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156 NATIONWIDE PRACTICE PATTERNS FOR THE USE OF VENOUS THROMBOEMBOLISM PROPHYLAXIS AMONG MEN UNDERGOING RADICAL PROSTATECTOMY
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THE JOURNAL OF UROLOGY姞
Vol. 189, No. 4S, Supplement, Sunday, May 5, 2013
phylaxis use was stable throughout the study period, except combination, which increased from 11% to 14%. Use of prophylaxis was not related to year of surgery, patient demographics, hospital factors, or surgical volume by hospital or surgeon. However, there was a trend toward increased use in robotic surgeries (OR 1.53, p⫽0.07). VTE was identified in 0.25% and was more likely to occur in men with greater comorbidities (OR 2.43, p⬍0.01), but less likely to occur in men who underwent robotic RP (OR 0.65, p⫽0.03 vs. open) and those that had mechanical prophylaxis (OR 0.63, p⫽0.01 vs. none). Pharmacologic prophylaxis trended toward reducing VTE (OR 0.75, p⫽0.08 vs. none). CONCLUSIONS: This study represents the first nationwide examination of VTE prophylaxis practice patterns in men undergoing RP. Despite guidelines recommending its use, VTE prophylaxis was used in only 28% of patients. The use of mechanical prophylaxis was protective against VTE. Large prospective trials to better define the optimal VTE prophylaxis regimen are warranted.
The Incidence of Symptomatic Venous Thromboembolism, Deep Venous Thrombosis, Pulmonary Embolism and Major Bleeding in Major Urologic Surgery Radical Radical Radical Partial Prostatectomy Cystectomy Nephrectomy Nephrectomy Venous 0.55% 4.96% 1.42% 1.05% Thromboembolism (n⫽2,699) (n⫽2,405) (n⫽4,457) (n⫽738) Deep Venous Thrombosis Pulmonary Embolism
0.39% (n⫽1,928)
4.25% (n⫽2,063)
1.22% (n⫽3,830)
0.77% (n⫽545)
0.27% (n⫽865)
0.92% (n⫽445)
0.27% (n⫽865)
0.38% (n⫽270)
4.97% (n⫽15,666)
3.85% (n⫽2,718)
1.77% 7.7% Major Bleeding (n⫽8,639) (n⫽3,735) All values are significant at p⬍ 0.001.
Source of Funding: Brigham and Women’s Hospital Department of Surgery Junior Fellowship Award.
Source of Funding: None
Kidney Cancer: Basic Research (I) Moderated Poster Session 7 Sunday, May 5, 2013
8:00 AM-10:00 AM
156
157
NATIONWIDE PRACTICE PATTERNS FOR THE USE OF VENOUS THROMBOEMBOLISM PROPHYLAXIS AMONG MEN UNDERGOING RADICAL PROSTATECTOMY
A NOVEL THERAPEUTIC APPROACH FOR RENAL CELL CANCER CELLS USING ORALLY AVAILABLE PHENYLPIPERAZINE DERIVATIVE NAFTOPIDIL
Aaron Weinberg*, Jason Wright, Yu-Shiang Lu, Christopher Deibert, Dawn Hershman, Al Neugut, Mitchell Benson, Benjamin Spencer, New York, NY
Yoichi Iwamoto*, Hideki Kanda, Takeshi Sasaki, Manabu Kato, Kenichiro Ishii, Kiminobu Arima, Taizo Shiraishi, Yoshiki Sugimura, Tsu city, Japan
INTRODUCTION AND OBJECTIVES: Prostate cancer patients undergoing radical prostatectomy (RP) are at higher risk for venous thromboembolism (VTE). Robotic surgery may confer an even greater risk. Evidence-based guidelines recommend both mechanical and pharmacologic prophylaxis during the perioperative period. It is unknown whether these guidelines are being followed. METHODS: Prostate cancer patients who underwent RP from 2000-10 were analyzed from the Perspective database. VTE prophylaxis was classified as none, mechanical, pharmacologic, or combination. We used generalized estimating equations to investigate the influence of patient, surgeon and hospital characteristics on VTE prophylaxis use and VTE. RESULTS: We identified 94,709 men who underwent RP, including 28% robotic. Mechanical, pharmacologic, and combination prophylaxis were received by 49%, 10% and 13%, respectively. Pro-
INTRODUCTION AND OBJECTIVES: Clear cell renal-cell cancer (cRCC) is resistant to most chemotherapy, and cytokine treatment used to be the standard of care for non-surgical management of advanced cRCC. cRCC is an angiogenesis-dependent and hypoxiadriven malignancy. However, the efficacies of these therapy regimens tend to be insufficient due to their toxicity and generally poor overall response rates. Although we have recently reported the growth-inhibitory effects of the ␣1AD-selective antagonist naftopidil on hPCa cells, little is known about the relationship between the growth-inhibitory effects of naftopidil and another cancer cells. In this study, we investigated the biochemical mechanisms of growth-inhibitory effects by ␣1-AR antagonists on RCC cells. METHODS: The two ␣1-AR antagonists (naftopidil and tamsulosin) were used. We first evaluated the effects of each antagonist (0 –20 uM) on the cell proliferation of ACHN and Caki-2. Next, to
THE JOURNAL OF UROLOGY姞
Vol. 189, No. 4S, Supplement, Sunday, May 5, 2013
phylaxis use was stable throughout the study period, except combination, which increased from 11% to 14%. Use of prophylaxis was not related to year of surgery, patient demographics, hospital factors, or surgical volume by hospital or surgeon. However, there was a trend toward increased use in robotic surgeries (OR 1.53, p⫽0.07). VTE was identified in 0.25% and was more likely to occur in men with greater comorbidities (OR 2.43, p⬍0.01), but less likely to occur in men who underwent robotic RP (OR 0.65, p⫽0.03 vs. open) and those that had mechanical prophylaxis (OR 0.63, p⫽0.01 vs. none). Pharmacologic prophylaxis trended toward reducing VTE (OR 0.75, p⫽0.08 vs. none). CONCLUSIONS: This study represents the first nationwide examination of VTE prophylaxis practice patterns in men undergoing RP. Despite guidelines recommending its use, VTE prophylaxis was used in only 28% of patients. The use of mechanical prophylaxis was protective against VTE. Large prospective trials to better define the optimal VTE prophylaxis regimen are warranted.
The Incidence of Symptomatic Venous Thromboembolism, Deep Venous Thrombosis, Pulmonary Embolism and Major Bleeding in Major Urologic Surgery Radical Radical Radical Partial Prostatectomy Cystectomy Nephrectomy Nephrectomy Venous 0.55% 4.96% 1.42% 1.05% Thromboembolism (n⫽2,699) (n⫽2,405) (n⫽4,457) (n⫽738) Deep Venous Thrombosis Pulmonary Embolism
0.39% (n⫽1,928)
4.25% (n⫽2,063)
1.22% (n⫽3,830)
0.77% (n⫽545)
0.27% (n⫽865)
0.92% (n⫽445)
0.27% (n⫽865)
0.38% (n⫽270)
4.97% (n⫽15,666)
3.85% (n⫽2,718)
1.77% 7.7% Major Bleeding (n⫽8,639) (n⫽3,735) All values are significant at p⬍ 0.001.
Source of Funding: Brigham and Women’s Hospital Department of Surgery Junior Fellowship Award.
Source of Funding: None
Kidney Cancer: Basic Research (I) Moderated Poster Session 7 Sunday, May 5, 2013
8:00 AM-10:00 AM
156
157
NATIONWIDE PRACTICE PATTERNS FOR THE USE OF VENOUS THROMBOEMBOLISM PROPHYLAXIS AMONG MEN UNDERGOING RADICAL PROSTATECTOMY
A NOVEL THERAPEUTIC APPROACH FOR RENAL CELL CANCER CELLS USING ORALLY AVAILABLE PHENYLPIPERAZINE DERIVATIVE NAFTOPIDIL
Aaron Weinberg*, Jason Wright, Yu-Shiang Lu, Christopher Deibert, Dawn Hershman, Al Neugut, Mitchell Benson, Benjamin Spencer, New York, NY
Yoichi Iwamoto*, Hideki Kanda, Takeshi Sasaki, Manabu Kato, Kenichiro Ishii, Kiminobu Arima, Taizo Shiraishi, Yoshiki Sugimura, Tsu city, Japan
INTRODUCTION AND OBJECTIVES: Prostate cancer patients undergoing radical prostatectomy (RP) are at higher risk for venous thromboembolism (VTE). Robotic surgery may confer an even greater risk. Evidence-based guidelines recommend both mechanical and pharmacologic prophylaxis during the perioperative period. It is unknown whether these guidelines are being followed. METHODS: Prostate cancer patients who underwent RP from 2000-10 were analyzed from the Perspective database. VTE prophylaxis was classified as none, mechanical, pharmacologic, or combination. We used generalized estimating equations to investigate the influence of patient, surgeon and hospital characteristics on VTE prophylaxis use and VTE. RESULTS: We identified 94,709 men who underwent RP, including 28% robotic. Mechanical, pharmacologic, and combination prophylaxis were received by 49%, 10% and 13%, respectively. Pro-
INTRODUCTION AND OBJECTIVES: Clear cell renal-cell cancer (cRCC) is resistant to most chemotherapy, and cytokine treatment used to be the standard of care for non-surgical management of advanced cRCC. cRCC is an angiogenesis-dependent and hypoxiadriven malignancy. However, the efficacies of these therapy regimens tend to be insufficient due to their toxicity and generally poor overall response rates. Although we have recently reported the growth-inhibitory effects of the ␣1AD-selective antagonist naftopidil on hPCa cells, little is known about the relationship between the growth-inhibitory effects of naftopidil and another cancer cells. In this study, we investigated the biochemical mechanisms of growth-inhibitory effects by ␣1-AR antagonists on RCC cells. METHODS: The two ␣1-AR antagonists (naftopidil and tamsulosin) were used. We first evaluated the effects of each antagonist (0 –20 uM) on the cell proliferation of ACHN and Caki-2. Next, to