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 language | English (US) |
|---|---|
| Journal | European Urology Focus |
| DOIs | |
| State | Accepted/In press - Jan 1 2018 |
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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 journal › Article
}
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
UR - http://www.scopus.com/inward/record.url?scp=85039912238&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85039912238&partnerID=8YFLogxK
U2 - 10.1016/j.euf.2017.12.005
DO - 10.1016/j.euf.2017.12.005
M3 - Article
AN - SCOPUS:85039912238
JO - European Urology Focus
JF - European Urology Focus
SN - 2405-4569
ER -