Page 12 - CUA2018 Abstracts - Oncology-Prostate

Poster session 1: Prostate Cancer I

(SD 2.73) vs. a mean PSA value of 5.49 (SD 0.76) among patients with Results: We identified 2441 patients with complete data on cancer aggres-
T2 disease in this group (p=0.0013). siveness and sufficient followup. A total of 381 (16%) patients were dia-
Conclusions: Higher pathological staging showed univariable association betic; 281 patients were treated with metformin ± other anti–diabetic
with higher mean SUV max values. A larger sample size is needed to medication and 101 patients were treated with other antidiabetic medica-
determine if PET SUV is an independent marker for higher–risk pros- tion, excluding metformin. Median followup was 48 months (interquartile
tate cancer in comparison to other biomarkers, such as PSA and biopsy range [IQR] 24–84); 218 patients (9%) died and 150 (6%) experienced
Gleason grade. biochemcal recurrence (BCR). Median (IQR) followup to recurrence was
52 months (27–69) and to death 52 months (24–78). Taking metformin
UP–1.7 had a protective effect in showing less BCR on univariate analysis only
and on multivariate analysis in better overall sirvival (OS) than in diabetics
Evolution of positive surgical margins in robotic prostatectomy: not taking metformin. More specifically, on univariate analysis for BCR–
Is there a plateau for proficiency? free survival, metformin showed les BCR compared to non–metformin
Félix Couture , Samer Traboulsi , Côme Tholomier , Khaled Ajib , takers (p=0.04). But this effect was not present anymore on multivariate
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Helen Davis Bondarenko , Pierre Karakiewicz , Assaad El–Hakim , Mila analysis (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.27–2.04;
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Mansour , Kevin Zorn 1 p=0.6). When analyzing the effect of diabetes and metformin on OS on
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1 Section of Urology, Department of Surgery, Centre Hospitalier de multivariate analysis, diabetics had worse OS than non–diabetics (HR
l’Université de Montréal, Montreal, QC, Canada; Section of Urology, 1.5; 1.08–2.06; p=0.01), but when diabetics took metformin, they fared
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Department of Surgery, McGill University Health Centre, Montreal, QC, better than diabetics not taking metformin (HR 0.5; 0.26–0.86; p=0.01).
Canada; Université de Montréal, Montreal, QC, Canada Taking metformin resulted in similar OS as in non–diabetics (HR1.13;
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Introduction: Robot–assisted radical prostatectomy (RARP) has continued 0.73–1.73; p=0.6).
to gain ground over the open approach for the treatment of localized Conclusions: We found that the effect of diabetes and metformin is incon-
prostate cancer. Surgical experience is an important factor determining sistent and must, therefore, depend on many different variables, which
oncological outcomes in RARP, notably positive surgical margins (PSM). are so far unknown.
We sought to assess if prior RARP experience correlated with PSM, and
to determine if there was any plateau in surgeon performance.
Methods: We analyzed prospective data from 1034 RARP cases done UP–1.9
by two surgeons (KCZ, AE) between March 2006 and April 2017. Combination of PUMA and NOXA expression in benign epithelial
Incidence of PSM was studied over the number of cases performed. cells in prostate cancer is predictive of biochemical recurrence
Logistic regressions were used to detect improvement in overall and apical in patients
PSM, both for individual and combined surgeons, controlling for factors Sylvie Clairefond , Benjamin Péant , Véronique Ouellet , Véronique
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such as patient age, prostate–specific antigen (PSA), Gleason score, and Barrès , Anne–Marie Mes–Masson 1,2,3 , Fred Saad 1,2,4
1,2
transrectal ultrasound (TRUS) prostate size. 1 Centre de Recherche du Centre Hospitalier de l’Université de Montréal,
Results: Analysis of PSM over Surgeon 1’s 620 cases showed no significant Montreal, QC, Canada; Institut du Cancer de Montréal, Montreal, QC,
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reduction in PSM or learning curve for this surgeon who had performed Canada; Département de Médecine, Université de Montréal, Montreal,
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about 1200 RARPs prior to entering our database. Surgeon 2, who had QC, Canada; Département de Chirurgie, Université de Montréal,
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less initial experience, had significant reduction all across his 414 cases Montreal, QC, Canada
in both overall and apical margins. When measuring progression for Study Groups: Molecular Pathology Platform at CRCHUM.
every 20 cases completed by Surgeon 2, odds ratios for overall and api- Introduction: PUMA and NOXA are two pro–apoptotic members of the
cal PSM were 0.91 (95% confidence interval [CI] 0.87–0.95) and 0.88 BH3–only subgroup of the BCL–2 family. These two proteins play a role
(95%CI 0.83–0.94), respectively (p<0.001). Subanalysis of pT2 disease in the initiation of apoptosis. The objective of this study is to analyze their
also revealed significant improvement over individual cases for Surgeon expression by immunofluorescence in benign and tumour prostate tissues
2 (p<0.05), but significance was lost for pT3 disease. to determine if there is a correlation between their expression and patient
Conclusions: Our analyses did not reveal a significant effect of addi- biochemical recurrence (BCR).
tional cases performed by the surgeon with more prior cases, suggesting Methods: Biomarker antibodies were verified for specificity and optimized
a plateau in the likelihood of PSM with experience. The less experienced by Western blot and with tissue microarrays (TMA) containing prostate
surgeon showed significant improvement in PSM over 414 cases, high- cancer cell lines and cell line–derived xenograft tissues. Subsequently,
lighting the learning curve present in early RARP experience. Furthermore, quantification of expression for both biomarkers was performed on six
improvements in the occurrence of PSM were significant for pT2, but TMA generated from radical prostatectomy samples (285 patients). The
not pT3 disease, which seems to mirror the learning curve in traditional TMA were constructed using two cores of benign adjacent to the tumour
open prostatectomy. and two cores of tumour tissue from each patient. Analysis of biomarker
expression was semi–automated using the VisiomorphDP software.
UP–1.8 Correlation with patient clinical outcome was determined with SPSS
V20 software.
Do diabetes and metformin have an impact on prostate cancer Results: There was no correlation of PUMA and NOXA expression and
prognosis after radiotherapy? Results of a large institutional BCR in tumour cores and stroma. In contrast, in benign epithelial cells,
database Kaplan–Meier analysis showed a significant association between an
Daniel Taussky , Felix Preisser , Carole Lambert , Jean–Paul Bahary , Guila extreme (low or high) PUMA expression and BCR (log rank=11.349;
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Delouya , Pierre Karakiewicz 2,3 p=0.001). Further analysis revealed a significant association between high
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1 Radiation Oncology, University of Montreal Health Centre, Montreal, NOXA expression in benign epithelial cells and BCR (log rank=6.133;
QC, Canada; Cancer Prognostics and Health Outcomes Unit, University p=0.013). The combination of extreme PUMA and high NOXA identified
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of Montreal Health Centre, Montreal, QC, Canada; Urology, University patients with a poor prognosis (log rank=16.041; p=0.000). In a multivari-
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of Montreal Health Centre, Montreal, QC, Canada ate Cox regression model, PUMA and NOXA proteins were also identified
Introduction: We investigated the importance of metformin in patients as independent predictive biomarkers of BCR.
treated with radiotherapy in a large institutionalized database. Conclusions: By studying benign tissue adjacent to the tumour, we identi-
Methods: We identified all patients from our database that were treated fied two potential biomarkers that discriminate high–risk patients, inde-
for primary localized prostate cancer with either prostate brachytherapy or pendent of Gleason score or pathological stage. We will next evaluate
external–beam radiotherapy ± androgen–deprivation therapy. Comparison PUMA and NOXA expression in benign cells in relation to the distance
between groups was done using Kaplan–Meier analyses and Cox regres- from the tumoural site.
sion models. Adjustments on multivariate analysis were made for CAPRA
score, type of treatment, and age.
S70 CUAJ • June 2018 • Volume 12(6Suppl2)