Neoadjuvant Systemic Therapy before Radical Prostatectomy in High-Risk Prostate Cancer Does Not Increase Surgical Morbidity

Contemporary Results Using the Clavien System

Stephen Williams, John W. Davis, Xuemei Wang, Mary F. Achim, Amado Zurita-Saavedra, Surena F. Matin, Louis L. Pisters, John F. Ward, Curtis A. Pettaway, Brian F. Chapin

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Multimodality therapies for men with high- and very high-risk prostate cancer, including neoadjuvant systemic therapy followed by subsequent radical prostatectomy (RP) are being increasingly explored despite the lack of adequate morbidity data. Materials and Methods We analyzed the data from 215 consecutive patients with high- and very high-risk prostate cancer who were previously untreated or had received neoadjuvant systemic therapy. All patients underwent RP with extended pelvic lymph node dissection from 2006 to 2010 at a single tertiary care academic center. All complications within 90 days of surgery were defined and categorized by a 5-grade and 10-domain modification of the Clavien system. Univariable and multivariable logistic regression analyses were used to identify preoperative predictors for complications. Results Of the 215 patients, 29% experienced a complication of any grade ≤ 90 days after surgery; 6% experienced grade ≥ 3, with no significant difference between either cohort (P =.50). On multivariate analysis, open RP (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.11-3.90; P =.02) and preoperative hemoglobin (OR, 1.98; 95% CI, 1.05-3.72; P =.03) were independent predictors of the occurrence of any grade complication. For major complications (Clavien ≥ 3), a Charlson comorbidity index of 6 to 7 versus 3 to 5 (OR, 5.45; 95% CI, 1.57-18.98; P =.008) and the most recent year of surgery (OR, 4.73; 95% CI, 1.36-16.39; P =.01) were significant predictors on multivariable analysis. Conclusion The use of neoadjuvant systemic therapy did not appear to increase the risk of perioperative complications. These findings support current clinical trials, which might elucidate the oncologic benefit of this multimodality approach.

Original languageEnglish (US)
Pages (from-to)130-138
Number of pages9
JournalClinical Genitourinary Cancer
Volume14
Issue number2
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

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Neoadjuvant Therapy
Prostatectomy
Prostatic Neoplasms
Odds Ratio
Confidence Intervals
Morbidity
Ambulatory Surgical Procedures
Lymph Node Excision
Tertiary Care Centers
Comorbidity
Hemoglobins
Multivariate Analysis
Logistic Models
Regression Analysis
Clinical Trials
Therapeutics

Keywords

  • Complications
  • High risk
  • Prostate cancer
  • Prostatectomy
  • Systemic therapy

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Neoadjuvant Systemic Therapy before Radical Prostatectomy in High-Risk Prostate Cancer Does Not Increase Surgical Morbidity : Contemporary Results Using the Clavien System. / Williams, Stephen; Davis, John W.; Wang, Xuemei; Achim, Mary F.; Zurita-Saavedra, Amado; Matin, Surena F.; Pisters, Louis L.; Ward, John F.; Pettaway, Curtis A.; Chapin, Brian F.

In: Clinical Genitourinary Cancer, Vol. 14, No. 2, 01.04.2016, p. 130-138.

Research output: Contribution to journalArticle

Williams, Stephen ; Davis, John W. ; Wang, Xuemei ; Achim, Mary F. ; Zurita-Saavedra, Amado ; Matin, Surena F. ; Pisters, Louis L. ; Ward, John F. ; Pettaway, Curtis A. ; Chapin, Brian F. / Neoadjuvant Systemic Therapy before Radical Prostatectomy in High-Risk Prostate Cancer Does Not Increase Surgical Morbidity : Contemporary Results Using the Clavien System. In: Clinical Genitourinary Cancer. 2016 ; Vol. 14, No. 2. pp. 130-138.
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abstract = "Background Multimodality therapies for men with high- and very high-risk prostate cancer, including neoadjuvant systemic therapy followed by subsequent radical prostatectomy (RP) are being increasingly explored despite the lack of adequate morbidity data. Materials and Methods We analyzed the data from 215 consecutive patients with high- and very high-risk prostate cancer who were previously untreated or had received neoadjuvant systemic therapy. All patients underwent RP with extended pelvic lymph node dissection from 2006 to 2010 at a single tertiary care academic center. All complications within 90 days of surgery were defined and categorized by a 5-grade and 10-domain modification of the Clavien system. Univariable and multivariable logistic regression analyses were used to identify preoperative predictors for complications. Results Of the 215 patients, 29{\%} experienced a complication of any grade ≤ 90 days after surgery; 6{\%} experienced grade ≥ 3, with no significant difference between either cohort (P =.50). On multivariate analysis, open RP (odds ratio [OR], 2.08; 95{\%} confidence interval [CI], 1.11-3.90; P =.02) and preoperative hemoglobin (OR, 1.98; 95{\%} CI, 1.05-3.72; P =.03) were independent predictors of the occurrence of any grade complication. For major complications (Clavien ≥ 3), a Charlson comorbidity index of 6 to 7 versus 3 to 5 (OR, 5.45; 95{\%} CI, 1.57-18.98; P =.008) and the most recent year of surgery (OR, 4.73; 95{\%} CI, 1.36-16.39; P =.01) were significant predictors on multivariable analysis. Conclusion The use of neoadjuvant systemic therapy did not appear to increase the risk of perioperative complications. These findings support current clinical trials, which might elucidate the oncologic benefit of this multimodality approach.",
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T2 - Contemporary Results Using the Clavien System

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AU - Davis, John W.

AU - Wang, Xuemei

AU - Achim, Mary F.

AU - Zurita-Saavedra, Amado

AU - Matin, Surena F.

AU - Pisters, Louis L.

AU - Ward, John F.

AU - Pettaway, Curtis A.

AU - Chapin, Brian F.

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N2 - Background Multimodality therapies for men with high- and very high-risk prostate cancer, including neoadjuvant systemic therapy followed by subsequent radical prostatectomy (RP) are being increasingly explored despite the lack of adequate morbidity data. Materials and Methods We analyzed the data from 215 consecutive patients with high- and very high-risk prostate cancer who were previously untreated or had received neoadjuvant systemic therapy. All patients underwent RP with extended pelvic lymph node dissection from 2006 to 2010 at a single tertiary care academic center. All complications within 90 days of surgery were defined and categorized by a 5-grade and 10-domain modification of the Clavien system. Univariable and multivariable logistic regression analyses were used to identify preoperative predictors for complications. Results Of the 215 patients, 29% experienced a complication of any grade ≤ 90 days after surgery; 6% experienced grade ≥ 3, with no significant difference between either cohort (P =.50). On multivariate analysis, open RP (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.11-3.90; P =.02) and preoperative hemoglobin (OR, 1.98; 95% CI, 1.05-3.72; P =.03) were independent predictors of the occurrence of any grade complication. For major complications (Clavien ≥ 3), a Charlson comorbidity index of 6 to 7 versus 3 to 5 (OR, 5.45; 95% CI, 1.57-18.98; P =.008) and the most recent year of surgery (OR, 4.73; 95% CI, 1.36-16.39; P =.01) were significant predictors on multivariable analysis. Conclusion The use of neoadjuvant systemic therapy did not appear to increase the risk of perioperative complications. These findings support current clinical trials, which might elucidate the oncologic benefit of this multimodality approach.

AB - Background Multimodality therapies for men with high- and very high-risk prostate cancer, including neoadjuvant systemic therapy followed by subsequent radical prostatectomy (RP) are being increasingly explored despite the lack of adequate morbidity data. Materials and Methods We analyzed the data from 215 consecutive patients with high- and very high-risk prostate cancer who were previously untreated or had received neoadjuvant systemic therapy. All patients underwent RP with extended pelvic lymph node dissection from 2006 to 2010 at a single tertiary care academic center. All complications within 90 days of surgery were defined and categorized by a 5-grade and 10-domain modification of the Clavien system. Univariable and multivariable logistic regression analyses were used to identify preoperative predictors for complications. Results Of the 215 patients, 29% experienced a complication of any grade ≤ 90 days after surgery; 6% experienced grade ≥ 3, with no significant difference between either cohort (P =.50). On multivariate analysis, open RP (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.11-3.90; P =.02) and preoperative hemoglobin (OR, 1.98; 95% CI, 1.05-3.72; P =.03) were independent predictors of the occurrence of any grade complication. For major complications (Clavien ≥ 3), a Charlson comorbidity index of 6 to 7 versus 3 to 5 (OR, 5.45; 95% CI, 1.57-18.98; P =.008) and the most recent year of surgery (OR, 4.73; 95% CI, 1.36-16.39; P =.01) were significant predictors on multivariable analysis. Conclusion The use of neoadjuvant systemic therapy did not appear to increase the risk of perioperative complications. These findings support current clinical trials, which might elucidate the oncologic benefit of this multimodality approach.

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