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

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compared to the traditional Camey II technique. Results: The results in the short postoperative follow-up did not seem to differ from those of the original technique in terms of morphology and urodynamics. However, our technique had a lower incidence of uretero-ileal anastomotic stenosis, especially of the left side. Discussion and Conclusion: Although the Camey II technique is well documented, we suggest that our modification of this surgical technique facilitates the descent of the reservoir into the pelvis and reduces the incidence of uretero-neovesical stenosis. 1 Hautmann RE, de Petriconi RC and Volkmer BG: Lessons learned from 1,000 neobladders: the 90-day complication rate. J Urol 184(3): 990-994, 2010. 2 Manoharan M, Ayyathurai R and Soloway MS: Radical cystectomy for urothelial carcinoma of the bladder: an analysis of perioperative and survival outcome. BJU Int 104(9): 1227-1232, 2009. 3 Hautmann RE, Abol-Enein H, Hafez K, Haro I, Mansson W, Mills RD, Montie JD, Sagalowsky AI, Stein JP, Stenzl A, Studer UE and Volkmer BG: Urinary diversion. World Health Organization (WHO) Consensus Conference on Bladder Cancer. Urology 69(1 Suppl): 17-49, 2007. 80 ROLE OF SELECTIVE UPPER URINARY TRACT CYTOLOGY IN PATIENTS WITH SUSPICIOUS TRANSITIONAL LESIONS Federico Pellucchi1 , Lorenzo Rocchini1 , Buthaina Ibrahim1 , Massimo Freschi2 , Carmen Maccagnano1 , Giuseppe Zanni1 , Niccolo’ Passoni1 , Nicola Fossati1 , Luca Villa1 , Giorgio Gandaglia1 , Paolo Capogrosso1 and Renzo Colombo1 1Urologia and 2Anatomia Patologica, I.R.C.C.S. San Raffaele, Universitá Vita-Salute, Milano, Italy Aim: To evaluate both sensitivity and specificity of urinary cytology obtained by selective upper-tract (UT) washing in predicting transitional cell carcinoma (TCC) when compared to bladder-voided cytology and radiological imaging in a selected series of patients with suspicious transitional tumor. Patients and Methods: Between 1991 and 2009, 127 consecutive patients with a clinical suspicion of UT-TCC underwent selective UT washing, bladder urinary cytology and radiological imaging. After completion of clinical assessment, all patients underwent a surgical approach for or biopsy of any suspicious lesion. Based on histology, both sensitivity and specificity of selective UT washing cytology were assessed and also compared with bladder-voided cytology and radiological imaging results. Results: The mean patient age was 65.9 (range: 34-84) years; 25 patients were female (19.7%). Eighty- 1852 ANTICANCER RESEARCH 31: 1807-1956 (2011) eight patients (69.3%) had a previous history of bladder TCC. The suspicion of UT-TCC was based on radiological imaging in 69 patients (54.3%), positive voided cytology without evidence of bladder disease in 37 patients (29.2%) and hematuria in the remaining 21 patients (16.5%). All patients had at least one negative cystoscopy before surgery. Overall, 50 patients (39.4%) underwent surgery with histological diagnosis of UT-TCC (26 patients with transitional kidney cancer, 21 patients with ureteral transitional cancer and 3 patients with concomitant kidney and ureteral tumor), with high prevalence of high-grade cancer. The number of cases of pTa, pT1, pT2, pT3 and pT4 at surgery were: 13 (7.4%), 12 (6.9%), 6 (3.4%), 14 (8%) and 1 (0.6%), respectively. The remaining patients were only followed up. The mean followup was 36.5 (median: 12; range: 1-180) months. The sensitivity of voided urinary cytology was 48.65% and specificity was 69.35%, with positive and negative predictive values (PPV and NPV, respectively) of 48.65% and 69.35%, respectively. Sensitivity and specificity of selective UT washing were 76.60% and 91.25%, respectively, with PPV of 83.72% and NPV of 86.90%. In this series of patients, radiological imaging had a low accuracy (sensitivity, specificity, PPV and NPV were 85.29%, 29.82%, 42.03% and 77.27%, respectively). Discussion and Conclusion: Radiological imaging had high sensitivity for primary screening in patients with suspected UT- TCC. Selective UT washing cytology had higher specificity than either bladder cytology or radiology. These findings support the use of selective UT washing as a reliable secondlevel tool for patients with positive voiding cytology and negative or suspicious UT imaging. 81 PROSTATIC CAPSULE-SPARING CYSTECTOMY FOR ORGAN-CONFINED BLADDER CANCER: A SINGLE-INSTITUTION EXPERIENCE WITH LONG-TERM FOLLOW-UP Renzo Colombo, Nazareno Suardi, Lorenzo Rocchini, Federico Pellucchi, Carmen Maccagnano, Buthaina Ibrahim, Luca Villa, Giuseppe Zanni, Niccoló Passoni, Giorgio Gandaglia, Paolo Capogrosso and Patrizio Rigatti I.R.C.S.S. San Raffaele, Universitá Vita-Salute, Milano, Italy Background: Prostatic capsule and seminal-sparing cystectomy (CSSC) has been proposed for young (age
Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy many clinical contexts. We report the long-term follow-up of patients undergoing CSSC in a single institution. Patients and Methods: Between 1997 and 2005, 28 patients with clinical stage ≤T2 were treated with CSSC at our institution. Preoperative assessment included definitive histology of biopsies and transurethral resection of the prostate (performed 7-10 days before surgery), as well as abdominal CT or MRI examination and completion of an erectile function questionnaire (IIEF-5) in all cases. Cystectomy included extended pelvic lymphadenectomy and complete bladder removal while preserving the prostate capsule, seminal vesicles and vas deferens. An ileal orthotopic bladder substitution was subsequently accomplished in all cases. Clinical, pathological and follow-up data were available for all patients. Kaplan-Meier analyses were used to calculate cancerspecific survival. Functional results at long-term follow-up were available for 16 patients (84.2%). Results: The mean age at the time of cystectomy was 52.4 (median: 52.3, range: 36- 68) years. Definitive pathology documented pT0 in 10 patients (35.7%), pTa/Tis in 6 (21.4%), pT1 in 3 (10.7%), pT2 in 8 (28.5%) and pT3 in 1 patient (3.6%). Concomitant pTis was found in 3 patients (10.7%). Lymph-node invasion was present in 3 patients (10.7%). The median follow-up in patients who did not die from bladder cancer was 92 (mean: 90. range: 48- 152) months. During follow-up, 8 patients (28.5%) died from bladder cancer. One patient died from other causes. The 5- and 10-year bladder cancer-specific survival rates were 88% and 65%, respectively. The 5- and 10-year recurrence-free survival rates were 66% and 28%, respectively. The IIEF-5 score preoperatively and at 12 months of follow-up was 28.9 and 27.9, respectively. At the last follow-up, 16 patients (84.2%) were continent and reported normal erectile function. Cox regression analysis was not able to identify the prognostic factors associated with optimal oncologic outcome in a definitive multivariate analysis, probably due to the small number of patients included in our study. Discussion and Conclusion: In our series, CSSC provided oncologic outcome comparable to that referred to in the literature for similar stage patients and length of follow-up after standard radical cystectomy. Satisfactory erectile function was definitively confirmed. Rigorous preoperative clinical assessment remains the most critical issue. 82 CLINICAL IMPACT OF WHO 2004 COMPARED TO WHO 1973 HISTOLOGIC CLASSIFICATION ON Ta PRIMARY BLADDER CANCER TUMORS: A SINGLE INSTITUTION EXPERIENCE WITH LONG-TERM FOLLOW-UP Federico Pellucchi, Lorenzo Rocchini, Buthaina Ibrahim, Claudio Doglioni, Carmen Maccagnano, Giuseppe Zanni, Niccoló Passoni, Nicola Fossati, Luca Villa, Giorgio Gandaglia, Paolo Capogrosso and Renzo Colombo I.R.C.C.S. San Raffaele, Universitá Vita-Salute, Milano, Italy Aim: To define 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 classification system for grading. Patients and Methods: We retrospectively evaluated clinical data concerning 270 consecutive patients suffering from first-episode bladder cancer and diagnosed with Ta stage tumor at transurethral resection (TUR) between 2004-2008. In all cases, tumors were classified as low-grade according to the WHO 2004 classification system and as G1 or G2 according to the WHO 1973 classification system, by a single uropathologist. 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 three months after resection and then every six months for five years. Univariate analysis for RFS and PFS was performed using the Kaplan-Meier method with the log-rank test. Results: The mean age was 67.3 (median: 67, range: 27- 91) years. Fifty patients were female (18.1%). Grade distribution was low according to WHO 2004 in all cases; grade was G1 in 87 patients (32.2%) and G2 in 183 patients (67.8%) according to WHO 1973. The median follow-up period was 25 (mean: 27.4, range: 1-72) months. The 5-year RFS rate was 62% for the G1 and 40% for the G2 groups. RFS rate was 49.4% for all patients (low-grade). The 5-year PFS rate was 97.6% and 93.3% for the G1 and G2 groups, respectively, and 93.5% for all patients (low grade). Only one case of progression to T1 was documented in the G1 group and 13 cases of progression (8 to T1, 2 to T2 and 3 CIS) in the G2 group. The differences in the 5-year RFS rate were statistically significant when comparing G1 and G2 patients (p=0.004). No statistically significant difference was found for the 5-year PFS rate when comparing G1 and G2 patients. Discussion and Conclusion: The WHO 1973 classification more accurately predicted Ta patients at higher risk of recurrence. However, the WHO 2004 classification was as accurate as the WHO 1973 classification in predicting the long-term PFS. These findings seem to confirm the clinical reliability of the new histological classification for the definition of both treatment and followup schedules of Ta tumors. 83 INTENSIVE INTRAVESICAL MITOMYCIN C REGIMEN VERSUS STANDARD SCHEDULE AS NEOADJUVANT THERAPY FOR NON MUSCLE-INVASIVE BLADDER CANCER: A RANDOMIZED PHASE II STUDY 1853
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Nucciotti R, 35 Oderda M, 37, 38, 1
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