Radical c ystectomy: The benefit of l ymph n ode density .

1. No. 113 Radical cystectomy: The benefit of lymph node density. Athina Pirpiris, Kathryn Rzetelski-West, Jeremy Grummet The Alfred Hospital, Melbourne. Posters Proudly Supported by: Introduction Lymph node (LN) density, is the proportion of lymph nodes that are positive for cancer. It has been described as a useful prognosticator of urothelial carcinoma (UC) of the bladder. • Results • 54 patients included. • 83% (n=45) were male. • Mean age = 67 years. • 30% (n=16) received neo-adjuvant chemotherapy. • 50% (n = 27) had a T pathological stage of 3 or 4. • Mean number of lymph nodes removed per patient was 8. • Mean number of positive lymph nodes per patient was 1. • Lymph nodes: • 24% (n=13) had positive lymph nodes. • 19% (n=10) had a LN density > 20%. • Neo-adjuvant chemotherapy: • Of the 16 patients who received neo-adjuvant chemotherapy, 6 had a LN density >20%. • There was no statistically significant effect of neo-adjuvant chemotherapy on survival (p > 0.05). • Deaths: • There were 20 deaths (37%): • 11 were from metastatic UC, 6 were secondary to other reasons and 3 had no recorded cause of death. • Survival: • Mean overall survival of patients with a LN density >20% was 1.2 years. • Mean overall survival of patients with a LN density <20% was 3 .3 years • (p = 0.03). • A greater number of positive lymph nodes and a higher lymph node density, > 20%, were associated with a poorer survival. Aim To determine whether there is any association between LN density and overall survival at our institution. Methods  Retrospective analysis, on consecutive patients who underwent a radical cystectomy and pelvic lymph node dissection at the Alfred Hospital between January 2003 and May 2012.  Exclusions: If bladder cancer was not UC.  Data was collated on the histopathology of the bladder cancer, the number of lymph nodes removed, the number of positive lymph nodes and whether (neo)adjuvant radiotherapy and/or chemotherapy was administered.  Overall survival was the number of months from cystectomy until their most recent follow-up appointment or to death. Legend: Conclusions This study demonstrates that a LN density of greater than 20% was associated with a significantly poorer overall survival. LN density may be useful in guiding discussions with patients about adjuvant therapy. Survival time (years) Acknowledgements Medical records, The Alfred Hospital. Eldho Paul, Statistician, Biostatistics Unit, Monash University. References Kassouf W, Agarwall P, Herr H et al., Lymph Node Density Is Superior to TNM Nodal Status in Predicting Disease-Specific Survival After Radical Cystectomy for Bladder Cancer: Analysis of Pooled Data From MDACC and MSKCC. JCO . 2008 vol. 26 no. 1 121-126 .