Page 5 - CUA2018 Abstracts - Oncology-Testis

Poster session 12: Other Oncology III

toneal lymph node dissection (RPLND), but the role of RPLND at time of 43% to 43% (p=0.336); RPLND 9% to 3% (p=0.476). OS for the entire
nephrectomy for higher–risk tumours remains controversial. We hypoth- cohort at five and 10 years was 97% and 96%, respectovely; CSS was 98%
esize that patients with locally advanced disease have a worse progno- and 98%. There was no significant change in OS or CSS for seminoma
sis and may benefit from nodal dissection. Here, we identify predictors or NSGCT over the study period.
of pathologically node–positive (pN1) disease in patients treated with Conclusions: There has been substantial de–escalation in treatment of
RPLND at time of nephrectomy. testicular cancer in routine practice since 2000. Long–term survival in
Methods: We analyzed data from a prospectively maintained multi–insti- routine practice is excellent and has not decreased with uptake of sur-
tutional cohort of patients in the Canadian Kidney Cancer Information veillance strategies.
System (CKCis) who underwent nephrectomy for RCC with or without
RPLND from 2011–2017. Analysis was used to determine: 1) preoperative MP–12.11
predictors of undergoing RPLND; and 2) predictors of pN1 in patients
receiving RPLND. Does prior inguinoscrotal surgery alter recurrence patterns
Results: A total of 6084 patients with cT(any)N(any)M(any) RCC treated and survival outcome for patients with testitcular cancer? The
with partial (n=2788) or radical (n=3296) nephrectomy were identified; Princess Margaret Cancer Centre experience 1
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1
886 (16%) patients had clinical T3–T4 disease, 322 (6%) had clini- Dixon Woon , Thenappan Chandrasekar , Jaime Omar Herrera Cáceres ,
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1
1
1
cally positive nodes (cN1), and 504 (9%) had metastatic (M1) disease. Hanan Goldberg , Zachary Klaassen , Neil Fleshner , Michael Jewett ,
1
One thousand seven hundred seventy–seven (29%) patients underwent 1 Robert Hamilton
RPLND. Of patients treated with RPLND, 248 (14%) had pN1 disease. Department of Surgical Oncology, Division of Urology, University Health
Patients with Eastern Cooperative Oncology Group (ECOG) performance Network, Toronto, ON, Canada
status (PS) >1, larger tumour size, stages cT2–T4 vs. T1, cN1, M1, and Introduction: Inguinoscrotal surgery (ISS) before testicular cancer (TCa)
histological grades 3–4 were more likely to undergo RPLND at time of diagnosis and treatment has historically been reportedly associated
surgery. Predictors of pN1 disease were body mass index (BMI) 20–30 with altered drainage patterns. While inguinal lymph node metastases
vs. BMI >30, ECOG PS >1, larger tumour size, stages cT2–T4 vs. cT1, among all stage I TCa is approximately 2%, it is uncertain if men with prior
cN1, M1, histological grades 3–4, and non–clear–cell histology (Table ISS have similar recurrence patterns. We present the largest contemporary
1; available at https://cua.guide/). institutional series of patients with a history of prior ISS.
Conclusions: In the largest study of its kind to date, several risk factors for Methods: A retrospective review of a prospectively collected database
pN1 status were identified. Of interest, BMI 20–30 and non–clear–cell of patients diagnosed with TCa between 1981 and 2016 was performed.
histology have not been previously identified as predictors of pN1 disease Data on all men with TCa and history of prior ISS was analyzed.
and may, therefore, represent a novel subset of patients that could benefit Results: A total of 338 patients were identified, of which 267 had
from nodal dissection. adequate records for analysis; 141 men had seminoma, of which 114
Reference: (80.9%) were on surveillance. Of these, 24 (21.1%) had recurrence and
1. Blom JH, Poppel VH, Marechal JM et al. Radical nephrectomy four (3.5%) were in the inguinoscrotal region (three had surgery and
with and without lymph–node dissection: Final results of European one received radiotherapy for their recurrence). Twenty–four men pre-
Organization for Research and Treatment of Cancer (EORTC) ran- sented with metastatic disease at diagnosis; of these, three (12.5%) had
domized phase 3 trial 30881. Eur Urol 2009;55:28–34. https://doi. inguinal disease and one (4.2%) had scrotal disease at presentation. Of
org/10.1016/j.eururo.2008.09.052 the 126 men with non–seminomatous germ cell tumours (NSGCT), 50
(39.7%) were put on surveillance. Fourteen (28.0%) had recurrence; of
these, one (2.0%) had inguinal recurrence and received chemotherapy.
MP–12.10 Sixty–six men presented with metastatic disease, of which seven (10.6%)
Temporal trends in management and outcomes of testicular had inguino–scrotal disease at presentation. Overall, recurrence in the
cancer: A population–based study inguinoscrotal region among all stage I men on surveillance was 3.0%.
Michael Leveridge , Robert Siemens , Kelly Brennan , Jason Izard , With a mean followup of five years after orchidectomy, the disease–free
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1,2
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Safiya Karim , William Mackillop 2,3,4 , Christopher Booth 2,3,4 survival rates with seminoma and NSGCT on active surveillance were
2,4
1 Department of Urology, Queen’s University Cancer Research Institute, 98.2% and 98.0%, respectively. (Recurence patterns are shown in Fig.
Kingston, ON, Canada; Department of Oncology, Queen’s University 1; available at https://cua.guide/.)
2
Cancer Research Institute, Kingston, ON, Canada; Department of Public Conclusions: The risk of inguinoscrotal recurrence for men with prior
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Health Sciences, Queen’s University Cancer Research Institute, Kingston, ISS on surveillance for TCa is slightly higher than historical series; how-
ON, Canada; Division of Cancer Care and Epidemiology, Queen’s ever, the disease–specific survival remains high. While inguinoscrotal
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University, Kingston, ON, Canada recurrence rates are not insignificant, current surveillance strategies are
Introduction: Treatment guidelines for early–stage testicular cancer have adequate for capturing out–of–field recurrences.
increasingly recommended de–escalation of therapy with surveillance
strategies. We sought to describe temporal trends in routine clinical prac- MP–12.12
tice and whether de–escalation of therapy is associated with inferior
survival in the general population. Nerve–sparing in retroperitoneal lymph node dissection for
Methods: The Ontario Cancer Registry was linked to electronic records of testicular cancer prevents postoperative retrograde ejaculation:
treatment to identify all patients diagnosed with testicular cancer treated A Canadian perspective 2 3 2
1
with orchiectomy in Ontario from 2000–2010. Treatment after orchiec- Ailsa Gan , Nahid Punjani , Tyler Beveridge , Nicholas Power
1
tomy was classified as radiotherapy (RT), retroperitoneal lymph node Schulich School of Medicine and Dentistry, Western University, London,
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dissection (RPLND), chemotherapy, or none. Surveillance was defined as ON, Canada; Department of Surgery, Urology Division, Western
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no identified treatment within 90 days of orchiectomy. Overall (OS) and University, London, ON, Canada; Department of Anatomy and Cell
cancer–specific (CSS) survival were measured from date of orchiectomy. Biology, Schulich School of Medicine and Dentistry, Western University,
Results: The study population included 1564 and 1086 cases of semi- London, ON, Canada
noma and non–seminoma (NSGCT), respectively. Among patients with Introduction: Retrograde ejaculation caused by injury to the preaortic
seminoma there was a significant increase in the proportion of patients sympathetic nerves is a significant postoperative complication follow-
with no treatment within 90 days of orchiectomy (from 51% to 84%; ing retroperitoneal lymph node dissection (RPLND). Large–volume U.S.
p<0.001); use of RT decreased over time (38% to 8%; p<0.001) and use centres demonstrate nerve–sparing (NS) to be successful in preserving
of chemotherapy remained stable (from 6% to 9%; p=0.289). Ninety–day antegrade ejaculation; however, few reports exist to describe its imple-
post–orchiectomy practice patterns remained stable over time among mentation at Canadian centres. Therefore, our study explores ejaculatory
patients with NSGCT: no treatment 51% to 57% (p=0.435); chemotherapy function in patients who underwent RPLND for testis cancer at a tertiary
Canadian institution with and without the application of NS techniques.
S134 CUAJ • June 2018 • Volume 12(6Suppl2)