ABSTRACTS OF THE 21st ANNUAL MEETING OF THE ITALIAN ...

Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy
the predefined inclusion criteria. Data were analyzed in two
ways: a fixed-effect logistic regression approach and a
classical meta-analysis. Results: A total of 13,185 patients
were included. Follow-up was described in 22 studies, ranging
from 0.36 to 349.2 months. The overall prevalence of
recurrence of the upper urinary tract after cystectomy ranged
from 0.75 to 6.4%. TCC recurrence evidence appeared after
0.4 to 164 months. The presentation was in an advanced
(64.6%) or metastatic way (35.6%). Both situations had poor
survival rates. Patients affected by low-grade disease showed a
strong significant difference in TCC recurrence compared to
those having higher grade disease. The same difference in
TCC recurrence was reported between patients with carcinoma
in situ or superficial disease and those with muscle-invasive
disease. Patients with a history of carcinoma in situ did not
have statistically significant different recurrence rates from
those presenting with solitary bladder TCC. Moreover, there
was no statistically significant difference in TCC recurrence
rates between the different types of diversion adopted. In 24
studies, follow-up was carried out through periodic
radiological assessment of the upper urinary tract, while in 20
studies, urinary cytology was used in the follow-up. In 14
studies, 166 recurrences were reported. For 63 patients
(63/166; 38%), the upper urinary tract recurrence was
diagnosed due to the follow-up. The other recurrences (62%)
were diagnosed after the appearance of symptoms. Among the
5537 patients who underwent the follow-up pathway with a
urinary cytological examination, recurrences were diagnosed
in 1.8‰. This rate rose to 7.6‰ with a follow-up performed
with periodic upper urinary tract imaging. Conclusion: The
recurrence values appear low considering the panurothelial
field defect theory, but these values reflect the mortality
related to the initial bladder cancer. A group of patients at high
risk does exist, considering their anamnesis and their definitive
pathological examination taken from cystectomy specimens.
An extensive regular follow-up with cytology and upper
urinary tract imaging gives insufficient benefit. Periodic CT
scans with a pyelographic study combines upper urinary tract
imaging with the identification of any secondary parenchymal,
osseous or lymph-nodal metastatic lesion.
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EXTERNAL VALIDATION OF PREOPERATIVE AND
POSTOPERATIVE PROGNOSTIC KARAKIEWICZ
NOMOGRAMS FOR RENAL CELL CARCINOMA:
A MULTICENTER EUROPEAN STUDY
L. Cindolo 1 , P. Chiodini 2 , O. De Cobelli 3 , A. Brookman-
May 4 , L. Santoro 5 , M. May 4 , C. De Nunzio 6 , A. Tubaro 6 ,
I. Coman 7 , B. Feciche 7 , B. Rocco 3 , O. Dalpiaz 8 , M. Truss 8 ,
S. Squillacciotti 9 , M.P. Wirth 9 , F. Neri 10 , F. Berardinelli 10
and L. Schips 10
1UOC Urologia Ospedale San Pio
da Pietrelcina Vasto (CH), Italy;
2Department of Public Health, Seconda
Università Degli Studi Di Napoli, Naples, Italy;
Departments of 3Urology and 5Epidemiology and
Biostatistics, European Institute of Oncology, Milan, Italy;
4Department of Public Health, Caritas-St. Josef Medical
Centre, University of Regensburg, Regensburg, Germany;
6Department of Urology, S. Andrea Hospital, Rome, Italy;
7Department of Urology, Clinical Municipal
Hospital, Cluj-Napoca, Romania;
8Department of Urology, Klinikum Dortmund,
Dortmund, Germany;
9Department of Urology, Uniklinikum
Carl Gustav Carus, Dresden, Germany;
10Department of Urology, S.Pio Da Pietrelcina
Hospital, Vasto, Italy
Background: Pre- and postoperative prognostic models for
patients with renal cell carcinoma (RCC) were recently
released, considering only clinical parameters such as
symptoms, TNM and tumor size, as prognostic variables.
These models have been internally validated and they still
require external validation. Our aim was to externally validate
the pre- and postoperative model developed by Karakiewicz
predicting cancer-specific survival in patients affected by
RCC. Patients and Methods: Our multicenter retrospective
study consisted of a total of 2570 cases from 7 European sites.
Patients who underwent either radical or partial nephrectomy
were enrolled. For each patient, prognostic scores were
calculated according to two models: the preoperative
Karakiewicz (2009) model and the postoperative Karakiewicz
(2007) model. According to the original studies, the primary
endpoint was cancer-specific survival (CSS). Survival curves
were estimated by Kaplan–Meier method. Discriminating
ability was assessed by the Harrell C-index for censored data
stratified by center and with 95% confidence intervals (CI).
Results: A total of 2046 patients were eligible for the analyses
(mean age at diagnosis: 61±11 years; male-to-female ratio:
1.6; mean tumor size: 5.7±3.1 cm). Local and systemic
symptoms were present in 383 (18.7%) and 181 (8.8%) of the
patients, respectively. The median follow-up was 46 months.
At the last follow-up, 460 patients had died (305 cancerrelated
deaths), with a 1-, 3- and 5-year CSS equal to 95%,
88% and 85%, respectively. Both models discriminated well.
The stratified C-index for CSS was: 0.776 (95% CI=0.741-
0.811) for the preoperative model (on 2011 patients) and 0.840
(95% CI=0.811-0.868) for the postoperative one (on 1997
patients). Conclusion: Our study better defined the general
applicability of these prognostic models for predicting survival
in patients with RCC treated with nephrectomy. Our results
suggest that the postoperative model discriminates
substantially better than the preoperative model. These
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