Læknablaðið : fylgirit - 01.06.2009, Blaðsíða 21

27TH CONGR SCAND ASSOC UROL
F Y L GIR I T 6 1
be interpreted cautiously, as they might have been affected
by stage migration and shorter follow-up in the extended
dissection group.
35 Size and volume of metastatic and non-metastatic
lymph nodes in radical cystectomy
JB Jensen1, BP Ulhoi2, KM Jensen'
:Department of Urology and2Institute ofPathology, Aarhus University Hospital,
Aarhus Sygehus NBG, Aarhus, Denmark
jb@doktor.dk
Aim: The present study provides an evaluation of the usability
of size and volume of lymph nodes (LNs) in the pelvis and
iower abdomen to predict metastatic disease in patients with
carcinoma of the urinary bladder.
Material and methods: LNs retrieved from 157 patients
undergoing radical cystectomy and extended lymphadenectomy
to the level of the inferior mesenteric artery were registered with
number, location, presence of metastatic disease, longitudinal
and axial length and a calculated LN volume.
Results: A mean of 21.2 LNs were removed from each patient.
Thirty-two patients (20.4%) had metastatic disease. There
were no significant differences between size of negative LNs
compared to size of positive LNs and no optimal cut-off value
predicting metastatic disease based on LN size could be found.
Analysing calculated volume of each LN and total LN volume
per patient did not contribute with useful information as to
prediction of metastatic disease. Total LN volume per patient
was found to be independent of number of LNs removed while
mean volume per LN was inversely proportional with number
of LNs removed in node negative patients.
Conclusions: Size of LNs remains a poor predictor of metastatic
disease in bladder cancer. A fixed volume of lymphatic tissue
rather than a fixed number of LNs seems to be present in node
negative patients.
36 PUNLMP - How low is “low malignant potential”?
T Maigaard, BP Ulhoi, K Zieger
Departments ofUrology and Pathology, Aarhus University Hospital, Skejby,
Árhus, Denmark
karsten.zieger@ki.au.dk
Objective: The 1998 WHO/ISUP consensus conference revised
the pathological classification of bladder neoplasms, introducing
"papillary urothelial neoplasms of low malignant potential
(PUNLMP)". The clinical significance of this entity with regard
to risk of progression and follow-up policy is still debated.
Scientific evidence is sparse. In Scandinavia, a very similar
category has been used routinely for decades: stage Ta Bergkvist
grade 1.
Methods: In a cohort of 1176 patients with primary bladder
tumors, we identified 113 patients with Bergkvist grade 1
lesions. Pathology slides were reviewed according to the 1998
WHO classification. Voided urine cytology was taken routinely.
No adjuvant treatment was given. The patients were followed in
a routine schedule, and censored at last cystoscopy.
Results: Follow-up was mean 50 (range 4-128) months. No
progression to muscle invasive stages was observed. Lamina
propria invasion (stage Tl) or high-grade lesions were seen in 11
patients (10%). In eight of these, cytology was positive at debut.
The specificity of cytology as a marker of "progression" was
93%. 61 patients (54%) suffered recurrence, which in 53 cases
(87%) occurred within 2 years.
Conclusion: PUNLMP hardly, if ever, progress to muscle
invasive cancer, but may develop high-grade or superficially
invasive disease in about 10% of cases. Two years cystoscopic
follow-up with urine cytology appears to be a reasonable safe
follow-up regimen for this type of tumors.
37 Expression of Maspin and Cathepsin E predict
progression in pTa and pT1 bladder cancer
N Fristrup1-2, L Dyrskjot2, TF 0rntoft2, BP Ulhoi3, M Borre'
Departments of Urology', Molecular Medicine2 and Pathology3, Aarhus
University Hospital, Denmark
NFR@studmed.au.dk
Aim. The superficial tumors of the bladder form aheterogeneous
group regarding risk of recurrence or progression and
consequently the patients have to be monitored thoroughly and
thereby become a major burden for health care systems. The aim
of the study is to identify markers that can predict the outcome
for each patient.
Materials & methods: This study is based on long-time follow-up
on prospectively collected data and tissue at Aarhus University
Hospital. A total of 289 primary urothelial tumors were chosen
for tissue microarray fabrication. 118 patients progressed to pT2-
4 bladder cancer during a median follow-up of 74 months. None
of the remaining 171 patients progressed. Protein expression
was investigated using immunohistochemistry.
Results: Presence of cytoplasmatic Cathepsin E proved to be an
independently significant variable associated with evasion of
disease progression after adjusting for stage, WHO grading, CIS
and BCG (HR: 0.64; P=0.039). The percentage of nuclear Maspin
correlated significantly with evasion of disease progression
(HR: 0.57; P=0.012), (not shown). Regarding the presence of
cytoplasmatic Maspin we found the inverse correlation in a
multivariate analysis (HR: 1.66; P=0.030).
Conclusions: Cathepsin E and Maspin might contribute to a new
generation of prognostic markers stratifying risk and thereby
potentially having a major impact on future therapeutical
strategy, human survival rates and health care economics.
38 FGFR3 - another Janus-protein?
R Rotterud, A Svindland, R Wahlquist
Oslo Urological University Clinic, Oslo University Hospital, Aker,
Trondheimsvn, Oslo, Norway
ran veig. rotterud@med isin.uio.no
Aim: Mutated FGFR3 is overexpressed in low-grade bladder
tumours. We mapped wild-type FGFR3 expression in T1
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