Role of Metabolic Syndrome on Perioperative and Oncological Outcomes at Radical Prostatectomy in a Low-risk Prostate Cancer Cohort Potentially Eligible for Active Surveillance

Michele Colicchia, Alessandro Morlacco, Laureano J. Rangel, Rachel E. Carlson, Fabrizio Dal Moro, Robert Jeffrey Karnes

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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 ≤0.15ng/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.

Original languageEnglish (US)
JournalEuropean Urology Focus
DOIs
StateAccepted/In press - Jan 1 2018

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Prostatectomy
Prostatic Neoplasms
Proportional Hazards Models
Multivariate Analysis
Logistic Models
Confidence Intervals
National Heart, Lung, and Blood Institute (U.S.)
Kaplan-Meier Estimate
Prostate-Specific Antigen
Survival Analysis
Tertiary Care Centers

Keywords

  • Active surveillance
  • Low-risk prostate cancer
  • Metabolic syndrome
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

Role of Metabolic Syndrome on Perioperative and Oncological Outcomes at Radical Prostatectomy in a Low-risk Prostate Cancer Cohort Potentially Eligible for Active Surveillance. / Colicchia, Michele; Morlacco, Alessandro; Rangel, Laureano J.; Carlson, Rachel E.; Dal Moro, Fabrizio; Karnes, Robert Jeffrey.

In: European Urology Focus, 01.01.2018.

Research output: Contribution to journalArticle

@article{2491d64b6aa4442ba68d8eb056d7cafb,
title = "Role of Metabolic Syndrome on Perioperative and Oncological Outcomes at Radical Prostatectomy in a Low-risk Prostate Cancer Cohort Potentially Eligible for Active Surveillance",
abstract = "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 ≤0.15ng/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.",
keywords = "Active surveillance, Low-risk prostate cancer, Metabolic syndrome, Prostate cancer, Radical prostatectomy",
author = "Michele Colicchia and Alessandro Morlacco and Rangel, {Laureano J.} and Carlson, {Rachel E.} and {Dal Moro}, Fabrizio and Karnes, {Robert Jeffrey}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.euf.2017.12.005",
language = "English (US)",
journal = "European Urology Focus",
issn = "2405-4569",
publisher = "Elsevier BV",

}

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, Robert Jeffrey

PY - 2018/1/1

Y1 - 2018/1/1

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 ≤0.15ng/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 ≤0.15ng/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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