Post-surgical outcomes of patients with chronic kidney disease and end stage renal disease undergoing radical prostatectomy: 10-year results from the US National Inpatient Sample.
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ABSTRACT: Background
Chronic kidney disease (CKD) and end stage renal disease (ESRD) are not well characterized in prostate cancer patients. This study aimed to examine the clinical characteristics and postsurgical outcomes of patients with or without CKD and ESRD undergoing radical prostatectomy for prostate cancer.Methods
This population-based, retrospective study used patient data from the Nationwide Inpatient Sample, the largest all-payer US inpatient care database. From 2005 to 2014, 136,790 male patients aged > 20 years diagnosed with prostate cancer and who received radical prostatectomy were included. Postoperative complications, postoperative acute kidney injury (AKI) and urinary complications, and length of hospital stay were compared between patients with or without underlying CKD and ESRD.Results
After adjusting for relevant factors, the CKD group had a significantly higher risk of postoperative complications than the non-CKD group. In addition, the CKD group had a 5-times greater risk of postoperative AKI and urinary complications than the non-CKD group. Both CKD and ESRD groups had significantly longer hospital stays than the non-CKD group. Patients receiving RARP had a lower risk of postoperative complications than those who received open radical prostatectomy, regardless of having CKD or not. Both non-CKD and CKD patients receiving RARP had shorter hospital stays than those who received open surgery.Conclusions
Prostate cancer patients with underlying CKD had significantly greater risk of postoperative complications, postoperative AKI and urinary complications, and longer hospital stays than those without CKD. The use of RARP significantly shortened hospital stays and reduced complications for these patients.
SUBMITTER: Ning C
PROVIDER: S-EPMC6651956 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:A positive surgical margin (PSM) following radical prostatectomy (RP) for prostate cancer is associated with increased risk of biochemical recurrence. We sought to examine whether the pathologist is an independent predictor of PSMs. METHODS:We performed a retrospective review of 3,557 men who underwent RP for localized prostate cancer at our institution from 2003 to 2015. We evaluated 29 separate pathologists. Univariate and multivariable logistic regression were used to test variables previously shown to influence PSM rates. RESULTS:Overall rate of PSM was 18.9%. Compared with patients without PSM, patients with PSM had higher body mass index (mean: 28.8 vs. 28.3), Gleason score?7 (84% vs. 66%), extracapsular extension (51% vs. 20%), and median prostate-specific antigen (5.9 vs. 5.1ng/ml) (all P<0.05). Univariate logistic regression showed that surgeon experience, pathologist experience, and pathologist genitourinary fellowship training were all predictors of PSMs (all P<0.05). Multivariable regression analysis confirmed that decreased surgeon experience, increased pathologist experience, higher pathologic Gleason score, higher pathologic stage, and higher prostate-specific antigen were significant predictors of PSMs. Increasing surgeon experience was associated with decreased odds of PSM (odds ratio = 0.79 per 1 standard deviation increase, 95% CI [0.70-0.89]). In contrast, increasing pathologist experience was associated with increased odds of PSM (odds ratio = 1.11 per 1 standard deviation increase, 95% CI [1.03-1.19]). The relationship between pathologist experience and PSM appeared to be nonlinear (Fig. 2). CONCLUSIONS:Greater pathologist experience appears to be associated with greater odds of PSMs following radical prostatectomy, even after controlling for case mix, pathologist fellowship training, and surgeon experience. Based on these findings, pathologists with less experience reviewing RP specimens may consider requesting rereview by a dedicated genitourinary pathologist.
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