Cirrhosis and liver disease vs. adverse in-hospital outcomes after radical prostatectomy.

Abstract

Introduction: Radical prostatectomy (RP) may be a treatment option for prostate cancer patients with cirrhosis and liver disease (CLD). However, the effect of CLD on adverse in-hospital outcomes after RP has not been well described.

Methods: Descriptive analyses, propensity score matching (PSM), and multivariable logistic and Poisson regression models were used to address National Inpatient Sample RP patients between 2005 and 2019. CLD severity was stratified as mild vs. moderate/severe.

Results: Of 191,050 RP patients, 1,559 (0.8%) had CLD. Of those, 1,515 (97.2%) vs. 44 (2.8%) were classified as having mild and moderate/severe CLD, respectively. Any CLD rate increased from 0.6% to 1.5% (2005-2019, EAPC: +7.9%, P < 0.001). CLD patients exhibited higher rates of all 15 examined adverse in-hospital outcomes. The absolute differences were largest for overall complications (+13.9%), length of stay >2 days (+8.9%), and blood transfusions (+4.0%, all P < 0.001). After detailed multivariable adjustment, CLD independently predicted higher rates of all 15 adverse in-hospital outcomes (P < 0.01). The detrimental effect was most pronounced for in-hospital mortality (multivariable odds ratio (OR) 8.74), infectious complications (OR 4.59), and hepatic complications (OR 4.45). Finally, a convincing dose-response relationship, where the effect magnitude of moderate/severe CLD was at least 3 times higher than that of mild CLD, applied in 4 of 15 comparisons.

Conclusions: CLD patients exhibited higher rates of adverse in-hospital outcomes after RP. However, mild CLD did not exert a prohibitive effect that would clearly preclude RP as a treatment option.