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Objective The objective of this research was to construct and validate prognostic nomograms predicting overall survival (OS) and cancer-specific survival (CSS) in patients with pancreatic neuroendocrine tumors (pNETs). Methods We extracted 3787 patients with pNETs from the Surveillance, Epidemiology and End Results database. Nomograms for estimating 3- and 5-year OS and CSS were first established. Then, we used Harrell's Concordance Index, calibration plots, and the area under receiver operating characteristic curve to evaluate the nomograms. The Kaplan-Meier curve was plotted to evaluate the different survival outcomes. Results In the multivariate analysis, age, grade, functional status, American Joint Committee on Cancer stage, and surgery were associated with OS and CSS. The established nomograms had good discriminative ability, with a Harrell's Concordance Index of 0.830 for OS and 0.855 for CSS. The calibration plots also revealed good agreement. The area under receiver operating characteristic curve values of the nomograms predicting 3- and 5-year OS and CSS rates were 0.836, 0.816 and 0.859, 0.841, respectively. In addition, Kaplan-Meier curve indicated that patients with higher risk had worse survival outcomes. Conclusions We have proposed and validated the nomograms predicting OS and CSS of pNETs. They can be convenient individualized tools to facilitate clinical decision making.

The aim of this study was to evaluate the survival outcomes of different prostate-specific antigens (PSA) levels in men with high-grade prostate cancer.From 2004 to 2015 in the Surveillance, Epidemiology, and End Results database, men diagnosed with clinically localized prostate cancer and a Gleason score (GS) 8-10 were identified. Patients were divided into the PSA levels4.0 ng/ml, 4.0-10.0 ng/ml, 10.1-20.0 ng/ml, and20.0 ng/ml groups. Multivariable Cox regressions and Kaplan-Meier analysis were adopted to analyze the prostate cancer-specific survival (PCSS).59,336 men with a median age of 70 (63-76) years with a GS 8-10 were included. The PCSS of patients with a PSA4.0 ng/ml was significantly worse than that of patients with a PSA 4.0-10.0 ng/ml [hazard ratio (HR): 1.43 (1.28-1.58)], but was better than that of patients with a PSA 10.1-20.0 ng/ml [HR: 1.18 (1.06-1.31)]. After stratifying patients by GS, the differences between patients with a PSA4.0 ng/ml and a PSA 4.0-10.0 ng/ml were only significant in those with a GS 9 and 10 [GS 9 HR: 1.49 (1.28-1.72); GS 10 HR: 1.42 (1.12-1.8)], but not in those with a GS 8 [HR: 1.04 (0.95-1.14)]. Moreover, the PCSS of patients with a PSA4.0 ng/ml and a PSA 10.0-20.0 ng/ml were similar in patients with GS 9 and 10 diseases [GS 9: HR: 1.06 (0.91-1.23); GS 10: HR: 1.13 (0.89-1.44)].Patients with a PSA4.0 ng/ml had poorer PCSS than patients with a PSA 4.0-10.0 ng/ml. Similar PCSS was found in patients whose PSA levels were 10.1-20.0 ng/ml in patients with GS 9-10 prostate cancer.

INTRODUCTION AND OBJECTIVE:Prostate biopsy is the golden standard for the diagnosis of prostate cancer (PCa). The discordance between the PCa Grade Group (GG) on biopsy (Bx) and the PCa GG from the...

Retrospective analysis.To develop and validate nomograms to predict overall survival (OS) and cancer-specific survival (CSS) of spinal chondrosarcoma patients.In this era of personalized medicine, data those are available to predict the survival of spinal chondrosarcoma patients are still limited due to the rarity of the disease. Nomogram, which has been widely used in clinical oncology, could conveniently and precisely predict survival outcome for individual patient.We retrospectively collected 450 spinal chondrosarcoma patients from the Surveillance, Epidemiology, and End Results (SEER) database between 1984 and 2013. Univariate log-rank and multivariate Cox analyses were used to identify independent prognostic factors. These prognostic factors were included in the nomograms, which predict 3- and 5-year OS and CSS rate. The nomograms were bootstrap validated internally and externally.A total of 450 patients were collected and randomly assigned into the training (n = 225) and validation (n = 225) cohorts. Age, histologic subtype, grade, tumor size, stage, and surgery were identified as independent prognostic factors for OS and CSS (all P 0.05) and were further incorporated to construct the nomograms. The concordance indices (C-indices) for internal validation of OS and CSS prediction were 0.807 and 0.821, while for external validation of OS and CSS prediction were 0.756 and 0.767. Internal and external calibration plots both revealed an excellent agreement between nomogram prediction and actual survival.Nomograms were developed to predict OS and CSS for spinal chondrosarcoma patients. The nomograms could assist clinicians in making more accurate survival evaluation and identifying patients with high risk of mortality.4.

Background Many factors have been reported to be associated with the prognosis of patients with chondrosarcoma, but clinicians have few tools to estimate precisely an individual patient’s likelihood of surviving the illness. We therefore sought to develop effective nomograms to better estimate the survival of patients with chondrosarcoma. Questions/purposes (1) Which clinicopathologic features are independent prognostic factors for patients with chondrosarcoma? (2) Can we develop a nomogram to predict 3- and 5-year overall and cancer-specific survival of individual patients with chondrosarcoma based on personalized information? Methods We collected information on patients diagnosed with chondrosarcoma between 1988 and 2011 from the Surveillance, Epidemiology, and End Results (SEER) database. The SEER database consists of 18 cancer registries and covers approximately 30% of the total United States population. One thousand thirty-four adult patients with grade II or III chondrosarcoma were included in the cohort (patients with grade I chondrosarcoma were not evaluated in this study), while 327 patients were excluded from the study owing to missing data regarding tumor size or metastasis. Nine hundred nineteen patients (89%) in the cohort had complete followup for at least 1 year. The X-tile program was used to determine optimal cutoff points. Univariate and multivariate analyses were applied to identify independent factors that were further included in the nomograms predicting 3- and 5-year overall survival and cancer-specific survival. Records of 1034 patients were collected and randomly divided into training (n = 517) and validation (n = 517) cohorts. The nomograms were developed based on training cohort. Data for the training cohort were obtained for internal validation of the nomograms, whereas data for the validation cohort were obtained for external validation of the nomograms. Bootstrapped validation, which used a resample with 500 iterations, was applied to validate the nomograms internally and externally. Results Six independent prognostic factors for overall survival and six for cancer-specific survival were identified and incorporated to construct nomograms for 3- and 5-year overall and cancer-specific survival. These nomograms can easily be used by providers in the office to estimate a patient’s prognosis; the only clinical details a provider needs to use these nomograms effectively are age, histologic subtype, tumor grade, whether surgery was performed, tumor size, and the presence or absence of metastases. Internal and external calibration plots for the probability of 3- and 5-year overall survival and cancer-specific survival showed good agreement between nomogram prediction and observed outcomes. The concordance indices (C-indices) for internal validation of overall survival and cancer-specific survival prediction were 0.803 and 0.829, respectively, whereas the C-indices for external validation were 0.753 and 0.759, respectively. Conclusions We were able to develop effective nomograms to predict overall survival and cancer-specific survival for patients with chondrosarcoma; these nomograms require only basic information, which should be available to all providers in the office setting. If these observations can be validated in different registries or databases, the nomograms can assist clinicians in counseling patients regarding therapeutic choices. Level of Evidence Level III, prognostic study.

We evaluated differences in clinicopathological characteristics and oncologic outcomes between patients with upper tract urothelial carcinoma in mainland China and the United States.We retrospectively compiled clinicopathological and oncologic outcomes data on patients with upper tract urothelial carcinoma treated surgically at tertiary care medical facilities in the United States or China from 1998 to 2015. Baseline demographics, comorbidities and pathological features were evaluated. Oncologic end points, including intravesical recurrence and cancer specific survival, were obtained after excluding patients who received systemic chemotherapy. Multivariable Cox regression was performed to determine predictors of adverse oncologic outcomes for each country.A total of 775 patients with upper tract urothelial carcinoma were identified, including 451 in China and 324 in the United States. Median followup was 42 months. American patients were more frequently male (65% vs 44%) and smokers (79% vs 18%), and had a worse mean ASA® (American Society of Anesthesiologists®) score (2.7 vs 2.2) and prior bladder cancer (41% vs 4%, all p 0.001). Chinese patients more often had preoperative hydronephrosis (56% vs 40%), high grade pathology (98% vs 77%), muscle invasion (64% vs 38%) and nodal metastases (26% vs 6%, all p0.001). American patients had worse overall survival on Kaplan-Meier analysis (p = 0.049). However, country of origin did not predict local relapse or cancer specific survival.Patient and disease characteristics of upper tract urothelial carcinoma differed between the Chinese and American cohorts. Chinese patients appeared relatively healthier at presentation but more often exhibited adverse pathological features. While evaluation and management patterns may account for these variations, the pathological findings may reflect a differential underlying pathogenesis of disease. Additional study is warranted to further characterize these differences.

INTRODUCTION AND OBJECTIVES:Despite earlier recognition of small renal masses, the racial disparities in stage for stage cancer specific survival persists for unclear reasons. Cancer specific survi...

INTRODUCTION AND OBJECTIVES:According to the d’Amico classification, high-risk prostate cancer (PCa)disease is defined as either preoperative PSA>20ng/ml, clinical tumor stage (cT) ≥T2c or biopsy...

INTRODUCTION AND OBJECTIVES:Non-muscle invasive bladder cancer current scoring models cannot precisely predict the individual disease course and do not reflect the optimal treatment. Furthermore, i...

INTRODUCTION AND OBJECTIVES:For many solid and malignant tumours thrombocytosis is associated with an impaired onclogical outcome concerning cancer specific survival (CSS).So far there is only limi...

INTRODUCTION AND OBJECTIVE:The 8th edition of the unified TNM staging for penile SCC considers G2 disease as intermediate risk. The aim of this study was to analyse and compare predictors for LR an...

Current EAU (European Association of Urology) guidelines state that prostate specific antigen 100 ng/ml or greater at diagnosis indicates metastatic disease. We examined the association of prostate specific antigen 100 ng/ml or greater at diagnosis with distant metastasis and prostate cancer specific survival.A total of 15,635 men with prostate cancer diagnosed between 1998 and 2009 who were identified in PCBaSe (Prostate Cancer Data Base Sweden 2.0) were included in a population based registry study. Prostate cancer specific survival was compared among 3 groups, including 1,879 men with prostate specific antigen 100 ng/ml or greater and negative imaging (M0), 5,642 with distant metastases on imaging (M1) and prostate specific antigen 100 ng/ml or greater, and 3,828 with M1 and prostate specific antigen less than 100 ng/ml. A fourth group consisted of 4,286 men with prostate specific antigen 100 ng/ml or greater who had not undergone imaging (Mx). The latter men were not included in the assessment of survival.Of 7,521 men with prostate specific antigen 100 ng/ml or greater who underwent imaging for staging 75% were classified with M1 disease. Only 59% of 3,527 men with prostate specific antigen 100 to 300 mg/ml had distant metastases on imaging. Five-year prostate cancer specific survival was 72% (95% CI 70-74) in men with prostate specific antigen 100 ng/ml or greater and M0, 24% (95% CI 23-25) in men with prostate specific antigen 100 ng/ml or greater and M1, and 39% (95% CI 37-40) in men with prostate specific antigen less than 100 ng/ml and M1.A fourth of men with prostate specific antigen 100 ng/ml or greater did not have distant metastases. They had twofold to threefold higher 5-year survival than men with distant metastases on imaging. Our findings strongly suggest that using prostate specific antigen 100 ng/ml or greater as an indicator of metastatic disease should be reconsidered.

More than 50 million people reside in rural America. However, the impact of patient rurality on colon cancer care has been incompletely characterized, despite its known impact on screening.Our study sought to examine the impact of patient rurality on quality and comprehensive colon cancer care.We constructed a retrospective cohort of 123,129 patients with stage 0 to IV colon cancer. Rural residence was established based on the patient medical service study area designated by the registry.The study was conducted using the 1996-2008 California Cancer Registry.All of the patients diagnosed between 1996 and 2008 with tumors located in the colon were eligible for inclusion in this study.Baseline characteristics were compared by rurality status. Multivariate regression models then were used to examine the impact of rurality on stage in the entire cohort, adequate lymphadenectomy in stage I to III disease, and receipt of chemotherapy for stage III disease. Proportional-hazards regression was used to examine the impact of rurality on cancer-specific survival.Of all of the patients diagnosed with colon cancer, 18,735 (15%) resided in rural areas. Our multivariate models demonstrate that rurality was associated with later stage of diagnosis, inadequate lymphadenectomy in stage I to III disease, and lower likelihood of receiving chemotherapy for stage III disease. In addition, rurality was associated with worse cancer-specific survival.We could not account for socioeconomic status directly, although we used insurance status as a surrogate. Furthermore, we did not have access to treatment location or distance traveled. We also could not account for provider or hospital case volume, patient comorbidities, or complications.A significant portion of patients treated for colon cancer live in rural areas. Yet, rural residence is associated with modest differences in stage, adherence to quality measures, and survival. Future endeavors should help improve care to this vulnerable population (see video, Supplemental Digital Content 1, http://links.lww.com/DCR/A143).

This study of stage III (locally advanced) breast cancer patients evaluated the survival improvement conferred by immediate breast reconstruction by transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction after modified radical mastectomy (MRM) in comparison with MRM alone.This retrospective study analyzed data for all women who had received TRAM immediately after unilateral modified radical mastectomy for locally advanced breast cancer at a single institution from January 2002 to December 2009. The analysis included 192 patients divided into 2 groups: patients who had received MRM immediately followed by TRAM flap reconstruction (MRM-TRAM group, n=52) and patients who had received MRM alone (MRM group, n=140). Data collection included demographic characteristics, underlying comorbidities, and cancer characteristics. Postoperative adjuvant therapies, oncologic outcomes, and survival were compared between the 2 groups. Kaplan-Meier plots, univariate log-rank test, multivariate Cox proportional hazards regression models, and t-test were used to evaluate potential predictors of cancer recurrence and patient survival.In comparison with the MRM group, significant differences in the MRM-TRAM group included a younger mean age, a better overall health status, and a higher education level (all P0.001). Severity of breast cancer disease did not significantly differ in terms of cancer characteristics. Additionally, there were no significant differences in local recurrence (P=0.326) and distant metastasis (P=0.338). Immediate breast reconstruction was not associated with delays in detection of local recurrence and initiation of adjuvant therapiesThe 5-year breast cancer-specific survival rate was significantly higher in the MRM-TRAM group (84.6%) compared with the MRM group (61.2%) (P=0.003). Multivariate analysis showed that TRAM flap reconstruction is an independent predictor of survival in breast cancer patients. The MRM-TRAM group had a significantly lower hazard of death (HR, 0.235; 95% CI, 0.070-0.788; P=0.019) compared with the MRM group.Immediate TRAM flap reconstruction is oncologically safe and is unassociated with delayed adjuvant therapies or delayed detection of local recurrence. Patients with locally advanced breast cancer can be considered appropriate candidates for TRAM flap reconstruction because the procedure is an independent predictor of breast cancer survival and is associated with a 76.5% decrease (HR, 0.235) in the risk of cancer death.

We evaluated the outcome in patients with late recurrence of urothelial carcinoma after radical cystectomy.We identified 2,091 patients who underwent radical cystectomy at our institution between 1980 and 2006. Survival was estimated using the Kaplan-Meier method and compared based on recurrence timing (less than 5 years vs 5 or greater) and location (urothelial vs nonurothelial) using the log rank test. Cox proportional hazard regression models were used to evaluate variables associated with late recurrence and death from bladder cancer.Median postoperative followup was 16.6 years. Late recurrence was identified in 82 patients (3.9%). On multivariate analysis younger age (p = 0.0008), nonmuscle invasive disease (p = 0.01) and prostatic urethral involvement (p0.0001) were significantly associated with an increased risk of late recurrence. Five-year post-recurrence cancer specific survival was significantly worse after recurrence within 5 years from radical cystectomy vs after late recurrence (17% vs 37%, p = 0.001). Patients with nonurothelial late recurrence had adverse 5-year cancer specific survival compared to those with urothelial late recurrence (19% vs 67%, p0.0001). On multivariate analysis younger patient age (HR 1.01, p = 0.003), muscle invasive disease (HR 1.31, p0.0001) and nonurothelial recurrence site (HR 2.76, p0.0001) but not time to recurrence (p = 0.38) were associated with a significantly increased risk of death from bladder cancer following recurrence after radical cystectomy.Late recurrence is uncommon after radical cystectomy. Younger patient age, nonmuscle invasive disease and prostatic urethral involvement were associated with a significantly increased risk of late recurrence. Interestingly, time to recurrence was not associated with a subsequent risk of patient death.

genetic counseling, Klinefelter syndrome (3.6%) who underwent testicular sperm extraction (no men with Klinefelter syndrome had a positive YCM assay), and men with chromosomal abnormalities of the Y chromosome (1.9%) who chose donor sperm or adoption. Sequential testing for karyotype first and then YCM, results in 9.8% of men savings of $500. This reduces the average cost of testing to $1,250.69 per patient, a savings of 3.8%. CONCLUSIONS: The probability of having both a karyotype abnormality and YCM in men with testicular failure is extremely rare. Sequential performance of karyotype, followed by YCM assay if there are no abnormal karyotype findings results in demonstrable financial savings.

Background: This study retrospectively assessed prognostic outcomes following radical cystectomy in patients with node-positive bladder cancer. Patients and Methods

To determine the effect of the extent of thyroidectomy and additional postsurgical radioiodine remnant ablation (RRA) on the survival of patients with differentiated thyroid carcinoma (DTC) after adjustment for risk stage.We electronically identified 614 cases of DTC at our institution between 1987 and 2006. Two treatment variables were created, surgical extent dichotomized to total versus other and a composite of surgery and radioactive iodine ablation. The odds of cancer specific survival and disease-free survival (DFS) were determined using Cox proportional hazards model with adjustment for quantitative tumor-node-metastasis risk score.Of 614 patients with DTC during our period, 504 (83%) underwent total thyroidectomy and 104 (17%) underwent lesser surgery. Radioiodine administration was reported for 394 patients who underwent total thyroidectomy with a dose range of 24 to 297 mCi (mean of 116 mCi). Ten-year survival was higher for patients with total thyroidectomy compared with lobectomy: 96% versus 84% (P0.001, Gehan's Wilcoxon test). Ten-year survival for complete versus incomplete surgery for tumor stages 1 and 2 was 99% versus 96%, and for stages 3 and 4 was 88% versus 52%. Cancer specific death tended to occur earlier in those without RRA postsurgery. There was no overall relationship between DFS and RRA or surgery, but in the higher risk categories surgery retained significance.Our data support the routine use of both total or near-total thyroidectomy followed by RRA over all risk categories in DTC. Although the effect of surgery is clear, there is also a trend toward improvement in outcome with RRA for cancer specific survival.

INTRODUCTION AND OBJECTIVES: Extirpative treatment of Upper Urinary Tract Urothelial Carcinoma (UTUC) has long been the standard of care regardless of tumor grade. We herein stratify oncologic outcomes based on tumor grade with implications for the role of systemic chemotherapy. We present long-term oncologic outcomes of all patients treated with nephroureterectomy (NU) for UTUC over a 15 year time period. METHODS: All patients (N1⁄480) were treated by a single surgeon with extirpative surgery for UTUC as a primary treatment. The majority (90%) underwent laparoscopic NU via a retroperitoneal approach, with transurethral incision of the ureteric orifice and then open bladder-cuff excision through a Gibson incision. The open surgical approach was used in 6 (7.5%) cases and distal/ segmental ureterectomy only was used sparingly (2.5%). Data was prospectively collected and concurrent outpatient follow up data were retrospectively reviewed. Statistical analysis was performed using Kaplan Meier methodology to calculate overall survival (OS), cancer specific survival (CSS), and metastasis-free survival (MFS). RESULTS: The mean age of patients was 72.5 (range 46-90), 50 male (62.5%) and mean Charlston Comorbidity Index of 5.1 (range 0-13). Mean follow-up time was 30.4 months (range 1-185.3) with median overall survival 109.2 months. Twenty-three patients (28.8%) with low grade tumors, treated with primary NU, had 2-, 5-, and 10-year OS of 100, 88, 73%. In contrast, 57 (71.3%) with high grade tumors had a lower 2-, 5-, and 10-year OS of 83, 68, 0%. Table 1 summarizes the oncologic outcomes based on histologic grade. Lymph node positive disease portends a particularly grim prognosis with 2and 5-year OS and CSS of 24 and 0% respectively CONCLUSIONS: Grade is a significant predictor of OS, CSS, and MFS in patients treated with nephroureterectomy for UTUC. Extirpative therapy was found to result in relatively poor long-term CSS in patients with high grade disease, underscoring the need for adjuvant or neoadjuvant therapies.

INTRODUCTION AND OBJECTIVES: Extirpative treatment of Upper Urinary Tract Urothelial Carcinoma (UTUC) has long been the standard of care regardless of tumor grade. We herein stratify oncologic outcomes based on tumor grade with implications for the role of systemic chemotherapy. We present long-term oncologic outcomes of all patients treated with nephroureterectomy (NU) for UTUC over a 15 year time period. METHODS: All patients (N1⁄480) were treated by a single surgeon with extirpative surgery for UTUC as a primary treatment. The majority (90%) underwent laparoscopic NU via a retroperitoneal approach, with transurethral incision of the ureteric orifice and then open bladder-cuff excision through a Gibson incision. The open surgical approach was used in 6 (7.5%) cases and distal/ segmental ureterectomy only was used sparingly (2.5%). Data was prospectively collected and concurrent outpatient follow up data were retrospectively reviewed. Statistical analysis was performed using Kaplan Meier methodology to calculate overall survival (OS), cancer specific survival (CSS), and metastasis-free survival (MFS). RESULTS: The mean age of patients was 72.5 (range 46-90), 50 male (62.5%) and mean Charlston Comorbidity Index of 5.1 (range 0-13). Mean follow-up time was 30.4 months (range 1-185.3) with median overall survival 109.2 months. Twenty-three patients (28.8%) with low grade tumors, treated with primary NU, had 2-, 5-, and 10-year OS of 100, 88, 73%. In contrast, 57 (71.3%) with high grade tumors had a lower 2-, 5-, and 10-year OS of 83, 68, 0%. Table 1 summarizes the oncologic outcomes based on histologic grade. Lymph node positive disease portends a particularly grim prognosis with 2and 5-year OS and CSS of 24 and 0% respectively CONCLUSIONS: Grade is a significant predictor of OS, CSS, and MFS in patients treated with nephroureterectomy for UTUC. Extirpative therapy was found to result in relatively poor long-term CSS in patients with high grade disease, underscoring the need for adjuvant or neoadjuvant therapies.

INTRODUCTION AND OBJECTIVES: Evidence of lymph node invasion (pN+) in patients treated with radical prostatectomy (RP) for prostate cancer (PCa) is associated with a shorter recurrence free survival. However, not all pN+ patients will develop distant metastases (M+) during remaining life-time. The aim of this study was to evaluate the sequel from pN+ to M+ and to identify predictors for development of M+ in pN+ patients. METHODS: Data from 411 pN+ patients surgically treated at our institution between 1992 and 2012 were available. Visceral or bone metastases were considered as M+. The median follow-up of our patient collective was 48.2 (2.1-240.4) months. Long-term M+ free survival rates were estimated by the Kaplan Meier method. Multivariable Cox proportional hazard regression models were used to predict M+. Covariates consisted of preoperative PSA, pathological Gleason score, pT-stage, margin status, number of positive lymph nodes, and time from RP to BCR. RESULTS: Overall, 62 patients (15.0%) developed M+. The median time from RP to M+ was 32.0 (1.6-164.4) months. The 5and 10-year-metastases-free and cancer specific survival rates were 82.5% and 69.6%, and 85.9% and 70.0%, respectively. In multivariate analysis pathologic Gleason score, PSA, number of positive lymph nodes and time from RP to BCR were independent predictors (p-values

INTRODUCTION AND OBJECTIVES: Radical prostatectomy (RP) and initial observation may be considered as therapeutic options for the management of patients with locally advanced prostate cancer (PCa). The aim of our study was to describe the survival benefit associated with RP, as compared to initial observation, in these patients. Specifically, we relied on competing-risks analyses to estimate cancer-specific mortality (CSM) rates of patients treated with RP and to compare them to patients treated with initial observation. METHODS: Overall, 1,382 patients with locally advanced PCa (clinical stage T3/T4) treated with RP or initial observation between 1995 and 2009 within the Surveillance, Epidemiology, and End Results Medicare-linked were evaluated. Patients in both treatment arms (RP vs. observation) were matched using propensity-score methodology. Ten-year cancer-specific mortality (CSM) rates were estimated, and the number needed to treat (NNT) was calculated. Competing-risks regression analyses tested the relationship between treatment type and CSM. All analyses were repeated after stratifying patients according to Gleason score ( 7 vs. 8-10) and clinical stage (T3a vs. T3b/T4). RESULTS: Overall, 908 (65.7%) and 474 (34.3%) patients were treated with observation and RP. Overall, the 10-year CSM rates were 11.8 vs. 19.3% for patients treated with RP vs. initial observation, respectively (P

1 Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA, 2 Department of Urology, University Hospital Basel, Basel, Switzerland, 3 Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, 4 Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France, 5 Department of Urology, Vita-Salute University San Raffaele, Milan, Italy, 6 Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA, 7 Department of Urology, University of Munster Medical Center, Munster, Germany, 8 Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA, 9 Department of Urology, Medical University of Vienna, Vienna, Austria, 10 Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. MP40-14

INTRODUCTION AND OBJECTIVES: Previous studies demonstrated that patients (pts) with one or two positive nodes have a significantly better cancer specific survival (CSS) compared to pts with three or more nodes involved at radical prostatectomy (RP). However the impact of the number of positive nodes on CSS have never been tested in pts with locally-advanced PCa. The aim of the study was to examine CSS according to the number of positive nodes in pts harboring pT3 PCa at RP. METHODS: We identified 1562 pT3 pts treated with RP and extended pelvic lymph node dissection between 1988 and 2012 at our institution. Pts were stratified according to the absence of seminal vesicle invasion (SVI) vs presence of SVI and according to the number of positive nodes: 0 (N0), 1-2 (N1a) and 3 (N1b). Kaplan-Meier analyses assessed CSS. Multivariable (MVA) Cox regression analyses was used to test the impact of number of positive nodes on CSS. Covariates included patient age, surgical margin (SM) status, pathological Gleason score (GS), and adjuvant therapy. RESULTS: Overall, SVI was reported in 806 (51.6%) pts and 990 (63.4%), 366 (23.4%), and 206 (13.2%) pts were N0, N1a, and N1b, respectively. Mean follow-up time was 71 months (median 60 months). The mean number of nodes removed was 17 (median: 16, range: 1-66). The 5 and 10 year CSS after RP was 94.5% and 86.5%. After stratification according to the number of positive nodes, 5 and 10 year CSS was 96% and 86% for N0, 93% and 78% for N1a, 78% and 61% for N1b (all p 0.02). At MVA, no difference between N0 and N1a pts was recorded (p 0.3). Conversely N1b pts were 3 times more likely to die for PCa than N0 pts (HR:3.2, p 0.001). After stratification according to stage, the 5 and 10 year CSS was 99% and 89% for N0, 96 and 77% for N1a, 60% and 47% for N1b in the group without SVI (all p 0.04). Conversely, in pts with SVI, no significant difference was observed in CSS at 5 and 10 years between N0 and N1a pts (92vs82% for N0 and 93% and 77% for N1a respectively, p 0.7), while CSS was significantly lower in N1b pts (77% and 60% respectively, p 0.001). At MVA, no significant difference was observed between pts with N0 and N1a both in pts with or without SVI (all p 0.2). Conversely N1b pts had a significantly higher risk of dying of PCa compared to N0 and N1a pts (HR 14.2 and 2.1 for pts with and without SVI respectively, all p 0.02). CONCLUSIONS: In conclusion in pT3 pts, the presence of a high nodal burden is associated with poor prognosis. However, a limited (2 or less) number of nodes involved does not compromise cancer control in pts with locally advanced disease.

INTRODUCTION AND OBJECTIVES: To compare the oncological results of radial prostatectomy (RP) and High Intensity Focused Ultrasound (HIFU) performed in the same urological department during the same period (2000 – 2005). METHODS: All consecutive patients 70 years old were included in this study. All data were collected prospectively on secured database. Patients treated with HIFU underwent systematic control biopsy and a second HIFU session in case of positive biopsy. RESULTS: A total of 723 patients were included in the study: 423 RP (open: 259, Laparoscopic: 154) and 310 HIFU. Except the mean age (RP: 61 years, HIFU: 64 years, p 0.001) they was no difference between the 2 groups for PSA (RP: 9.2ng/ml, HIFU: 8.5ng/ ml), Gleason score (RP: 6.3 1, HIFU: 6.2 1) and the D’Amico risk group (Low 42.6% vs. 39.5%, intermediate 43.1% vs. 44.8% and high 14.4% vs. 15.7% for RP and HIFU respectively). The mean nadir PSA was significantly different between RP and HIFU: 0.17ng/ml (median: 0.06ng/ml) and 0.72ng/ml (median: 0.16ng/ml). A salvage EBRT was performed in 22.3% of the RP group versus 34.5% in the HIFU group (p 0.01) but the rate of palliative androgen deprivation (AD) was not different: 9.4% for RP and 12.3% for HIFU (p 0.22). At 9 years, no difference was found in the overall survival rate (RP: 93%, HIFU: 89%, p 0.1) and in the cancer specific survival rate (RP: 99%, HIFU: 97%, p 0.31). The metastasis survival rate was 97% for RP and 94% for HIFU (p 0.01). The AD free survival rate was 87% in the RP group and 85% in the HIFU group (p 0.29). CONCLUSIONS: The RP provide a better local control and metastasis free survival rate at 9 years compared to HIFU. However, the specific survival rate and AD survival rate were not different at 9 years between RP and HIFU.