this study is to evaluate the ability of three-dimensional 14-core biopsy (3D14PBx: a combination of transrectal 6-core biopsy and transperineal 8-core biopsy) ...
kHz (P < .001 and P = .003, respectively).Pulmonary function, assessed as FVC and FEV1 was not decreased at follow-up (P = .570 and P = .463, respectively) and creatinine clearance was also not decreased (P = .572). Significant complaints of Raynaud phenomenon in the hands was reported in 15% (95% confidence interval (CI) = 4%-26%), 13% (CI = 3%-23%) reported tinnitus, 11% (CI = 2%-20%) reported sensory neuropathy in the hands and 9% (CI = 0%-17%) was troubled by hearing impairment. 71% of the patients who reported Raynaud phenomenon was not significantly troubled by these symptoms. For sensory neuropathy this was 60% and for patients with hearing impairment on both measured levels, 85% reported not to be significantly troubled by this. Conclusions: Long-term testicular cancer survivors treated with a relatively low (standard) dose cisplatin-based chemotherapy (100mg/m²/cycle) have higher hearing thresholds, but show low prevalence with regards to self-reported symptoms. Also a majority of patients who reported Raynaud phenomenon or sensory neuropathy is not troubled by these symptoms in daily life.
1036
Health-related quality of life, anxiety and depression in long-term survivors of testicular germ cell cancer
Spiegel T.1, Gerharz E.W.2, Müller J.G.3, Riedmiller H.4, Faller H.5 1 Urologic Centre Schweinfurt, Dept. of Urology, Schweinfurt, Germany, 2Urology Associates, Dept. of Urology, Frankfurt, Germany, 3University of Würzburg, Institute of Pathology, Würzburg, Germany, 4University of Würzburg, Dept. of Urology & Pediatric Urology, Würzburg, Germany, 5University of Würzburg, Institute of Psychotherapy & Medical Psychology, Würzburg, Germany Introduction & Objectives: With the advent of cisplatin-based polychemotherapy testicular germ cell cancer (TGCC) has become curable in more than 95% of patients. Thus, a growing number of men with TGCC will be long-term survivors, with health-related quality of life (HRQOL) steadily gaining importance. Our aim was to investigate HRQOL, depression and anxiety at least 4 years after completion of primary therapy of TGCC. Materials & Methods: 354 TGCC survivors were identified and enrolled in this retrospective cross-sectional single-center cohort study. Evaluation included mail-administered European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire for Cancer Patients (QLQ C30), Short Form-36 Health Survey (SF-36), Patient Health Questionnaire depression (PHQ9) and anxiety modules (GAD-7), International Index of Erectile Function (IIEF) and a standardized socioeconomic questionnaire. Results: Complete data sets of 193 TGCC survivors (mean age at investigation 47.8 years [22-75]) with a mean follow-up of 13.7 years (4,2-34,1) could be analyzed (response rate 54.5%). There were no differences in quality of life and psychological outcomes between patients with seminoma (n=99) and nonseminomatous germ-cell tumors (NSGCT, n=94). While SF-36 scores were similar in TGCC survivors and age-matched healthy men, patients disclosed insomnia, fatigue, dyspnea and impaired social, cognitive and emotional functioning when their EORTC QLQ C30 scores were compared to normative data. Impaired aspects of HRQOL varied with age. No or minimal depression was recorded in 92,8%, no or minor anxiety in 88.6% of patients. High anxiety and depression levels were significantly correlated with impaired HRQOL. There was no correlation between tumor stage and HRQOL. Conclusions: Irrespective of age, treatment modality, tumor entity and stage, HRQOL is high and the prevalence of depression and anxiety is low in TGCC survivors. However, a subset of patients suffers from disturbed functioning and a distinct repertoire of diagnosis and/or treatment related symptoms. The profile of HRQOL impairment varies with age.
1037
Prognostic clinical parameters to predict the necessity of reconstructive vascular surgery for patients who undergo postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for advanced nonseminatous germ cell tumors (NSGCT)
Heidenreich A.1, Dieckmann K.P.2, Busch F.3, Schrader M.4, Schmelz H.5, Krege S.6, Winter C.7, D.1 Pfister, German Testicular Cancer Study Group, Germany 1 RWTH University Aachen, Dept. of Urology, Aachen, Germany, 2Albertinen Hospital, Dept. of Urology, Hamburg, Germany, 3Charité, Dept. of Urology, Berlin, Germany, 4University of Ulm, Dept. of Urology, Ulm, Germany, 5Bundeswehrzentral Hospital, Dept. of Urology, Koblenz, Germany, 6Hospital Maria Hilf, Dept. of Urology, Krefeld, Germany, 7Heinrich-Heine University, Dept. of Urology, Düsseldorf, Germany Introduction & Objectives: PC-RPLND remains an integral part of the multimodality treatment for advanced NSGCT. The need to resect and to replace the major retroperitoneal vessels must be known preoperatively to enable complete resection of the residual masses. Materials & Methods: PC-RPLND was performed in 411 patients with NSGCT and normalized (81%) or plateauing (19%) tumor markers following 3-4 cycles PEB/ PEI. PC-RPLND was performed in 5 institutions with a variable surgical frequency of 14 to 158 PC-RPLNDs. Good, intermediate, and poor prognosis according to the
IGCCCG criteria was identified in 59.8%, 21.2%, and 19% respectively. Results: Resection of the inferior vena cava was performed in 28 (6.81%) patients, resection of the abdominal aorta was necessary in 13 (3.16%) patients. In 29/41 (70.7%) adjunctive surgical procedures such as nephrectomy, small bowel resection, ureteral resection had to be performed to ensure complete resection of the residual masses. Histologically vital carcinoma or mature teratoma was identified in 78.1% of the resected vascular specimens. Mean time of surgery was 295 (243-615) Min., mean blood loss was 690 (350 – 3400) ml. Good prognosis was identified in 15.4%, an intermediate and poor prognosis was present in 41%and 43.6%, respectively. Of all 411 patients involvement of the major retroperitoneal vessels was found in 3.2%, 18.4% and 21.8% with good, intermediate, and poor prognosis, respectively. The mean tumor diameter was 5.9 (1.0 – 32) cm for the entire cohort and 9.8 (4-32) cm for the cohort of patients with vascular surgery. Significant prognosticators to predict vascular involvement were identified by multivariate analysis: intermediate/poor prognosis, number of cycles of chemotherapy, tumor diameter > 14cm, circumferential encasement of > 50% of the vessel diameter. Conclusions: Complete resection of the inferior vena cava or the abdominal aorta during PC-RPLND is necessary in about 10% of patients. The identified predictors enable already preoperatively a risk adapted interdisciplinary approach for complete resection of the residual masses in an experienced centre.
1038
Redo-retroperitoneal lymphadenectomy (RPLA) for nonseminomatous germ cell tumors (NSGCT): Clinical presentation, patterns of recurrence and outcome
Argirovic D.1, Argirovic A.2 Clinic of Urology, CCS, Outpatient Clinic Argirovic, Dept. of Urology, Belgrade, Serbia, 2CHC Zemun, Dept. of Urology, Belgrade, Serbia
1
Introduction & Objectives: To describe the clinical characteristics and outcome of patients (pts) with NSGCT requiring re-operative (reop) RPLA, because such pts are poorly characterized. Materials & Methods: Between 1982 and 2005, 29 pts underwent 32 redo operations: 10 after primary (P)-RPLA and 19 after post-chemotherapy (PC)-RPLA. The initial presentation, histological finding, morbidity and oncologic outcome after surgery were analyzed. Results: All pts had NSGCT with metastasis in RPLN (17 pts [59%] had teratoma compound in the primary tumor). 19 (66%) pts and 3 (10%) pts had CS IIC and III, respectively. 9 (31%) pts had elevated STMs before redo-RPLA. 14 (48%) pts were classified to be intermediate/poor IGCCCG risk group. The MFI between initial and redo-RPLA was 27.3 months (range, 5-168) (in 12 [41%] pts > 2years). 16 (55%) pts required CDDP-based C before redo-RPLA. Redo-RPLA pathology demonstrated the presence of fibrosis (F) in 3 (10%) pts, teratoma (T) in 12 (41%) pts, teratoma with malignant transformation (TMT) in 1 (4%) pt, and vital carcinoma (VC) in 13 (45%) pts (52% had T compound at redo-RPLA). Concordant histology occurred in 19 (65%) pts (50% at P-RPLA and 68% at PC-RPLA). All pts at P-RPLA had VC, with discordant histology at redo-RPLA in 4 (40%) pts (2 F, 2 T). Of 15 (79%) pts with T elements in the RP at the initial PC-RPLA, 6 (40%) had worse histology at redo-RPLA (1 TMT, 5 VC). The most common sites of ds prompting reop were interaortocaval and paraaortic regions. At MFU of 118.33+/-44.59 months (m) the 5-year (y) DSS rate was achieved in 69% pts for entire cohort (70% after reop for P-RPLA and 68% following reop after PC-RPLA). At MFU of 3l+/-32 m, 11 (38%) pts died. The pts who died of T had 9.7 fold longer survival than those with VC/TMT (125 VS 21.6+/-10.62). The 5-y DSS rate for pts with finding of F and T only in the RP approach 100% vs 40% in those with VC/TMT (Log Rank =5.981; p< 0.01). The 2-year overall survival rate in pts with positive and negative STMs before redoRPLA occurred in relation of 38% vs 95% (Log Rank=32.863; p
