Eur Urol Suppl 2011;10(2):99 the future because otherwise, the subdivision into prognostically different groups by conventional histomorphology might remain of limited value. 246 CliniCal iMPaCt of who 2004 CoMPared to who 1973 histologiC ClassifiCation on ta PriMary bladder CanCer tuMors. long-terM follow-uP of a single institution exPerienCe Pellucchi F., Rocchini L., Ibrahim B., Doglioni C., Maccagnano C., Zanni G., Passoni N., Fossati N., Villa L., Gandaglia G., Capogrosso P., Colombo R. Urological Research Institute, Vita-Salute San Raffaele University, Dept. of Urology, Milan, Italy introduction & objectives: To defne both recurrence-free survival (RFS) and progression-free survival (PFS) in a series of patients with primary Ta bladder cancer (NMIBC) assessed by both WHO 2004 and WHO 1973 pathological classifcation system for grading. Materials & Methods: We retrospectively evaluated clinical data concerning 270 consecutive patients suffering from frst episode bladder cancer and diagnosed with Ta stage tumor at transurethral resection (TUR) between 2004-2008. In all cases the grading was assigned as low grade according to WHO 2004 and as G1,G2 according to WHO 1973 classifcation system, by a single uro-pathologist. All patients received only a single early-prophylaxis instillation with 50 mg epirubicin as adjuvant treatment. Follow-up examination included urine cytology and cystoscopy at 3 months after resection and then every six months for 5 years. Univariate analysis for recurrence-free survival (RFS) and progression-free survival (PFS) defnition, was performed by the Kaplan-Meier method with the long-rank test . results: Mean age was 67.3 yr (median: 67; range: 27-91); 50 patients were female (18.1%) and 227 (81.9%) were male. Grade distribution was low according to WHO 2004 in all cases and G1 in 87 patients (32.2%) and G2 in 183 (67.8%), according to WHO 1973, respectively Median follow-up period was 25 months (mean 27.4; range 1–72). The 5-year RFS rate was 62% for G1 and 40% for G2 group. RFS rate was documented to be 49.4% for overall low-grade patients. The 5-year PFS rate was 97.6% and 93.3% for G1 and G2 group, respectively and 93.5% for the overall low-grade population. We could document only one case of progression to T1 in G1 group and 13 (8 to T1, 2 to T2 and 3 CIS) in G2 group. The difference of 5-year RFS rate was documented to be statistically signifcant when comparing G1 and G2 patients (p=0.004). No signifcant difference from statistical point of view was registered for the 5-years PFS rate when comparing G1 and G2 patients. Conclusions: The WHO 1973 classifcation more accurately predicted Ta patients at higher risk to RFS. However, the WHO 2004 classifcation resulted as accurate as the WHO 1973 in predicting the long term PFS. This result seems to confrm the clinical reliability of the new histologic classifcation for the defnition of both treatment and follow-up schedules of Ta tumors. 247 Pt3 substaging is a PrognostiC indiCator in lyMPh node negative urothelial CarCinoMa of the bladder Tilki D. 1 , Novara G. 2 , Ficarra V. 2 , Seitz M. 1 , Kassouf W. 3 , Fradet Y. 4 , Skinner E. 5 , Stief C.G. 1 , Reich O. 6 , Shariat S.F. 7 1 Ludwig-Maximilians-University Munich, Dept. of Urology, Munich, Germany, 2 University of Padua, Dept. of Urology, Padua, Italy, 3 Mc Gill University Health Centre, Dept. of Urology, Montreal, Canada, 4 Laval University, Dept. of Urology, Quebec, Canada, 5 University of Southern California, Dept. of Urology, Los Angeles, United States of America, 6 Klinikum Harlaching, Dept. of Urology, Munich, Germany, 7 Weill Cornell Medical College, Dept. of Urology, New York, United States of America introduction & objectives: To assess the prognostic value of pT3 urothelial carcinoma of the bladder (UCB) substaging. Materials & Methods: The records of 2605 patients treated with RC for UCB at six international centers were reviewed. 808 (31.0%) patients had pT3 UCB. None of the patients received pre-operative systemic chemotherapy or radiotherapy. Median follow-up was 45 months for those patients alive at last follow-up. results: Median patient age was 68 years. 310 (38.4%) patients had stage pT3a and 498 patients (61.6%) had stage pT3b. 352 patients (43.6%) patients had metastases to regional lymph nodes. Five-year recurrence-free [43.8% vs. 41.4%] and cancer-specifc survival [48.6% vs. 46.8%] estimates were similar between pT3a and pT3b patients (p=0.277 and p=0.625, respectively). Conversely, in patients with pathologically negative lymph nodes, pT3b substaging was associated with worse recurrence-free [at 5years: 60.7% vs. 47.9%] and cancer- specifc [at 5years: 64.4% vs. 55.0%] survival (p=0.020 and p=0.048, respectively). Conclusions: Macroscopic perivesical fat extension (pT3b) is associated with worse outcome compared to pT3a in lymph node negative UCB patients. pT3 substaging may help identify pT3 patients who could beneft from adjuvant chemotherapy. 248 PrognostiC analysis of PathologiC stage t3a and t3b urothelial bladder CanCer without lyMPh node involveMent Dinçel C., Kara C., Balcı U., Özer K., Özbir S., Girgin C. Izmir Ataturk Training and Research Hospital, Dept. of 1st Urology, Izmir, Turkey introduction & objectives: To evaluate any difference in survival on patients we performed radical cystectomy for pathological stage pT3a and pT3b lymph node- negative urothelial bladder cancer. Materials & Methods: Totally 460 patients who underwent radical cystectomy, between 1991 and 2010 is reviewed. We excluded patients with nontransitional cell cancer, lymph node disease, or with unknown lymph node status. In total 74 patients are categorized under pT3 substages. results: The patients are divided into 2 groups. Group1 had 35 patients (47,2 %) with T3a and group 2 had 39 patients (52,8 %) with T3b. Average age in Group 1 was 61,61±8,13 year and average follow-up period was 20,34±16,99 months. Group2 average age was 62±8,87 year and average follow-up period was 21,17±18,33 months. Group 1 had 4, group 2 had 3 female patients. In both groups, there wasn’t a signifcant difference between age, sex and follow-up periods with complication rates and adjuvant therapy (p>0,05). In second group, grade 3 tumors were more frequent (p=0,032). Five-year OAS rates were 39,6% and 30,3% and OAS periods were 37,11±6,14 and 35,79±6,72 respectively(p=0,938). Five-year DSS rates were 46,9% and 34,4% respectively. DSS periods were 43,94±6,5 in group 1 and 39,01±7,19 months in Group 2 (p=0,539). On Cox regression analysis, there was no predictive value for survival with age, sex, grade and stage (p>0,05). Conclusions: There were no signifcant differences in DSS and OAS rates, complication rates and adjuvant therapy when comparing lymph node-negative pT3a versus pT3b urothelial bladder cancer. Therefore, we think there is no effect on substaging T3 cases on survival and prognosis. 249 does nodal staging of bladder CanCer in the new tnM ClassifiCation (tnM7) Provide a better PrognostiC value than nodal staging in the forMer ClassifiCation (tnM6) in a CysteCtoMy series? Jensen J.B. 1 , Ulhøi B.P. 2 , Jensen K.M. 1 1 Aarhus University Hospital, Skejby, Dept. of Urology, Aarhus, Denmark, 2 Aarhus University Hospital, Aarhus Sygehus NBG, Institute of Pathology, Aarhus, Denmark introduction & objectives: As of January 1 st 2010 a new TNM classifcation (TNM7) was introduced by UICC (Union Internationale Contre le Cancer). Changes regarding classifcation of invasive carcinoma of the bladder were primarily made on nodal staging. According to the former TNM classifcation (TNM6), classifcation was based on number and size of metastatic lymph nodes. In TNM7 however, the classifcation is based on number and location of metastatic lymph nodes. With this study we wanted to evaluate, whether the change from size criteria to location criteria had implication on the prognostic value of nodal staging according to TNM classifcation in a cystectomy population. Materials & Methods: From a consecutive cystectomy series of 300 patients, in whom lymph node dissection was performed at a minimum up to the aortic bifurcation, 72 patients with positive lymph nodes were included in the study. All metastatic lymph nodes were registered meticulously as to number, location and size. Thus, it was possible to classify all patients according to both TNM6 and TNM7. Clinical follow-up was made regarding recurrence free survival (RFS), cancer specifc survival (CSS) and overall survival (OS). results: Fifty patients (69%) remained unchanged in nodal stage, whereas 22 patients underwent either upstaging (20 pts – 28%) or downstaging (2 pts – 3%) according to the new TNM7. Patients, where a stage divergence between the TNM6 and TNM7 classifcations was present, had a lower RFS than patients who had the same nodal stage according to the two TNM classifcations. Interestingly, this was true in both patients that were upstaged as well as a tendency in patients that were downstaged according to TNM7. No patients were classifed N3 according TNM6 whereas 20 patients (28%) were classifed N3 according the TNM7 classifcation. We found, however, no difference in RFS, CSS and OS comparing N2 and N3 patients according to TNM7. Conclusions: In a cystectomy population, approximately one third of the node positive patients may be reclassifed to another nodal stage according to TNM7 compared with TNM6. Most of the stage divergence is a result of the new N3 category based on location of the metastases rather than size of the metastatic lymph nodes. This new group of N3 patients has however the same RFS, CSS and OS as N2 patients. We therefore do not fnd that the new TNM7 provides a better prognostic tool compared with the former TNM6 in a cystectomy series. 250 the added value of different nodal Coding sCheMes in bladder CanCer Patients following radiCal CysteCtoMy (rC): a PoPulation-based analysis Abdollah F. 1 , Lughezzani G. 1 , Sun M. 2 , Jeldres C. 2 , Liberman D. 2 , Ismail S. 3 , Shariat S.F. 4 , Perrotte P. 3