of which 82 patients met our inclusion and exclusion criteria; each group comprised 41 patients. No differences were noted in age, BMI, ASA score or pre-operative PSA. The tRARP group had a higher clinical stage (p1⁄40.016), biopsy Gleason score (p1⁄40.007) and D’Amico risk category (p<0.00001). The tRARP group had a higher rate of pelvic lymph node dissection (PLND, p<0.00001). No differences were noted in rate of nerve sparing. No differences were noted in OR time, estimated blood loss (EBL), length of stay (LOS) or time to catheter removal (TCR). No differences were noted in surgical margin status or overall complications (either calculated as binary or total number). On regression analysis, no differences were noted in complications, OR time, LOS, TCR or EBL. CONCLUSIONS: In this cohort, surgical approach (eRARP vs. tRARP) did not affect intraor peri-operative outcomes in morbidly obese men undergoing RARP so surgeons should tailor their approach based on comfort level.