RESULTS: The overall rate of locally-advanced RCC was 23.9% (n=16679). Of all patients, 16927, 18035, 17371 and 17382 were classified as lowest, low, intermediate and high SES. In univari- able analyses addressing the presence of pT3-4 or pN1-2 stage at diagnosis, SES was a statistically significant predictor. Specifically, patients in the lowest SES quartile were 1.10-fold more likely to have locally-advanced stage at diagnosis (p0.001). In multivariable analy- sis, SES achieved the independent predictor status (p0.001) and patients in the lowest SES quartile showed a 1.12-fold higher risk of harboring locally-advanced disease relative to high SES patients. Ad- vanced patient age (p0.001), male gender (p0.001), larger tumor size (p0.001) and higher tumor grade (p0.001) also achieved the independent predictor status. CONCLUSIONS: Low SES is an independent predictor of lo- cally-advanced RCC. This implies that low SES may represent a barrier to timely diagnosis of non-metastatic RCC. Source of Funding: None 1799 GENE EXPRESSION PROFILES OF LYMPHOCYTES IN PATIENTS WITH METASTATIC RENAL CELL CARCINOMA (RCC) TREATED WITH DENDRITIC CELL (DC)-BASED IMMUNOTHERAPY Thomas Schwaab*, Buffalo, NY; Benita Wolf, Adrian Schwarzer, Hannover, Germany; Thomas Hampton, Jan Fisher, Jiang Gui, John Seigne, Marc Ernstoff, Lebanon, NH INTRODUCTION AND OBJECTIVES: In a recent Phase II trial of DC-based immunotherapy (combined with HD IL-2/ IFN-alpha), we reported a 50% overall response rate and significant immunologic effects. We analyzed gene expression profiles of lymphocytes in this patient cohort. METHODS: 18 patients with metastatic RCC were enrolled. 9 healthy age-matched donors (HD) served as controls. Lymphocytes were isolated from leukapheresis products prior to treatment and after the induction cycle. RNA was isolated and hybridized on a GeneChip® Human Gene 1.0 ST Array Affymetrix gene chip. A fold change ranking and non-stringent p-value were used to generate gene lists. Groups were compared using student t-test and paired t-test. For hierarchical clustering, data were log transformed and normalized. Ingenuity Path- ways Analysis library was used to identify canonical pathways. Genes from the dataset that met the fold change and p-value cutoff were analyzed. Expression of certain target genes (TLRs, IL-2 receptor) was confirmed using standard RT-PCR. RESULTS: 9 patients were categorized as responders (R, 3 complete, 6 partial) and 9 as non-responders (NR, 4 stable, 5 progres- sive disease). In patients, 1455 genes were up and 147 genes were down-regulated with a fold-change (FC)1.6 and p0.01, including genes for innate immune system activation, PDGF signaling, immune diseases and post-translational modification. Post-treatment, 136 genes were up- and 217 down-regulated (p0.05, FC1.14). Immu- notherapy resulted more in down- than in up-regulation of gene expres- sion (antigen processing/ presentation, NK cell cytotoxicity, Cytokine- receptor interaction, cell adhesion molecules). Analysis with Ingenuity pathway analysis revealed 3 altered canonical pathways: T-helper cell differentiation (p: 2.2x10^-5, ratio: 5/38), B-cell receptor signaling (p:6.2x10^-4, ratio: 7/153), role of NFAT in regulation of the immune response (p: 9.42x10^-4, ratio: 7/186). Comparing R to NR, 100 genes were upregulated in R and 167 genes were downregulated (p0.05, FC: 1.2) pre-treatment. Post-treatment, 157 genes were upregulated in R (p0.05, FC1.2). Analysis with Ingenuity revealed changes in NK cytotoxicity (7 molecules, p: 0.02) as well as antigen processing and presentation (11 molecules, p0.0001). CONCLUSIONS: This study presents the most comprehensive analysis of the genomic profile of lymphocytes in patients treated with immunotherapy. A number of genes and functional pathways were implicated as potential prognostic and therapeutic targets. Source of Funding: Practicing Urologist Award NE-AUA, 2009 1800 RETROPERITONEAL LYMPH NODE METASTASIS IN M0 RENAL CELL CARCINOMA Scott Delacroix Jr*, Stephen Culp, Jaclyn Jin-Ling Chen, Tamboli Pheroze, Surena Matin, Christopher Wood, Houston, TX INTRODUCTION AND OBJECTIVES: Patients with renal cell carcinoma and retroperitoneal lymph node only metastasis represent a heterogeneous population for which limited prognostic data exists. Delineation of factors predicting survival as well as analysis of out- comes in the cohort would aid in deciding between upfront systemic therapy or surgical treatment. METHODS: Using the M.D. Anderson Cancer Center nephrec- tomy database, patients without clinical evidence of distant metastasis (M0) but with pathologic positive nodes (Tany,N1-2,M0) were selected. The cohort was analyzed for predictive factors for recurrence free (RFS) and overall survival (OS). Recovery from surgery was also assessed to determine if operative disability would preclude systemic therapy in those that recurred. RESULTS: Using the aforementioned criteria, 69 patients were identified. Histologic diagnosis included clear cell (47), papillary (12), unclassified (7), and chromophobe RCC (3). The overall survival (OS) of patients with TanyN+M0 was 26.0 months (95% CI:17.7-49.7) with a median follow up of 19.2 months (range, 0.3-103.9). For the entire cohort, median RFS was 6.2 months with a total of 54 patients (75.4%) having a recurrence after surgical resection. Time to recurrence was within the first 4 months after surgery for 31 patients (44.9%), between 4 and 12 months for 8 patients (11.5%), greater than a twelve months in 13 patients (18.8%), and 17 patients (24.6%) have remained disease free long term(median f/u 4.4 years). Predictors of RFS were presence of sarcomatoid features (HR 2.07-univariate), clear cell histology (HR 1.63-univariate), number of positive nodes(HR 6.56), Fuhrman grade (HR 2.77), and the presence of matted lymph nodes (HR 6.93). Pre- dictors of OS were presence of sarcomatoid features (HR 3.23-univar- iate), node density (HR 1.01), grade (HR 2.22), and number of positive nodes (HR 1.09). Clinical node status and total nodes removed did not predict for either OS or RFS. Most patients, 60/69 (86.9%), maintained their functional status and were able to receive systemic upon recur- rence. Rapid functional decline precluding systemic therapy occurred in 6 patients (8.8%) with early progressive disease. Mortality prior to hospital discharge occurred in 3 patients (4.3%). CONCLUSIONS: For patients with isolated retroperitoneal lymph node metastasis, a majority of patients (56.6%) recur in the first year while a significant percentage (43.4%) will be surgically cured or recur after 1 year and probably derive benefit from upfront surgical therapy. In most patients, surgical resection did not preclude the use of systemic therapy. Source of Funding: None 1801 IMPACT OF LYMPH NODE DENSITY ON CANCER-SPECIFIC SURVIVAL IN PATIENTS WITH NODE-POSITIVE RENAL CELL CARCINOMA Marco Roscigno*, Elena Strada, Giovanni Petralia, Francesco Sozzi, Milan, Italy; Carlo Terrone, Alessandro Volpe, Novara, Italy; Diego Angiolilli, Andrea Gallina, Nazareno Suardi, Firas Abdollah, Andrea Salonia, Vincenzo Scattoni, Francesco Montorsi, Patrizio Rigatti, Roberto Bertini, Milan, Italy INTRODUCTION AND OBJECTIVES: To evaluate the impact of the lymph node density (LND) on cancer-specific survival (CSS) in patients with node-positive renal cell carcinoma (RCC). METHODS: The study included 153 consecutive patients who underwent RN and lymph node dissection (who presented positive nodes at final specimen) between 1987 and 2006 in three urologic centers. Median patient age was 60 years (range: 21-83). The extent of lymphadenectomy was at the discretion of the primary surgeon. The Kaplan-Meier method and univariable and multivariable Cox regression e698 THE JOURNAL OF UROLOGY Vol. 183, No. 4, Supplement, Tuesday, June 1, 2010