Abstract
BackgroundWe evaluated the influence of comorbidity inferred risks for lymph node metastasis (pN1) and positive surgical margins (R1) after radical prostatectomy in order to optimize pretherapeutic risk classification.We analyzed 454 patients after radical prostatectomy (RP) between 2009 and 2014. Comorbidities were defined by patients’ medication from our electronic patient chart and stratified according to the ATC WHO code. Endpoints were lymph node metastasis (pN1) and positive surgical margins (R1).ResultsRates for pN1 and R1 were 21.4% (97/454) and 29.3% (133/454), respectively. In addition to CAPRA and Gleason score, we identified diabetes as a significant medication inferred risk factor for pN1 (OR 2.9, p = 0.004/OR 3.2, p = 0.001/OR 3.5, p = 0.001) and beta-blockers for R1 (OR 1.9, p = 0.020/OR 2.9, p = 0.004). Patients with diabetes showed no statistically significant difference in Gleason score, CAPRA Score, PSA, and age compared to non-diabetic patients.ConclusionsWe identified diabetes and beta1 adrenergic blockage as significant risk factors for lymph node metastasis and positive surgical margins in prostate cancer (PCa). Patients at risk will need intensive pretherapeutic staging for optimal therapeutic stratification.
Highlights
We evaluated the influence of comorbidity inferred risks for lymph node metastasis and positive surgical margins (R1) after radical prostatectomy in order to optimize pretherapeutic risk classification
Risk stratification is based on histologic analysis of invasive prostate biopsies, which are indicated by elevated prostate-specific antigen (PSA) levels or suspicious digital rectal examination (DRE) findings
Four hundred fifty-four prostate cancer patients after radical prostatectomy were analyzed in this study
Summary
We evaluated the influence of comorbidity inferred risks for lymph node metastasis (pN1) and positive surgical margins (R1) after radical prostatectomy in order to optimize pretherapeutic risk classification. Comorbidities were defined by patients’ medication from our electronic patient chart and stratified according to the ATC WHO code. Several risk classification tools exist for pretherapeutic stratification such as Kattan normograms [2], D’Amico score [3, 4] or CAPRA (Cancer of Prostate Risk Assessment) score [5,6,7]. A reduced risk for developing PCa has been described for diabetes patients [11]; little is known about the impact on cancer stage. We have used our electronic patient chart to generate the prostate cancer patients’ comorbidity profile by the self-medication during hospitalization for radical prostatectomy. We assessed the comorbidity profile’s impact on cancer stage at diagnosis represented by R status and pN status as the key determinants of primary and adjuvant therapeutical strategy
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