Eur Urol Suppl 2007;6(2):64 165 PROgNOSTIC FACTORS FOR OUTCOME FOllOWINg RAdICAl NEPhRECTOMY Hanchanale V., Javle P. Leighton Hospital, Urology, Crewe, United Kingdom Introduction & Objectives: Mortality rate following radical nephrectomy (RN) is declining over the last decade due to improvement in anaesthetic, surgical techniques and peri-operative care. We examined the Hospital Episode Statistics (HES) data from England to assess the prognostic factors for outcome following radical nephrectomy. Material & Methods: Hospital Episode Statistics (HES) database of Department of Health of England was extracted for RN using ICD-10 and OPCS-4 codes. Charlson scores were estimated using preoperative co- morbidity data and divided into 3 groups. Mortality rate (MR) and length of hospital stay (LOS) were analysed in four age groups (years) (<50, 50-59, 60-69 and ≥70). Results: A total of 20,672 patients recorded as undergone radical nephrectomy over 7 year study period were included in the study. Mortality rate in <50, 50-59, 60-69 and ≥70 age groups was 0.7%, 0.8%, 2.2% and 4.6 % respectively. In case mix-adjusted multivariate analysis, age had prognostic inluence when the patients <50 year group was compared to the ≥70 year group for RC (odd ratio (OR), 6.75; 95% conidence interval (CI), 4.32-10.55; P<0.001). Other predictive factors for higher mortality were co-morbidity (OR-1.65; 95% CI, 1.53-1.77; p<0.001), male gender (OR-1.32; 95% CI, 1.05-1.66; p=0.017) and emergency surgery (OR-0.36; 95% CI, 0.28-0.47; p<0.001). Age and co-morbidity had less signiicant impact on the median LOS. CHARLSON SCORE <50 50-59 60-69 ≥70 Test (p value) MR (%) 0 0.4 0.5 1.2 2.7 χ² =102.142, 3df. (p< 0.001) 1-2 2.4 0.9 4.7 8.0 χ² =41.666, 3df. (p<0.001) ≥3 2.4 3.3 5.6 14.0 χ² =61.917, 3df. (p<0.001) Median LOS, days 0 7 8 9 10 χ² =1290.610, 3df. (p< 0.001) 1-2 8 9 10 12 χ² =194.084, 3df. (p<0.001) ≥3 9 10 11 13 χ² =109.642, 3df. (p<0.001) Conclusions: Prognostic factors for higher mortality following radical nephrectomy are age more than 70years, co-morbidity, male gender and emergency surgery. Furthermore these prognostic factors have a signiicant impact on the hospital stay following radical nephrectomy. 166 PRESENCE OF SYSTEMIC SYMPTOMS IS ThE FOREMOST PREdICTOR OF MORTAlITYIN PATIENTS WITh ExClUSIvE NOdAl METASTASES Karakiewicz P.I. 1 , Trinh Q.D. 1 , Bhojani N. 2 , Bensalah K. 3 , Salomon L. 4 , De La Taille A. 4 , Tostain J. 5 , Cindolo L. 6 , Altieri V. 6 , Ficarra V. 7 , Schips L. 8 , Zigeuner R. 8 , Mulders P.F. 9 , Valeri A. 10 , Descotes J.L. 11 , Mejean A. 12 , Patard J.J. 3 1 University of Montreal Health Center, Cancer Prognostics and Health Outcomes Unit, Montreal, Canada, 2 University of Montreal Health Center, Urology, Montreal, Canada, 3 Rennes University Hospital, Urology, Rennes, France, 4 Centre Hospitalier Universitaire Henri Mondor, Urology, Creteil, France, 5 Centre Hospitalier Universitaire of Saint-Etienne, North Hospital, Urology, Saint-Etienne, France, 6 ”Medical School of University Federico II”, Urology, Naples, Italy, 7 University of Verona, Urology, Verona, Italy, 8 Medical University of Graz, Urology, Graz, Austria, 9 University Medical Center Nijmegen, Urology, Nijmegen, The Netherlands, 10 Comite de Cancerologie de l’Association Francaise d’Urologie (CCAFU), Urology, Brest, France, 11 Comite de Cancerologie de l’Association Francaise d’Urologie (CCAFU), Urology, Grenoble, France, 12 Comite de Cancerologie de l’Association Francaise d’Urologie (CCAFU), Urology, Paris, France Introduction & Objectives: Outcome of patients with exclusive renal cell carcinoma (RCC) nodal metastases without distant metastases is not extensively described. We searched for the most important predictors of renal cell carcinoma speciic survival (RCC-SS) in these patients. Material & Methods: Analyses targeted 171 patients with RCC nodal metastases and absence of distant metastases. Univariable, multivariable and predictive accuracy analyses addressed RCC-SS with the intent of identifying independent and most informative predictors of RCC-SS in this cohort of patients. Results: Median RCC-SS was 2.3 years. At 10 years, 30% were alive and 40% of asymptomatic patients were alive at 10 years vs. 12% of those with systemic symptoms. In multivariable analyses, symptom classiication contributed the most to the combined predictive accuracy of all variables (+4.2%, p<0.001) and was followed by Fuhrman grade (+2.3%) and histological subtype (+1.0%). Conclusions: Renal cell carcinoma speciic survival of patients with exclusive nodal metastases may show important variability and is mostly afected by the presence of systemic symptoms. Patients with systemic symptoms may warrant early systemic therapy. Time (years) Asymptomatic Number at risk: 48 11 NA NA NA Number of events: 0 16 NA NA NA local Number at risk: 62 17 9 3 1 Number of events: 0 24 26 26 26 Systemic Number at risk: 57 8 5 3 NA Number of events: 0 39 41 42 NA 167 A NOMOgRAM PREdICTINg RENAl CEll CARCINOMA-SPECIFIC SURvIvAl IN PATIENTS WITh NOdAl METASTASES IS MORE ACCURATE ThAN ANY INdIvIdUAl vARIAblE Karakiewicz P.I. 1 , Trinh Q.D. 1 , Hutterer G.C. 1 , Bhojani N. 2 , Bensalah K. 3 , Patard J.J. 3 , Salomon L. 4 , De La Taille A. 4 , Tostain J. 5 , Cindolo L. 6 , Altieri V. 6 , Ficarra V. 7 , Schips L. 8 , Zigeuner R. 8 , Mulders P.F. 9 , Valeri A. 10 , Descotes J.L. 11 , Mejean A. 12 1 University of Montreal Health Center, Cancer Prognostics and Health Outcomes Unit, Montreal, Canada, 2 University of Montreal Health Center, Urology, Montreal, Canada, 3 Rennes University Hospital, Urology, Rennes, France, 4 Centre Hospitalier Universitaire Henri Mondor, Urology, Creteil, France, 5 Centre Hospitalier Universitaire of Saint-Etienne, North Hospital, Urology, Saint-Etienne, France, 6 Medical School of University “Federico II”, Urology, Naples, Italy, 7 University of Verona, Urology, Verona, Italy, 8 Medical University of Graz, Urology, Graz, Austria, 9 University Medical Center Nijmegen, Urology, Nijmegen, The Netherlands, 10 Comite de Cancerologie de l’Association Francaise d’Urologie (CCAFU), Urology, Brest, France, 11 Comite de Cancerologie de l’Association Francaise d’Urologie (CCAFU), Urology, Grenoble, France, 12 Necker University Hospital, Urology, Paris, France Introduction & Objectives: Outcome of patients with exclusive renal cell carcinoma (RCC) nodal metastases without distant metastases is not extensively described. We developed and validated a standardized nomogram predicting the probability of renal cell carcinoma-speciic mortality (RCC-SM) in this subgroup of patients. Material & Methods: Analyses targeted 171 patients with RCC nodal metastases and absence of distant metastases (TanyN1-2M0). Cox regression analyses were used to develop a prognostic nomogram for prediction of RCC-SM. Results: Median RCC-SS in this subgroup of patients was 2.3 years. In multivariable analyses, symptom classiication (p<0.001), Fuhrman grade (p=0.02) and histological subtype (p=0.04) were independent predictors of RCC-SM. The nomogram predicting RCC-SM based on histological subtype, Fuhrman grade, symptom classiication, T stage and tumour size was 67.3% accurate and performed signiicantly better than symptom classiication alone, where presence of systemic symptoms represented the strongest predictor of mortality. Conclusions: RCC-SM of patients with exclusive nodal metastases may show important variability. Models predicting RCC-SS in patients with exclusive nodal metastases are not perfectly accurate. However, they systematically combine the available predictors and are signiicantly better than single variables or chance predictions. We developed and validated a nomogram predicting RCC-SM in this group of patients. This nomogram may assist clinical decisions regarding treatment choice and follow-up as well as identifying patients at high risk of mortality who may beneit from neo-adjuvant and/or adjuvant treatment modalities. 168 ThE ROlE OF hElICAl COMPUTERIzEd TOMOgRAPhY (CT) IN dETECTINg SPORAdIC MUlTIFOCAl RENAl CORTICAl TUMORS: IMAgINg ANd PAThOlOgY CORRElATIONS Porcaro A.B. 1 , Cesaro G. 2 , Pomaro E. 2 , Longo M. 1 , Pianon R. 1 , Balzarro M. 1 , Migliorini F. 1 , Monaco C. 1 , Zecchini Antoniolli S. 1 , Sava T. 3 , Comunale L. 1 1 Civil Major Hospital, Urology, Verona, Italy, 2 Civil Major Hospital, Radiology, Verona, Italy, 3 Civil Major Hospital, Oncology, Verona, Italy Introduction & Objectives: Multifocal renal cortical tumors have been well described in cases of hereditary renal cancer cell carcinomas. However, the contemporary urologic literature ofers only limited data on sporadic multifocal renal cortical tumors where incidence ranges between 5 to 25 %. Actually Helical CT detection of renal multifocal tumors is a hard task, indeed clinical occult multifocality ranges between 3,5 to 18,4%. Objective of this report was to evaluate the clinical incidence of multifocal renal cortical tumors in a contemporary and consecutive series and to assess the role of Helical CT in detecting preoperatively clinical multifocality as well the frequency of clinically occult multifocality. Material & Methods: From January 2004 to July 2006, 105 consecutive patients underwent surgery for renal parenchimal tumors. Volumetric multislice helical CT was performed preoperatively in all patients according to a predeinite protocol in order to detect multifocality. The surgical specimen was investigated by the Uropathologist according to the predeinite protocol in order to assess multifocality. Renal tumors were classiied according to the last WHO classiication. The size of primary unifocal and multifocal renal tumors were compared by the median statistical test of Mood. It was investigated in the literature the clinical incidence and CT sensitivity in detecting multifocal renal tumors which were compared with our experience Results: Surgical treatments performed included nephron sparing surgery in 29 patients and radical nephrectomy in 76. Clinical multifocality was detected in 14/105 patients and the incidence was 13%. Helical CT scan detected multifocality in 8/14 patients and its sensitivity was 57%. Pathology detected clinical occult multifocality in 6/105 patients (5,7%). Average primary tumor size was 5,1 (range 1,2 – 14 cm) for unifocal tumors and 3,33 cm (0,5-14) in multifocal tumors; this diference resulted statistically signiicant (p=0,02). The overall incidence of multifocal parenchimal renal tumors, as reported from the literature was 11,9%. Overall occult multifocality reported in the literature was 7,4%. Overall imaging sensitivity was 28,7%. Helical CT sensitivity detected by our experience (57%) was compared with that reported from the literature (28,7%) and thus diference resulted statistically signiicant (p=0,02). Conclusions: In our experience, sporadic primary multifocal renal tumors had lower mean size than multifocal tumors and helical CT was efective in improving preoperative detection of multifocality as well as in lowering clinical occult multifocality. Preoperative detection of clinical multifocality may help in planning efective preoperative surgical treatment as well as lowering local recurrence after nephron sparing surgery. Technical and methodological improvements in performing Helical CT will improve it sensibility in detecting renal masses lower than 0,5 cm.