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Cost-effectiveness comparison between neoadjuvant chemohormonal therapy and extended pelvic lymph node dissection in high-risk prostate cancer patients treated with radical prostatectomy: a multi-institutional analysis

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Abstract

The aim of the present study was to assess the cost-effectiveness of extended pelvic lymph node dissection (ePLND) compared to neoadjuvant chemohormonal therapy using gonadotropin-releasing hormone agonist/antagonist and estramustine. We retrospectively analyzed data within Michinoku Urological Cancer Study Group database containing 2971 PC patients treated with radical prostatectomy (RP) at four institutes between July 1996 and July 2017. We identified 237 and 403 high-risk patients who underwent RP and ePLND (ePLND group), and neoadjuvant chemohormonal therapy followed by RP and limited PLND (neoadjuvant group), respectively. The oncological outcomes and cost-effectiveness were compared between groups. Medical cost calculation focused on PC-related medication and adjuvant radiotherapy. Biochemical recurrence-free and overall survival rates in the neoadjuvant group were significantly higher than those in the ePLND group. Significantly higher number of patients progressed to castration-resistant PC in the ePLND group than in the neoadjuvant group. Background-adjusted multivariate Cox regression analysis using inverse probability of treatment weighting (IPTW) revealed that neoadjuvant chemohormonal therapy independently reduced the risk of biochemical recurrence after RP. The 5-year cost per person was significantly higher in the ePLND group than in the neoadjuvant group. Although the present study was retrospective, neoadjuvant chemohormonal therapy followed by RP as a concurrent strategy has potential to improve oncological outcome and cost-effectiveness.

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Abbreviations

PC:

Prostate cancer

RP:

Radical prostatectomy

ePLND:

Extended lymph node dissection

GS:

Gleason score

PSA:

Prostate-specific antigen

GnRH-A:

Gonadotropin-releasing hormone agonist/antagonist

CRPC:

Castration-resistant prostate cancer

GCSF:

Granulocyte-colony stimulating factor

IPTW:

Inverse probability of treatment weighting

HR:

Hazard ratio

CI:

Confidence interval

OS:

Overall survival

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Acknowledgements

We thank Yuki Fujita, Mihoko Osanai, and Yukie Nishizawa for their invaluable help with data collection. We would also like to thank Enago (www.enago.jp) for the English language review.

Funding

This work was supported by a Grant-in-Aid for Scientific Research (Nos. 15H02563, 15K15579, 17K11118, 17K11119, 17K16768, 17K16770, and 17K16771) from the Japan Society for the Promotion of Science.

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Authors and Affiliations

  1. Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562, Japan

    Teppei Matsumoto, Shingo Hatakeyama, Takuma Narita, Takuya Koie & Chikara Ohyama

  2. Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan

    Teppei Ookubo, Koji Mitsuzuka, Shinichi Yamashita & Yoichi Arai

  3. Department of Urology, Akita University Graduate School of Medicine, Akita, Japan

    Shintaro Narita, Takamitsu Inoue & Tomonori Habuchi

  4. Department of Urology, Miyagi Cancer Center, Natori, Japan

    Sadafumi Kawamura & Tatsuo Tochigi

  5. Department of Urology, Yamagata University Graduate School of Medicine, Yamagata, Japan

    Norihiko Tsuchiya

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  1. Teppei Matsumoto
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Contributions

SH, TK and CO helped in conception and design. TM, SH, TO, SN, TI, SY, KM, TN, HY, TY, YH, TK, SK, TT and NT contributed to acquisition of data. SH, TK and TN involved in analysis and interpretation of data. SH and TK involved in drafting of the manuscript. SN, TK and KM helped in critical revision of the manuscript. SH and TK helped in statistical analysis. SH, TK and CO contributed to obtaining funding. TH, YA and CO involved in administrative, technical or material support.

Corresponding author

Correspondence to Shingo Hatakeyama.

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Conflict of interest

The authors declare no conflicts of interests.

Ethical standards

This retrospective study was performed in accordance with the ethical standards of the Declaration of Helsinki and approved by each institutional review board of Hirosaki University, Tohoku University, Akita University, and Miyagi Cancer Center.

Informed consent

For this type of study, formal written consent is not required. Pursuant to the provisions of the ethics committee and the ethic guideline in Japan, written consent was not required in exchange for public disclosure of study information in the case of retrospective and/or observational study using a material such as the existing documentation. The study information was open for the public consumption at http://www.med.hirosaki-u.ac.jp/~uro/html/IRB/IRBdoc.html.

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Matsumoto, T., Hatakeyama, S., Ookubo, T. et al. Cost-effectiveness comparison between neoadjuvant chemohormonal therapy and extended pelvic lymph node dissection in high-risk prostate cancer patients treated with radical prostatectomy: a multi-institutional analysis. Med Oncol 34, 190 (2017). https://doi.org/10.1007/s12032-017-1050-y

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