Eur Urol Suppl 2011;10(2):104 Conclusions: Based on analysis of the largest known cohort of patients with RCC along with Level III and IV thrombus involvement, Fuhrman grade and existence of preoperative metastasis were independent predictors of survival. Our findings support that based on oncological outcomes both approaches (with or without by- pass using) are safe. 264 EXTENDED LYMPHADENECTOMY INCREASES SURVIVAL IN T3-T4 RENAL CELL CARCINOMA WITH CLINICAL POSITIVE NODES Capitanio U. 1 , Suardi N. 1 , Strada E. 1 , Petralia G. 1 , Matloob R. 1 , Roscigno M. 2 , Angiolilli D. 1 , Doglioni C. 3 , Da Pozzo L.F. 2 , Bertini R. 1 1 Urological Research Institute, Vita-Salute San Raffaele University, Dept. of Urology, Milan, Italy, 2 Ospedali Riuniti, Dept. of Urology, Bergamo, Italy, 3 Urological Research Institute, Vita-Salute San Raffaele University, Dept. of Pathology, Milan, Italy Introduction & Objectives: Controversies exist regarding the effect of lymphadenectomy in renal cell carcinoma. We hypothesized that clinical positive node high risk kidney cancer patients might benefit from extended LND not only for staging but also for survival purposes. Materials & Methods: Clinical and pathologic data were prospectively gathered in 1258 patients treated at a single Academic Center, between 1991 and 2010. Only pts with T3abc-T4 RCC (357, 28.4%) were included. Univariable and multivariable Cox regression analyses targeted the association between the number of negative and positive lymph nodes removed and cancer specific mortality (CSM). Analyses were adjusted for age, Fuhrman grade, symptoms and metastases at diagnosis and presence of necrosis. Results: At a median 56-month follow-up, 184 T3-4 renal cell carcinoma related deaths had occurred (51.5%). T classification according to TNM 2009 was T3a- b-c and T4 in 324 (90.8%) and 33 (9.2%), respectively. At diagnosis, lymph node and distant metastases were present in 111 (31.1%) and 122 cases (37.0%), respectively. Grade 1-2 or 3-4 was noted in 123 (34.5%) and 234 (65.5%) tumors, respectively. Mean number of lymph nodes removed was 6.2 (median 4). One, 2, 5 and 10-year cancer specific survival rates were 75.0%, 64.1%, 49.3% and 39.5%, respectively. In patients with clinical nodal involvement, after adjustment for all possible confounders, the number of lymph nodes removed and the number of positive nodes were independent predictors of CSM (HR 0.96 p=0.02 and HR 1.09 p=0.001, respectively). Conclusions: Extended lymphadenectomy increases survival in T3-T4 renal cell carcinoma with clinical positive nodes. 265 TREATMENT MANAGEMENT OF T1A RENAL CELL CARCINOMA IN THE 21ST CENTURY: A POPULATION- BASED ANALYSIS Sun M. 1 , Jeldres C. 1 , Liberman D. 2 , Tian Z. 1 , Djahangirian O. 2 , Ismail S. 2 , Shariat S.F. 3 , Karakiewicz P.I. 1 1 University of Montreal Health Center, Cancer Prognostics and Health Outcomes Unit, Montreal, Canada, 2 University of Montreal Health Center, Dept. of Urology, Montreal, Canada, 3 Weill Medical College of Cornell University, Dept. of Urology, New York, United States of America Introduction & Objectives: Partial (PN) or radical nephrectomy (RN) represent the standard of care for patients with small renal masses. Active surveillance (AS) may also be considered. We examined the rates of PN, RN and AS within a contemporary population-based cohort. Materials & Methods: Using the Surveillance, Epidemiology and End Results database, we identified 20663 patients diagnosed with T1aN0M0 renal cell carcinoma, between years 1988 and 2006. Determinants of PN and AS were assessed using logistic regression analyses within surgically managed patients and within the entire cohort, respectively. Results: Overall, 5935 (29%), 13721 (66%) and 1007 (5%) patients underwent PN, RN and AS, respectively. The rate of PN increased over time: 6.7% in 1988 to 39.6% in 2006 (p<0.001). The rate of RN declined over time: 86.1% in 1988 to 54.7% in 2006 (p<0.001). The rate of AS remained stable over time: 7.2% in 1988 to 5.7% in 2006 (p=0.6). In multivariable analyses, the determinants for PN consisted of more contemporary year of diagnosis, younger patient age, male gender, Caucasian race, and decreasing tumor size (all p<0.001). The determinants of AS consisted of more historical year of diagnosis, more advanced age, female gender, black race, decreasing tumor size, unmarried marital status, and low socioeconomic status (all p≤0.001). Conclusions: PN was still underutilized in the most contemporary year of the study. The low rates of AS were expected as per recent guideline recommendations. Several sociodemographic factors that are unrelated to tumor characteristics determined the type of treatment. 266 EXTERNAL VALIDATION OF THE RENAL NEPHROMETRY SCORE (RENAL NS) AS A PREDICTOR OF TOTAL NEPHRECTOMY AND COMPLICATIONS IN NEPHRON SPARING SURGERY (NSS) Long J.A., Arnoux V., Fiard G., Terrier N., Arvin Berod A., Descotes J.L., Rambeaud J.J. University Hospital, Dept. of Urology, Grenoble, France Introduction & Objectives: The RENAL NS described by Kutikov et al. to predict the difficulty of a partial nephrectomy is based on five reproducible anatomical features : tumor size, nearness to the collecting system, location of the tumor in the axial and sagittal plans, and endo/exophytic character. The aim of the study is to assess the validity of the RENAL NS by showing its correlation with the risk of failed NSS (total nephrectomy) and an increased rate of complications. Materials & Methods: We retrospectively reviewed the files of 107 consecutive patients candidates to a partial nephrectomy in our center. Median age was 57,4+/- 13 (23- 79). Median tumor size was 3.4 cm (1-6 cm). Surgery was performed through a flank incision in 91 cases and laparoscopically in 16 cases. Median clamp duration was 20,8 min (0-156 min). The RENAL classification was established by a single surgeon, based on preoperative CT-scan or MRI with coronal reconstructions. The need for totalization during or after the procedure, margin status, ischaemia time, blood loss and transfusion rate, surgical and medical complications according to the Clavien Classification were specifically assessed. Results: RENAL score was statistically correlated with the risk of totalization and the ischemia time (p=0,02), independently of surgical approach, BMI, and gender. Complication rate, blood loss, need for transfusion and positive margins were not associated with RENAL NS. Conclusions: RENAL NS is a good predictive tool for the risk of failed NSS (totalization during or after the procedure), and a longer ischemia time. In this study however, the RENAL NS wasn’t correlated to the risk of complications or an increased blood loss. Poster Session 23 RCC: BASIC RESEARCH 1 Saturday, 19 March, 16.00-17.30, Hall H 267 LOSS OF EPITHELIAL CELL ADHESION MOLECULE (EPCAM) IS ASSOCIATED WITH POOR OVERALL SURVIVAL IN CLEAR CELL RENAL CARCINOMA (CCRCC) - RESULTS OF A LARGE TMA-BASED ANALYSIS Eichelberg C. 1 , Chun F.K. 1 , Minner S. 2 , Schlomm T. 3 , Moch H. 4 , Terracciano L. 5 , Hinrichs K. 1 , Heuer R. 1 , Heinzer H. 3 , Fisch M. 1 , Simon R. 2 , Sauter G. 2 1 University Medical Center Hamburg-Eppendorf, Dept. of Urology, Hamburg, Germany, 2 University Medical Center Hamburg-Eppendorf, Institute of Pathology, Hamburg, Germany, 3 University Medical Center Hamburg-Eppendorf, Martini– Clinic Prostate Cancer Center, Hamburg, Germany, 4 University Hospital Zurich, Institute for Surgical Pathology, Zurich, Switzerland, 5 University Hospital Basel, Dept. of Molecular Pathology, Basel, Switzerland Introduction & Objectives: Controversy persists whether Epithelial cell adhesion molecule (EpCam) represents a valuable prognostic molecular marker in renal carcinoma (RCC). The aim of this study was to investigate the prevalence and prognostic significance of EpCam in a large European tissue micro-array (TMA)- based RCC cohort. Materials & Methods: A bi-institutional renal tumor tissue micro-array (TMA) consisting of 1081 tumor samples including 767 clear cell (cc) RCC, was investigated by EpCam immunohistochemistry (IHC) and evaluated by a single uropathologist (G.S.). Results were correlated with pathological features and clinical follow up information (median 34 months) using Chi-square, Cox-regression and Kaplan Meier analyses. Results: EpCam staining intensities significantly varied between RCC subgroups (p<0.0001). Specifically, in ccRCC, loss of EpCam expression was associated with high-grade disease (p=0.005) and nodal metastases (p=0.018). Kaplan Meier analysis demonstrated a significant association between EpCam IHC and overall survival (OS, Figure 1). On multivariable analysis, EpCam, Fuhrman grade and pT-stage represented independent risk factors of OS (all p≤ 0.03). Similarly, in subgroup analysis of localized, low-grade (G1-2) RCCs, EpCam but not Fuhrman grade remained independently associated with OS (p=0.028). Conclusions: To date, we present the largest TMA study on EpCam IHC in RCC. Loss of EpCam expression demonstrated a clear association with adverse