Advertisement

Clinical characteristics and outcomes of robot-assisted laparoscopic radical prostatectomy in HIV-positive patients: a nationwide population-based analysis

  • Hedong Han
  • Chen Ye
  • Zhongjun Tang
  • Yingyi Qin
  • Yiming Ruan
  • Yang Cao
  • Jia HeEmail author
Urology - Original Paper
  • 22 Downloads

Abstract

Purpose

To compare differences in clinical characteristics and outcomes between patients with and without human immunodeficiency virus (HIV) infection in light of robot-assisted laparoscopic radical prostatectomy (RALRP) as the most common surgical technique for prostate cancer. Previous data on perioperative complication rates of RALRP in HIV(+) patients are limited by small sample size.

Methods

The National Inpatient Sample database from 2008 to 2014 was used to query prostate cancer patients who underwent RALRP. HIV(+) patients were identified through ICD9 codes 042, 043, 044, V08 and 079.53. Intraoperative and postoperative complications, rate of blood transfusion, in-hospital mortality, prolonged length of stay and total cost were compared by univariate, multivariate regression and 1:4 propensity score matched analyses.

Results

Overall, 270,319 weighted patients undergoing RALRP were identified, among whom 546 (0.20%) patients were diagnosed with HIV. Patients with HIV were younger, less likely to be white and had more comorbidities. Multivariable regression analysis revealed that HIV(+) patients had significantly increased genitourinary complications (odds ratio [OR]: 3.31; 95% confidence interval [CI]: 1.03–10.68) and miscellaneous surgical events (OR 3.19; 95% CI 1.26–8.08). There were no differences in potentially life-threatening cardiac, respiratory and vascular events between patients with and without HIV after RALRP. Propensity score matched analysis yielded similar results.

Conclusions

Our findings suggest that patients who underwent RALRP with HIV did not experience higher risk of potentially life-threatening postoperative complications. RALRP could be safely considered as a surgical treatment for HIV(+) patients with prostate cancer.

Keywords

Robotic surgery Radical prostatectomy HIV Complications Propensity score 

Notes

Author contributions

HH, CY and ZT designed the research. HH and YR had full access to the data. HH and CY conducted all analysis. HH and ZT wrote the draft of this paper. YQ, YR and YC revised the article critically. All the authors contributed to the manuscript writing, read and approved the final manuscript. JH was the guarantor.

Funding

This study was supported by grants from the National key research and development program of China (No. 2017YFC0908005) and the Fourth Round of Shanghai Three-year Action Plan on Public Health Discipline and Talent Program: Evidence-based Public Health and Health Economics (No. 15GWZK0901).

Compliance with ethical standards

Conflict of interest

The authors report no disclosures relevant to the manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent is not required due to the retrospective de-identified dataset from the National Inpatient Sample.

Supplementary material

11255_2019_2321_MOESM1_ESM.eps (738 kb)
Supplementary material 1: Supplementary Fig. 1. Propensity score matching analysis of perioperative outcomes in RALRP patients (EPS 737 kb)
11255_2019_2321_MOESM2_ESM.docx (13 kb)
Supplementary material 2: Supplementary Table 1. Absolute standard differences for variables before and after propensity score matching (DOCX 13 kb)

References

  1. 1.
    Siegel RL, Miller KD, Jemal A (2018) Cancer statistics. CA Cancer J Clin 68:7–30CrossRefGoogle Scholar
  2. 2.
    Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 71:618–629CrossRefGoogle Scholar
  3. 3.
    Cornford P, Bellmunt J, Bolla M, Briers E, De Santis M, Gross T et al (2017) EAU-ESTRO-SIOG guidelines on prostate cancer. Part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur Urol 71:630–642CrossRefGoogle Scholar
  4. 4.
    Ilic D, Evans SM, Allan CA, Jung JH, Murphy D, Frydenberg M (2018) Laparoscopic and robot-assisted vs open radical prostatectomy for the treatment of localized prostate cancer: a Cochrane systematic review. BJU Int 121:845–853CrossRefGoogle Scholar
  5. 5.
    Leow JJ, Chang SL, Meyer CP, Wang Y, Hanske J, Sammon JD et al (2016) Robot-assisted versus open radical prostatectomy: a contemporary analysis of an all-payer discharge database. Eur Urol 70:837–845CrossRefGoogle Scholar
  6. 6.
    Murray CJ, Ortblad KF, Guinovart C, Lim SS, Wolock TM, Roberts DA et al (2014) Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study. Lancet 384:1005–1070CrossRefGoogle Scholar
  7. 7.
    Michaels SH, Clark R, Kissinger P (1998) Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. N Engl J Med 339:405–406CrossRefGoogle Scholar
  8. 8.
    Spano JP, Poizot-Martin I, Costagliola D, Boue F, Rosmorduc O, Lavole A et al (2016) Non-AIDS-related malignancies: expert consensus review and practical applications from the multidisciplinary CANCERVIH Working Group. Ann Oncol 27:397–408CrossRefGoogle Scholar
  9. 9.
    Mpondo BC (2016) HIV infection in the elderly: arising challenges. J Aging Res 2016:1–10CrossRefGoogle Scholar
  10. 10.
    Yanik EL, Katki HA, Engels EA (2016) Cancer risk among the HIV-infected elderly in the United States. Aids 30:1663–1668CrossRefGoogle Scholar
  11. 11.
    Robbins HA, Shiels MS, Pfeiffer RM, Engels EA (2014) Epidemiologic contributions to recent cancer trends among HIV-infected people in the United States. Aids 28:881–890CrossRefGoogle Scholar
  12. 12.
    Silberstein JL, Parsons JK, Palazzi-Churas K, Downs TM, Sakamoto K, Derweesh IH et al (2010) Robot-assisted laparoscopic radical prostatectomy in men with human immunodeficiency virus. Prostate Cancer Prostatic Dis 13:328–332CrossRefGoogle Scholar
  13. 13.
    Izadmehr S, Leapman M, Hobbs AR, Katsigeorgis M, Nabizada-Pace F, Jazayeri SB, Samadi DB (2016) Clinical characteristics and outcomes of HIV-seropositive men treated with surgery for prostate cancer. Int Urol Nephrol 48:1639–1645CrossRefGoogle Scholar
  14. 14.
    Preisser F, Mazzone E, Nazzani S, Bandini M, Tian Z, Marchioni M et al (2018) Comparison of perioperative outcomes between cytoreductive radical prostatectomy and radical prostatectomy for nonmetastatic prostate cancer. Eur Urol 74:693–696CrossRefGoogle Scholar
  15. 15.
    Gershman B, Meier SK, Jeffery MM, Moreira DM, Tollefson MK, Kim SP et al (2017) Redefining and contextualizing the hospital volume-outcome relationship for robot-assisted radical prostatectomy: implications for centralization of care. J Urol 198:92–99CrossRefGoogle Scholar
  16. 16.
    Trinh QD, Sammon J, Sun M, Ravi P, Ghani KR, Bianchi M et al (2012) Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample. Eur Urol 61:679–685CrossRefGoogle Scholar
  17. 17.
    Mehta K, Im A, Rahman F, Wang H, Veldkamp P (2018) Epidemiology and outcomes of hematopoietic stem cell transplantation in human immunodeficiency virus-positive patients from 1998 to 2012: a nationwide analysis. Clin Infect Dis 67:128–133CrossRefGoogle Scholar
  18. 18.
    Ettinger DS, Kuettel M, Malin J, McClure JS, Smith ML, Zelenetz AD, Stewart FM (2015) NCCN roundtable: What are the characteristics of an optimal clinical practice guideline? J Natl Compr Cancer Netw 13:640–642CrossRefGoogle Scholar
  19. 19.
    Murphy AB, Bhatia R, Martin IK, Klein DA, Hollowell C, Nyame Y et al (2014) Are HIV-infected men vulnerable to prostate cancer treatment disparities? Cancer Epidemiol Biomark Prev 23:2009–2018CrossRefGoogle Scholar
  20. 20.
    Silberstein J, Downs T, Lakin C, Kane CJ (2009) HIV and prostate cancer: a systematic review of the literature. Prostate Cancer Prostatic Dis 12:6–12CrossRefGoogle Scholar
  21. 21.
    Levinson A, Nagler EA, Lowe FC (2005) Approach to management of clinically localized prostate cancer in patients with human immunodeficiency virus. Urology 65:91–94CrossRefGoogle Scholar
  22. 22.
    Huang WC, Kwon EO, Scardino PT, Eastham JA (2006) Radical prostatectomy in patients infected with human immunodeficiency virus. BJU Int 98:303–307CrossRefGoogle Scholar
  23. 23.
    Shiels MS, Pfeiffer RM, Gail MH, Hall HI, Li J, Chaturvedi AK et al (2011) Cancer burden in the HIV-infected population in the United States. J Natl Cancer Inst 103:753–762CrossRefGoogle Scholar
  24. 24.
    Quatan N, Nair S, Harrowes F, Hay P (2017) Should HIV patients be considered a high risk group for the development of prostate cancer? Ann R Coll Surg Engl 87:437–438CrossRefGoogle Scholar
  25. 25.
    Dutta A, Uno H, Holman A, Lorenz DR, Gabuzda D (2017) Racial differences in prostate cancer risk in young HIV-positive and HIV-negative men: a prospective cohort study. Cancer Causes Control 28:767–777CrossRefGoogle Scholar
  26. 26.
    Wood E, Hogg RS, Lima VD, Kerr T, Yip B, Marshall BD, Montaner JS (2008) Highly active antiretroviral therapy and survival in HIV-infected injection drug users. JAMA 300:550–554CrossRefGoogle Scholar
  27. 27.
    Nanni MG, Caruso R, Mitchell AJ, Meggiolaro E, Grassi L (2015) Depression in HIV infected patients: a review. Curr Psychiatry Rep 17:530CrossRefGoogle Scholar
  28. 28.
    Falade-Nwulia O, Thio CL (2011) Liver disease, HIV and aging. Sex Health 8:512–520CrossRefGoogle Scholar
  29. 29.
    Masarani M, Dinneen M, Coyne KM, Hawkins DA (2008) The genitourinary complications of HIV infection in men. Br J Hosp Med (Lond) 69:141–146CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Health StatisticsSecond Military Medical UniversityShanghaiChina
  2. 2.Department of UrologyChanghai Hospital, Second Military Medical UniversityShanghaiChina
  3. 3.Department of OphthalmologyMinhang Hospital, Fudan UniversityShanghaiChina
  4. 4.Clinical Epidemiology and Biostatistics, School of Medical SciencesÖrebro UniversityÖrebroSweden
  5. 5.Tongji University School of MedicineShanghaiChina

Personalised recommendations