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168 Abstracts

  • Introduction & Objectives

    Enzalutamide significantly suppress the growth of prostate cancer, particularly metastatic Castration-Resistant Prostate Cancer (mCRPC), by targeting androgen receptor signaling pathway. However, there are paucity of evidences on the clinical benefits of enzalutamide in Korea. Here, we analyzed the real-world outcomes of enzalutamide treatment in Korean men with mCRPC following chemotherapy.

    Material & Methods

    We retrospectively reviewed the medical records of 110 mCRPC patients who received oral enzalutamide at a dose of 160 mg per day following chemotherapy in three tertiary centers in Korea between 2014 and 2016. Primary endpoint was Overall Survival (OS). Secondary endpoints were time-to first Skeletal-Related Event (SRE), time-to PSA progression and the PSA responsiveness. Kaplan-Meier analysis and log-rank tests were adopted to compare these oncological outcomes according to the various clinicopathological variables. Multivariate Cox regression model was used to identify the predictors for OS.

    Results

    All-cause mortality rate was 18.4% (N=18). The median overall and PSA progression-free were 18.2 months (95% confidence interval [CI], not yet reached) and 9.5 months (95% CI, 6.4 – 12.5), respectively. Notably, patients with poor ECOG scores (≥ 2), visceral metastasis, prior abiraterone treatment, and no concomitant hormonal therapy showed significant worse OS outcomes in Kaplan-Meier analysis (Fig.1). Conversely, there were comparable PSA responses in these subgroups. After adjusting confounding factors among various clinicopathological factors, we finally identified ECOG scores (≥ 2) [hazard ratio (HR), 3.28; 95% CI, 1.11 – 9.68], prior abiraterone treatment (HR, 5.29; 95% CI, 1.68 – 16.67), and concomitant androgen deprivation therapy (HR, 0.19; 95% CI, 0.05 – 0.76) as the independent predictors for OS.

    Conclusions

    In sum, this is the first report for the real-world outcomes of the post-chemotherapeutic enzalutamide in Korean men with mCRPC. Although our study included a small number of patients, it suggests the valuable information for the treatment of mCPRC in a Korean population.

  • Introduction & Objectives

    Among evaluation tools for tumour response, the benefit of follow-up first contrast-enhanced CT after one or two cycles of initiation of systemic therapy had a superior correlation with prognosis in terms of therapeutic responsiveness than imaging studies performed during other follow-up periods. The degrees of responsiveness of unresectable primary renal tumour lesions, as well as several baseline patient parameters such as performance status and laboratory findings, were found to be important for the prediction of therapeutic outcomes. We aimed to determine the prognostic significance of computed tomography imaging parameters of unresectable primary renal tumour lesions, obtained at baseline and at first follow-up, on overall survival in naïve, unresectable metastatic renal cell carcinoma patients during first-line systemic therapy.

    Material & Methods

    Clinicopathological parameters of 56 patients treated between 2007 and 2015, including imaging parameters (such as the longest diameter of primary renal tumor lesions, necrotic area diameter, and attenuation on baseline computed tomography vs. follow-up computerized tomography), were retrospectively reviewed to derive predictive factors of overall survival. The best overall response was measured according to the RECIST v1.1.

    Results

    The median treatment period was 206.3 days, and the median follow-up was 14.6 months. Forty-four (78.6%) patients progressed after a median 4.6 months of progression-free survival, and 6 (10.7%) patients survived with a median overall survival of 12.5 months. Multivariate analysis showed that baseline primary renal tumor diameter (hazard ratio 0.958), necrotic area diameter (hazard ratio 1.127), and mean tumor attenuation (hazard ratio 0.955) on baseline computed tomography; change in percentage of primary renal tumor lesion necrotic area diameter between baseline computed tomography and follow-up computed tomography (HR 1.022); and treatment with sunitinib (hazard ratio 0.068) and pazopanib (hazard ratio 0.010) were significant factors for overall survival (p<0.05).

    Conclusions

    Baseline computed tomography and follow-up computed tomography provide critically useful information on primary renal tumor lesions for purposes of predicting overall survival in non-nephrectomized, naïve metastatic renal cell carcinoma patients.

  • Introduction & Objectives

    Gleason Score (GS) 3+4=7 prostate cancer patients with invasive cribriform or intraductal carcinoma (7+) have worse disease-specific survival than those without. It is, however, unknown whether the clinical behaviour of men with GS 3+4=7 prostate cancer without these pathologic features is worse than GS 3+3=6. The aim of this study was to compare the clinico-pathologic characteristics and patient outcomes of men with biopsy GS 3+4=7 without invasive cribriform and intraductal carcinoma (7-) to those with GS 3+3=6.

    Material & Methods

    We included all patients from the first screening round of the European Randomized Study of Screening for Prostate Cancer (1993-2000) with a revised GS ≤ 3+4=7 (n=796) following the 2014 ISUP criteria. Relations with biochemical recurrence after radical prostatectomy or radiotherapy were analyzed using log-rank testing and multivariable Cox regression analysis.

    Results

    In total 486 patients had GS 3+3=6 and 310 had GS 3+4=7, 54 of whom were GS 7+ (17%). At a median follow-up of 15 years, biochemical recurrence was seen in 61 (20%) GS 6, 54 (21%) GS 7- and 22 (41%) GS 7+ patients. Both biopsy GS 7- and 7+ patients had significantly higher PSA levels, mean tumor percentage, percentage of positive cores and ≥cT3 than those with GS 6 (all P<0.001). GS 7 patients did not have a poorer biochemical-recurrence-free-survival (BCRFS) after radical prostatectomy than GS 6 patients (log rank P=0.13), whereas those with GS 7+ had (log rank P=0.05). In multivariable analyses, biopsy GS 7- was not associated with poorer BCRFS after radical prostatectomy (HR 1.3, 95% CI 0.67-2.4, P=0.47) or radiotherapy (HR 0.88, 95% CI 0.51-1.5, P=0.63). GS 7+ was independently associated with poorer BCRFS after radical prostatectomy (HR 3.0, 95% CI 1.1-7.8, P=0.03), but not after radiotherapy (HR 1.2, 95% CI 0.58-2.3, P=0.67).

    Conclusions

    Men with biopsy GS 3+4=7 prostate cancer without invasive cribriform and intraductal carcinoma (7-) had similar BCRFS after radical prostatectomy or radiotherapy to those with GS 6. These patients may be candidates for active surveillance as long as other variables such as PSA and tumor volume are accounted for.

  • Introduction & Objectives

    Prostate cancer treatment is shifting from radical to focal therapy. Instant tumor visualization on a microscopic level is crucial for clinical application of focal therapy. Optical Coherence Tomography (OCT) produces instant tissue visualization on a µm scale. OCT also provides the attenuation as a measure of tissue organization. The objective is to correlate qualitative and quantitative OCT analysis with histopathology.

    Material & Methods

    Twenty prostates were analyzed by needle based OCT after radical prostatectomy. For precise correlation, whole mount histology slides were cut through the OCT trajectory. OCT images were classified in one of eight histological categories (RvK). Two reviewers (AS & BM) independently performed assessments of the OCT images into these categories. Sensitivity and specificity for detection of malignancy on OCT were calculated. Quantitative attenuation coefficient was found to discriminate stroma and malignant tissue. Figure: Correlation of histology and OCT: The arrows in A, B & C indicate the same atrophic cyst. A: Digitized H&E stained whole mount slide with tissue annotation. Both OCT measurement trajectories are visible. B: An OCT scan at the location of the atrophic cyst. C: The longitudinal section of the OCT scan that corresponds with the upper OCT measurement trajectory shown on A.



    Results

    Visual analyses showed that OCT can reliably differentiate between fat, cystic and regular atrophy and benign glands. Differentiation of benign stroma and inflammation and also malignancy Gleason 3 and 4 is more difficult. Sensitivity and specificity for detection of malignancy on OCT were calculated at 77% and 84%. Quantitative analysis by means of the attenuation coefficient for differentiation between stroma and malignancy showed no significant difference (4.39 mm-1 vs. 5.31 mm-1).

    Conclusions

    One to one correlation of histology and OCT helps us to understand what we see and measure on OCT. Visual malignancy detection shows reasonable sensitivity and specificity. Our future studies focus on improving discrimination of malignancy with OCT for example by combining an extra imaging modality.

  • Introduction & Objectives

    This study aims to clarify the clinicopathologic features of long-term survivors after radical cystectomy in muscle invasive bladder cancer patients with lymph nodes metastasis.

    Material & Methods

    We analyzed data on 269 patients at two institutions who underwent radical cystectomy and urinary diversion for bladder cancer between 2006 and 2015 and were observed at least 2 year postoperatively.

    Results

    The incidence of lymph nodes metastasis was 25.2% (68 patients). Urinary diversion was orthotopic bladder substitutions in 16, ileal conduit in 22, ureterocutaneoustomy in 30 patients. Clinicopathologic features associated with above 2-year recurrence free survivors included low grade (p=0.001), no ureteral invasion (p=0.001), adjuvant chemotherapy (p=0.010) (Table 1).

    Conclusions

    This study shows that long-term recurrence-free survival above 2-years after radical cystectomy with pelvic lymphadenectomy can be achieved in patients with favorable tumor characteristics. In addition, ureteral status and adjuvant chemotherapy was reliable predictor of above 2-year recurrence free survivors.

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