TY - JOUR
T1 - Cancer-specific and other-cause mortality after radical prostatectomy versus observation in patients with prostate cancer
T2 - Competing-risks analysis of a large North American population-based cohort
AU - Abdollah, Firas
AU - Sun, Maxine
AU - Schmitges, Jan
AU - Tian, Zhe
AU - Jeldres, Claudio
AU - Briganti, Alberto
AU - Shariat, Shahrohk F.
AU - Perrotte, Paul
AU - Montorsi, Francesco
AU - Karakiewicz, Pierre I.
PY - 2011/11
Y1 - 2011/11
N2 - Background: Initial treatment options for low-risk clinically localized prostate cancer (PCa) include radical prostatectomy (RP) or observation. Objective: To examine cancer-specific mortality (CSM) after accounting for other-cause mortality (OCM) in PCa patients treated with either RP or observation. Design, setting, and participants: Using the Surveillance Epidemiology and End Results Medicare-linked database, a total of 44 694 patients ≥65 yr with localized (T1/2) PCa were identified (1992-2005). Intervention: RP and observation. Measurements: Propensity-score matching was used to adjust for potential selection biases associated with treatment type. The matched cohort was randomly divided into the development and validation sets. Competing-risks regression models were fitted and a competing-risks nomogram was developed and externally validated. Results and limitations: Overall, 22 244 (49.8%) patients were treated with RP versus 22450 (50.2%) with observation. Propensity score-matched analyses derived 11 669 matched pairs. In the development cohort, the 10-yr CSM rate was 2.8% (2.3-3.5%) for RP versus 5.8% (5.0-6.6%) for observation (absolute risk reduction: 3.0%; relative risk reduction: 0.5%; p <0.001). In multivariable analyses, the CSM hazard ratio for RP was 0.48 (0.38-0.59) relative to observation (p <0.001). The competing-risks nomogram discrimination was 73% and 69% for prediction of CSM and OCM, respectively, in external validation. The nature of observational data may have introduced a selection bias. Conclusions: On average RP reduces the risk of CSM by half in patients aged ≥65 yr, relative to observation. The individualized protective effect of RP relative to observation may be quantified with our nomogram.
AB - Background: Initial treatment options for low-risk clinically localized prostate cancer (PCa) include radical prostatectomy (RP) or observation. Objective: To examine cancer-specific mortality (CSM) after accounting for other-cause mortality (OCM) in PCa patients treated with either RP or observation. Design, setting, and participants: Using the Surveillance Epidemiology and End Results Medicare-linked database, a total of 44 694 patients ≥65 yr with localized (T1/2) PCa were identified (1992-2005). Intervention: RP and observation. Measurements: Propensity-score matching was used to adjust for potential selection biases associated with treatment type. The matched cohort was randomly divided into the development and validation sets. Competing-risks regression models were fitted and a competing-risks nomogram was developed and externally validated. Results and limitations: Overall, 22 244 (49.8%) patients were treated with RP versus 22450 (50.2%) with observation. Propensity score-matched analyses derived 11 669 matched pairs. In the development cohort, the 10-yr CSM rate was 2.8% (2.3-3.5%) for RP versus 5.8% (5.0-6.6%) for observation (absolute risk reduction: 3.0%; relative risk reduction: 0.5%; p <0.001). In multivariable analyses, the CSM hazard ratio for RP was 0.48 (0.38-0.59) relative to observation (p <0.001). The competing-risks nomogram discrimination was 73% and 69% for prediction of CSM and OCM, respectively, in external validation. The nature of observational data may have introduced a selection bias. Conclusions: On average RP reduces the risk of CSM by half in patients aged ≥65 yr, relative to observation. The individualized protective effect of RP relative to observation may be quantified with our nomogram.
KW - Cancer-specific mortality
KW - Competing-risks regression
KW - Nomogram
KW - Other-cause mortality
KW - Prostate cancer
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U2 - 10.1016/j.eururo.2011.06.039
DO - 10.1016/j.eururo.2011.06.039
M3 - Article
C2 - 21741762
AN - SCOPUS:80053339922
VL - 60
SP - 920
EP - 930
JO - European Urology
JF - European Urology
SN - 0302-2838
IS - 5
ER -