TY - JOUR
T1 - Role of Metabolic Syndrome on Perioperative and Oncological Outcomes at Radical Prostatectomy in a Low-risk Prostate Cancer Cohort Potentially Eligible for Active Surveillance
AU - Colicchia, Michele
AU - Morlacco, Alessandro
AU - Rangel, Laureano J.
AU - Carlson, Rachel E.
AU - Dal Moro, Fabrizio
AU - Karnes, R. Jeffrey
N1 - Funding Information:
Other: None. Financial disclosures: R. Jeffrey Karnes certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g. employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Funding/Support and role of the sponsor: This publication was made possible by CTSA grant number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). The funding organization had a role in the design and conduct of the study; collection, management, analysis, interpretation, preparation, and review of the data; and approval of the manuscript. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
Publisher Copyright:
© 2017 European Association of Urology
PY - 2019/5
Y1 - 2019/5
N2 - Background: Metabolic syndrome (MetS) is considered a potential risk factor for adverse outcomes after radical prostatectomy (RP). Furthermore, studies about the effect of MetS on low-risk prostate cancer (PCa) and its implications in active surveillance (AS) are limited. Objective: To investigate the role of MetS (using International Diabetes Federation–American Heart Association/National Heart, Lung, and Blood Institute criteria) on perioperative and oncological outcomes after RP in low-risk PCa and in a subgroup potentially eligible for AS. Design, setting, and participants: A total of 3662 patients treated with RP for low-risk PCa and further stratified as very low risk (VLR) PCa—prostate-specific antigen density of ≤0.15 ng/ml/cm3, ≤2 cores involved, and no core with >50% cancer involvement—at a tertiary referral hospital were identified. Outcome measurements and statistical analysis: Outcomes analyzed were pathological outcomes, perioperative complications, biochemical failure (BCF), and overall survival. Pathological outcomes and complications were analyzed with logistic regression models. Kaplan–Meier curves and Cox proportional hazards models were used to analyze survival outcomes. Results and limitations: In univariate/multivariate analyses, MetS was associated with upgrading and positive surgical margins in the entire cohort, upgrading only in the VLR group. In Kaplan–Meier analysis, MetS patients had a higher rate of overall death (p < 0.0001) and BCF (p = 0.03) for MetS patients. In the VLR group, no differences were found for BCF (p = 0.064). Further, in Cox proportional hazards models, MetS was not associated with BCF (hazard ratio = 1.23; 95% confidence interval [CI] = 0.95–1.60, p = 0.12). MetS patients had a higher rate of complications compared with non-MetS patients (23.7% vs 19.7%; p = 0.01). In multivariate analysis, MetS was associated with a higher rate of complications (odds ratio = 1.24, 95% CI = 1.04–1.49, p = 0.018) but did not impact the rate of major ones. This study is limited by its retrospective design. Conclusions: In low-risk PCa treated with RP but potentially eligible for AS, MetS impacted perioperative and pathological outcomes, suggesting further study of MetS in patients undergoing AS. Patient summary: Metabolic syndrome negatively impacts perioperative and pathological outcomes in low-risk prostate cancer patients treated with radical prostatectomy but potentially eligible for active surveillance, in a large American single-center cohort. These findings suggest the need for a more cautious approach to low-risk prostate cancer in patients with metabolic syndrome. Metabolic syndrome impacts the risk of outcomes in a cohort of low-risk prostate cancer treated with radical prostatectomy but potentially eligible for active surveillance, suggesting the need of a careful approach to low-risk prostate cancer in patients with metabolic syndrome.
AB - Background: Metabolic syndrome (MetS) is considered a potential risk factor for adverse outcomes after radical prostatectomy (RP). Furthermore, studies about the effect of MetS on low-risk prostate cancer (PCa) and its implications in active surveillance (AS) are limited. Objective: To investigate the role of MetS (using International Diabetes Federation–American Heart Association/National Heart, Lung, and Blood Institute criteria) on perioperative and oncological outcomes after RP in low-risk PCa and in a subgroup potentially eligible for AS. Design, setting, and participants: A total of 3662 patients treated with RP for low-risk PCa and further stratified as very low risk (VLR) PCa—prostate-specific antigen density of ≤0.15 ng/ml/cm3, ≤2 cores involved, and no core with >50% cancer involvement—at a tertiary referral hospital were identified. Outcome measurements and statistical analysis: Outcomes analyzed were pathological outcomes, perioperative complications, biochemical failure (BCF), and overall survival. Pathological outcomes and complications were analyzed with logistic regression models. Kaplan–Meier curves and Cox proportional hazards models were used to analyze survival outcomes. Results and limitations: In univariate/multivariate analyses, MetS was associated with upgrading and positive surgical margins in the entire cohort, upgrading only in the VLR group. In Kaplan–Meier analysis, MetS patients had a higher rate of overall death (p < 0.0001) and BCF (p = 0.03) for MetS patients. In the VLR group, no differences were found for BCF (p = 0.064). Further, in Cox proportional hazards models, MetS was not associated with BCF (hazard ratio = 1.23; 95% confidence interval [CI] = 0.95–1.60, p = 0.12). MetS patients had a higher rate of complications compared with non-MetS patients (23.7% vs 19.7%; p = 0.01). In multivariate analysis, MetS was associated with a higher rate of complications (odds ratio = 1.24, 95% CI = 1.04–1.49, p = 0.018) but did not impact the rate of major ones. This study is limited by its retrospective design. Conclusions: In low-risk PCa treated with RP but potentially eligible for AS, MetS impacted perioperative and pathological outcomes, suggesting further study of MetS in patients undergoing AS. Patient summary: Metabolic syndrome negatively impacts perioperative and pathological outcomes in low-risk prostate cancer patients treated with radical prostatectomy but potentially eligible for active surveillance, in a large American single-center cohort. These findings suggest the need for a more cautious approach to low-risk prostate cancer in patients with metabolic syndrome. Metabolic syndrome impacts the risk of outcomes in a cohort of low-risk prostate cancer treated with radical prostatectomy but potentially eligible for active surveillance, suggesting the need of a careful approach to low-risk prostate cancer in patients with metabolic syndrome.
KW - Active surveillance
KW - Low-risk prostate cancer
KW - Metabolic syndrome
KW - Prostate cancer
KW - Radical prostatectomy
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U2 - 10.1016/j.euf.2017.12.005
DO - 10.1016/j.euf.2017.12.005
M3 - Article
C2 - 29306730
AN - SCOPUS:85039912238
VL - 5
SP - 425
EP - 432
JO - European Urology Focus
JF - European Urology Focus
SN - 2405-4569
IS - 3
ER -