Page 1 - CUA2019 Abstracts - Oncology-Prostate

2019 CUA AbstrACts

Poster Session 4: Prostate Cancer I

June 30, 2019; 0730–0900

MP-4.1 their primary treatment. Subjects were allocated to either ORP (two sur-
Effect of a hospital funding reform in Ontario on patients geons) or RARP (seven surgeons) based on surgeon practice. The outcomes
diagnosed with localized prostate cancer: A population-based, were positive surgical margins (R1), estimated blood loss (EBL), blood trans-
retrospective cohort study fusion, serious adverse event (SAE; ≥ Clavien 3a), 90-day mortality, 90-day
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Marian S. Wettstein , Vicki Ling , J. Michael Paterson , Alvin H. Li , return to the emergency room, and length of hospital stay (LOS). T-tests
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Adalsteinn Brown , Karen S. Palmer , Noah Ivers , Girish S. Kulkarni 1 and Chi-square tests were used to analyze outcomes (two-sided p<0.05).
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1 Division of Urology, Department of Surgery, Princess Margaret Cancer Results: Between September 2007 and May 2018, 3152 men were prac-
Centre, University Health Network, University of Toronto, Toronto, ON, tice-allocated to ORP (n=331) or RARP (n=2821). Baseline characteristics
Canada; ICES, Toronto, ON, Canada; Ottawa Hospital Research Institute, did not differ between groups except that a lower proportion of men had
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Ottawa, ON, Canada; Dalla Lana School of Public Health, University National Comprehensive Cancer Network intermediate-risk disease in the
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of Toronto, Toronto, ON, Canada; Women’s College Research Institute, ORP group (49% vs. 62%; p<0.01). R1 (24.2% vs. 24.8%; p=0.81), SAE
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Women’s College Hospital, University of Toronto, Toronto, ON, Canada (1.8% vs. 2.2%; p=0.65), 90-day mortality (0.3% vs. 0.1%; p=0.35), and
Introduction: In the fiscal year of 2015/2016, the government of Ontario, 90-day return to the emergency room (20.0% vs. 23.5%; p=0.14) did not
Canada, introduced a new funding model (quality-based procedures, QBP). differ between the ORP and RARP groups. EBL (478 ml vs. 140 ml; p<0.01),
According to this model, hospitals that offer radical prostatectomy for local- blood transfusion (4.0% vs. 1.6%; p<0.01), and LOS (2.8 days vs. 2.4 days;
ized prostate cancer are reimbursed according “price x volume,” with quality p<0.01) were lower in the RARP group.
intended to be accounted for through adherence to best clinical practices Conclusions: RARP was associated with lower EBL, blood transfusion, and
outlined in QBP-specific handbooks. We investigated whether this policy LOS compared to ORP.
change led to changes in the management of localized prostate cancer or to
altered patient characteristics among those undergoing radical prostatectomy. MP-4.3
Methods: Linked health-administrative data were used to derive incident Validation of the prognostic value of NF-κB p65 in prostate cancer
cases of localized prostate cancer (January 2011 to October 2016) and using a large multi-institutional cohort of the Canadian Prostate
patients who underw ent radical prostatectomy for localized prostate cancer Cancer Biomarker Network
(January 2011 to November 2017). We then performed interrupted time Andrée-Anne Grosset , Veronique Ouellet , Christine Caron , Gabriela
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series analysis (implemented by autoregressive integrated moving aver- Fragoso , Veronique Barres , Nathalie Delvoye , Mathieu Latour , Armen
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age models) to investigate if the policy change led to changes of initial G. Aprikian , Alain Bergeron , Simone Chevalier , Ladan Fazli , Neil E.
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management, tumour risk profiles per management strategy, monthly case Fleshner , Martin E. Gleave , Pierre Karakiewicz , Louis Lacombe , Jean-
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volumes, monthly average length of stay, proportion of patients returning Baptiste Lattouf , Theodorus van der Kwast , Dominique Trudel , Anne-
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to the hospital or the emergency department, proportion of patients >65 Marie Mes-Masson , Fred Saad 1
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years, monthly average Charlson comorbidity index, and the proportion of 1 Axe Cancer/Institut du Cancer de Montréal, Centre de Recherche du
minimally invasive performed radical prostatectomies. Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada;
Results: We identified 33 128 patients with incident localized prostate cancer 2 Surgery and Urology, Research Institute - McGill University Health Centre,
and 17 159 patients who received radical prostatectomy. Our analyses did Montréal, QC, Canada; Axe Oncologie, Centre Hospitalier Universitaire
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not reveal any negative consequences of the policy change, neither for the de Québec et Universtié Laval, Québec City, QC, Canada; Vancouver
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management of localized prostate cancer, nor for characteristics of patients Prostate Centre, Vancouver, BC, Canada; University Health Network,
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undergoing radical prostatectomy. Conversely, QBPs appear to be associated Toronto, ON, Canada
with more appropriate patient selection for radical prostatectomy. Canadian Prostate Cancer Biomarker Network (CPCBN), Terry Fox Research
Conclusions: In the province of Ontario, the introduction of QBPs seems to Institute
have a beneficial impact on the management of localized prostate cancer. Introduction: The identification of patients with high-risk prostate cancer
(PCa) is a major challenge for clinicians, and the improvement of current
MP-4.2 prognostic parameters is an unmet clinical need. We and others have identi-
Prospective comparison of open and robot-assisted radical fied the association between the nuclear localization of NF-κB p65 (p65)
prostatectomy for clinically localized prostate cancer in the and biochemical recurrence (BCR) in PCa in small and/or single-centre
Canadian healthcare system cohorts of patients.
Benjamin Beech , Jan K. Rudzinski , Ryan McLarty , Sunita Ghosh , Graeme Methods: In this study, we accessed two different multicentre tissue microar-
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Follett , Adrian Fairey 1 rays (TMAs) representing cohorts of patients (Test-TMA and Validation-TMA
1 Department of Surgery, Division of Urology, University of Alberta, series) of the Canadian Prostate Cancer Biomarker Network (CPCBN) to vali-
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Edmonton, AB, Canada; Department of Oncology, University of Alberta, date the association between nuclear p65 expression and PCa outcomes.
Edmonton, AB, Canada Immunohistochemical staining of p65 was performed on the Test-TMA and
Introduction: High-quality data comparing open radical prostatectomy the Validation-TMA series, which include PCa tissues from patients treated
(ORP) and robot-assisted radical prostatectomy (RARP) are sparse. We com- by first-line radical prostatectomy (n=250 and n=1262, respectively). Two
pared pathological cancer control and perioperative outcomes in men with independent observers evaluated the frequency of nuclear p65 expression
clinically localized prostate cancer (CLPC). on digital images in either benign adjacent glands or cancer cells. Kaplan-
Methods: The study was a prospective, comparative analysis. Eligible sub- Meier curves coupled with a log-rank test and univariate and multivariate
jects had newly diagnosed CLPC and had chosen radical prostatectomy as Cox regression models were used for statistical analyses of continuous
values and dichotomized data (cutoff of 3%) of nuclear p65.
S104 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)
© 2019 Canadian Urological Association