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Purpose Muscle invasive bladder cancer surgical management has been historically a radical cystoprostatectomy in males and an anterior exenteration in females. Uterine, ovarian, and vaginal preservation are utilized, but raise concerns regarding risk to oncologic control, especially in variant histopathology or advanced stage. Materials and Methods A retrospective single institutional analysis identified radical cystectomies performed in women, including those with variant histology, which were defined as reproductive organ sparing (uterine, vaginal, and ovary sparing) or non-organ sparing. The Kaplan-Meier method was used for recurrence-free (RFS) cancer specific survival (CSS) and overall (OS) survival in patients with advanced disease. Results From 2000 to 2020, 289 women were identified, 188 underwent reproductive organ-sparing cystectomy. No statistical differences were noted for clinical parameters or presence of variant histology for organ-sparing (ROS) and non-organ sparing (non-ROS). Positive margin rates did not differ for ROS and non-ROS; 4.3% vs 7.9%, p=0.19, respectively. Median RFS was not statistically significantly different for ROS vs non-ROS (26.1 vs 15.3 months) p=0.937 HR 1.024. CSS was not statistically different for ROS vs non-ROS (36.3 vs 28.6 months), p=0.755 HR 0.9. OS was not statistically different for ROS vs non-ROS (25.8 v 23.8 months), p=0.5 HR=1.178. Variant histology did not change survival (HR 1.1, p=0.643). Conclusions In this analysis, ROS in women with advanced disease did not increase positive margin rates or decrease RFS, CSS, or OS compared to non-ROS. Variant histology did not decrease survival odds. Based on preoperative assessment and intraoperative findings, ROS in patients with variant histology and advanced disease should be considered.

INTRODUCTION AND OBJECTIVE:Muscle invasive bladder cancer (MIBC) surgical management has been historically a radical cystoprostatectomy in males and an anterior exenteration in females. Uterine and...

295 Background: Patients with small renal masses (SRM) can be managed conservatively by active surveillance (AS) or active treatment. A subset of patients who elect for AS undergo delayed intervention, either due to progression or other factors. Using a large, prospective registry of patients with SRMs we characterize differences in SRM growth trajectories on AS and pathologic differences among resected SRMs between African Americans (AA) and Caucasians. Methods: We stratified patients enrolled in the prospective Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry by race. DISSRM includes AS, primary intervention (PI), and delayed intervention (DI). The growth rate for patients who elected for AS was compared between AA and Caucasian patients. Pathologic features among patients who underwent PI or DI were compared by race. Results: We enrolled 745 patients in DISSRM who were either AA (n = 117, 15.7%) or Caucasian (n = 628 (84.3%)), with median follow-up of 3.3 years [IQR 1.5-6.6]. 410 patients elected for AS (84% Caucasian, 16% AA) and 401 opted for PI (n = 335) or DI (n = 66) (86% Caucasian, 14% AA). Within the AS cohort, no differences were seen in age, comorbidities, or tumor size, though Caucasians were more male-predominant (60.9% vs. 38.5%, p = 0.001), and body mass index was higher among AA (p = 0.03). Median overall growth rate for AA vs Caucasian was 0.04 cm/year [-0.03-0.3] vs 0.1 cm/year [0-0.33], p = 0.2 (Figure).In the DI arm, median time to intervention was 12.5 months, with HR (AA vs Caucasian) being 0.32 (0.13-0.82), p = 0.02. There were no differences in baseline clinical characteristics or tumor size in the DI or PI arm, however AA were more likely to undergo radical nephrectomy (24.6% vs. 10.4%, p = 0.01). pT stage and grade were similar between groups, and papillary histology was more common among AA (34.1% vs 19.9%, p = 0.007). There were 31 deaths among patients undergoing intervention, which was significantly worse for AA after multivariable adjustment (HR 2.51, p = 0.025). Conclusions: Using the largest prospective registry of SRM, we found the natural history of SRM on AS to be similar between AA and Caucasians. However, histology, surgical approach, and survival differed between groups, with worse OS among AA. Further socioeconomic and molecular analyses will help elucidate biological differences and identify strategies to improve outcomes among patients with SRM.

296 Background: The incidence of renal cell carcinoma (RCC) has gradually increased over the past decades, particularly among African Americans (AA). Lifestyle and other factors such as high blood pressure and tobacco exposure are associated with its incidence. We aim to compare differences in clinicopathologic characteristics and survival outcomes between AA and Caucasian patients undergoing nephrectomy for RCC. Methods: A retrospective single institutional analysis was performed on AA or Caucasian patients undergoing nephrectomy for RCC between 1996 and 2021. Baseline clinical and pathologic characteristics were compared by race. Survival outcomes, including cancer-specific survival (CSS) and overall survival (OS), were assessed by Kaplan-Meier methods and multivariable Cox regression analysis (MVA). Results: We included 2,439 patients (445 AA, 1987 Caucasians). AA patients were female-predominant compared to Caucasians (54.8% vs. 35.7%, p