1589 INFLUENCE OF SMOKING HISTORY ON BLADDER CANCER PATIENT OUTCOME FOLLOWING RADICAL CYSTECTOMY Anirban Mitra*, Denice Tsao-Wei, Tanya Dorff, Susan Groshen, Gus Miranda, Anne Schuckman, Siamak Daneshmand, Inderbir Gill, Donald Skinner, Eila Skinner, David Quinn, Los Angeles, CA INTRODUCTION AND OBJECTIVES: Smoking is a major risk factor for bladder cancer. However, effects of smoking on outcome of patients who have undergone cystectomy for bladder cancer is less clearly defined.This study used a large single-institution cohort to analyze the effects of prior exposure to cigarette smoke on prognosis following radical cystectomy. METHODS: 2,629 patients underwent radicalcystectomy for bladder cancer at USC between 1983 and 2008. Study inclusion criteria were (a) presence of bladder transitional cell carcinoma without distant metastasis,(b) minimum 2 yearpost-cystectomy follow up if patient was alive, and (c) documented pre-cystectomy smoking history by patient interview. Smoker status was defined as non-light, former and current. Duration of regular smoking until diagnosis/quitting, and den- sity of tobacco exposure as measured by number of cigarettes smoked daily were quantified. Associations with time to recurrence (TTR) and overallsurvival(OS) were analyzed using log-rank method and multi- variate Cox regression models. RESULTS: 1,185 patients methe inclusion criteria. Median patientage was 67 years. Median follow up was 67.8 months during which 696 (59%)patients died;321 (27%)patients died ofbladder cancer. 273 (23%), 396 (33%), 260 (22%) and 256 (22%) patients had noninvasive, organ-confined, extravesical and node-positive disease, respectively. Increased age was prognostic for TTR (p0.003) and OS (p0.001). Increasing pathologic stage, lymph node density, presence of lymphovascular invasion, and adjuvant therapy administration were univariately associated with increased risk of recurrence and death (all p0.001). Smoker status, duration ofsmoking,and number ofciga- rettes smoked daily were univariately associated with TTR (p0.006, 0.005, and 0.015, respectively) and OS (p0.001, 0.001, and 0.002, respectively).Following multivariatestratification,smoker status (p0.04) and duration of smoking (p0.04) were associated with TTR. Smoker status (p0.001), duration of smoking (p0.001), and number of cigarettes smoked daily (p0.006) were also associated with OS. In particular, the relative risks of death for current smokers and patients who smoked 40 years were 1.18 and 1.15 times that of nonsmokers. CONCLUSIONS: Pre-cystectomy smoking habits influence sur- vivalfollowing radical cystectomy. Currentsmokers and patients who smoke 40 years before diagnosis have a higher probability of death following radical cystectomy. Furtherwork willexamine the role of ongoing tobacco use on bladder cancer-specific mortality. Source of Funding: None 1590 ROBOTIC RADICAL CYSTECTOMY: MEDIUM-TERM ONCOLOGIC FOLLOW-UP Chinedu Mmeje*, Rafael Nunez, Phoenix, AZ; Raj Pruthi, Matthew Nielsen, Eric Wallen, Angela Smith, Chapel Hill, NC; Mitchell Humphreys, Erik Castle, Phoenix, AZ INTRODUCTION AND OBJECTIVES: We reportour experi- ence with robotassisted radicalcystectomy (RARC)with regard to medium-term (at least 2 year) oncologic outcomes. METHODS: A total of 275 patients have undergone RARC and urinary diversion at two institutions for invasive bladder cancer between 2005-present. We performed a retrospective analysis of the 139 pa- tients who underwent RARC with a minimum of2 years follow-up. Medium term oncologic outcomes including recurrence rates, time to recurrence,recurrence free survival (RFS), disease specific survival (DSS) were analyzed. Follow-up was measured from time of surgery to time of most recent clinical follow-up. RESULTS: This cohort of patients consisted of 108 men (78%) and 31 women (22%)at a mean age of 67.3 years (range 45– 86 years). Sixty-one (44%) patients had pT2 disease, 38 (27%) pT3/T4 disease, and 40 (29%) N disease. The mean number of lymph nodes removed was 18 (range 3– 41). The average clinical follow up in this case series was nearly 3 years with a mean of 35.9 months (range 24 – 64 months). At this follow-up, 39 patients have recurred, 27 pa- tients died ofdisease,and 5 patients died of other causes giving an overallRFS, DSS, and OS rates of 80%, 71%, and 68%, respectively. The mean (median) time to recurrence was 12.3 months (10 months). These findings are consistent with prior reports of the oncologic out- comes for open radical cystectomy. CONCLUSIONS: The oncologic follow-up of patients undergo- ing RARC appears to be favorable with acceptable outcomes in the medium-term (mean – 3 years). As our follow-up increases, we should expect to truly define the long-term clinical appropriateness and onco- logic success of this procedure. Source of Funding: None 1591 PROGNOSTIC ROLE OF LYMPH NODE DENSITY IN PNⴙ PATIENTS AT RADICAL CYSTECTOMY: A MULTICENTRE STUDY Giuseppe Simone*, Rocco Papalia, Salvatore Guaglianone, Mariaconsiglia Ferriero, Emanuela Altobelli, Maurizio Buscarini, Rome, Italy; Angelo Naselli, Genoa, Italy; Devis Collura, Turin, Italy; Carlo Introini, Paolo Puppo, Genoa, Italy; Giovanni Muto, Turin, Italy; Michele Gallucci, Rome, Italy INTRODUCTION AND OBJECTIVES: Lymph-node density (LN-d) in radicalcystectomy (RC)proved to be a strong prognostic factor but few reports are available in literature and it remains under- utilized into daily clinical practice. We analyzed the prognostic role of LN-d in a single series of patients undergone RC and we validated findings on an external series METHODS: Between May 2001 and September 2009 data of 750 RCs performed at our Institute were collected in a prospectively- maintained database. Out of 201 pN patients, 154 with non-meta- static urothelial carcinoma not undergone neoadjuvant treatments wer selected. Out of 750 RCs performed at two different centres in the same period 133 consecutive pN patients were selected as external vali- dation series. Template ofLND (Lymph-node dissection) was defined as standard when allymphatic tissue was removed from the obturator fossa up to the aortic bifurcation, limited when common nodes were no removed and aborted when LND was abandoned due to positive intraoperative frozen section. Once LN-d and lymph-node count (LN-c) cut-offvalues were identified by ROC analyses, the prognostic role of pT, pN, LN-d, LN-c, template and adjuvant treatments on cancer-specific survival (CSS) was assessed with univariate and multivariate Cox regression analy- ses. RESULTS: Significant thresholds were 11% and 30% for LN-d and 9 and 30 for LN-c. Statistically significant variables at univariate analysis were pT (p0.001), pN (p0.015), LN-d (p0.001), LN-c (p0.014) and tem- plate (p0.001). At stepwise Cox regression analysis only pT (p0.008), LN-d (p0.017) and Template (p0.023) proved to have independent role on CSS. Independentprognostic factors atstepwise Cox-regression analysis were LN-d (p0.001) and pT(p0.039) on the external series and pT (p0.005), LN-d (p0.022) and template (p0.002)on the whole cohort. e638 THE JOURNAL OF UROLOGY 姞 Vol. 185, No. 4S, Supplement, Tuesday, May 17, 2011